US Pharm. 2022;47(6):28-32.
ABSTRACT: In March 2020, the United States responded to the COVID-19 pandemic. With this response of quarantining, social distancing, and other precautions, a need to ensure that access to healthcare occurred. Technology in the form of telemedicine and virtual visits addresses this need. Patients can use telemedicine and virtual healthcare services to improve convenience, improve access, and reduce other healthcare and pharmacy service barriers. The continuation and expansion of telemedicine and virtual visits in the practice of pharmacy provide more equitable access to healthcare and offer solutions to health disparities concerning language barriers and cultural differences, provided practitioners utilize effective communication.
Research surrounding patients’ readiness and awareness of technology-based pharmacy services in the U.S. shows that most states have geographic areas lacking access to healthcare. Geographic areas associated with our study of technology-based health services have been identified by the Health Resources and Services Administration as medically underserved, lacking access to primary care services. This agency designates medically underserved areas in the U.S. using demographic and health indicators, including low provider-per-population ratios and high poverty levels.4 In Texas, 235 of the 254 counties have areas that are designated as medically underserved.5 Oregon has 28 of its 36 counties designated as medically underserved, while Washington state has designated 27 of its 39 counties.4 Georgia has designated 140 of its 159 counties, while Wisconsin has designated 48 of its 72 counties.5 This small sample clearly demonstrates the extent of healthcare inequalities by capturing data from different regions of the country.
As the COVID-19 outbreak has been declared a global pandemic by the World Health Organization, many healthcare professionals are now providing care remotely.6 In addition to geographic barriers, patients with lower income tend to have decreased access to care due to difficulties with affordability. Approximately one-quarter of adults with lower income report lacking a usual source of care, difficulty affording care, and delay receiving care.3 Patients may also have difficulty taking time off work to visit their doctors’ offices during regular business hours.3 Health professionals benefit from utilizing telehealth by removing costly office utilities, personal commuting, and other office-related expenses. Although telehealth appointments require just as much preparation, administrative, and documentation time as in-person visits—therefore justifying equivalent reimbursement—such visits may be more convenient for healthcare providers and providers with families.7 Technology-based platforms have emerged as an additional solution for medically underserved, lower income, and minority populations by providing readily available and often more affordable care.8
Health Disparities in Language Barriers and Cultural DifferencesHealth disparities have been documented for over 120 years in the U.S., with racial and ethnic minority adults having up to 77% higher risk for obtaining a chronic disease diagnosis, such as diabetes, than white adults.9 Language is a significant factor contributing to the challenges many minority populations face when it pertains to accessing quality healthcare.10 Almost 67 million U.S. residents speak a language other than English at home, and of these residents, 41% report speaking English “less than well.”11 Reports have shown Asian patients were 1.3 times more likely not to have a usual source of healthcare compared with their white counterparts.12 Patients who speak Spanish at home were more likely to report experiencing communication barriers with healthcare professionals than those who speak English at home.6
Virtual and telehealth capabilities allow access to many people whose culture or fear of stigma prevents them from seeking care for their health concerns. Examples of telehealth-reducing stigmas include veterans who previously refrained from mental health services, patients identifying as Mexican American not seeking contraception until telehealth was available, and Muslim patients not seeking healthcare due to fear of resistance from family and community members.13,14 Although multiple factors are involved in overall health inequities, minority populations are at an extreme disadvantage when receiving quality care and continue to face stigma and cultural challenges daily.6 Telehealth allows for more private healthcare encounters and helps to empower patients with more options that are not hindered by things such as stigma, the need for transportation, and lack of privacy from community and family.15
Healthcare Providers’ Utilization of Telehealth and Practitioner CommunicationTechnology provides a potential platform to increase access to care in underserved communities due to widespread smartphone ownership (regardless of age), socioeconomic status, or education level (see TABLE 1). For instance, 92% of U.S. adults aged 65 years and older own a cell phone, 61% of whom own a smartphone.16 Additionally, 95% of U.S. adults making less than $30,000 annually own a cell phone, 71% of whom own a smartphone.16 Finally, 96% of U.S. adults who have a high school level education or less own a cell phone, 75% of which are smartphones.17 These figures suggest accessibility to the technology needed to participate in telehealth care in a diverse patient population.16
Social media and mobile applications in minority groups are significantly higher than in their white counterparts, making these applications a promising option as a platform from which this population can reach healthcare providers.18 Not only can minorities benefit from the use of healthcare applications, but the increased engagement with virtual healthcare platforms is rising.12 For example, as of 2017, WebMD had 75 million monthly visitors.19 Additionally, one in three American adults has gone online in an attempt to diagnose a medical condition without professional medical care.20 Pharmacies have already began using technology to provide remote patient care through mobile adherence support and digital consultations.21 Improved access to pharmacist-provided care with technology may pave the way for quality, accessible, and equitable care.The prevalence of Internet usage and advancements in technology, such as telemedicine, health hub programs, and e-visits, raises the question of whether providers are appropriately trained in health communications to adapt to these new virtual roles. Studies have shown that one of the best ways to improve a patient’s experience is by engaging with good communication skills.21
The Center for Advancement of Pharmacy Education
In good communication, despite a virtual or in-person encounter, self-awareness is a critical component in constructing resilience among healthcare providers.25 In healthcare’s busy multitasking atmosphere, it is easy to forget that verbal and nonverbal communications are crucial for impression management.26 Tone or pitch can convey the meaning or intensity of the message, while cadence or rate and volume can lead to various emotional implications.27 Reflective listening restates or reflects what the patient expressed, to hear it in a new way, and to know the provider is actively engaged in the conversation.28 With the use of telehealth and in-person encounters, providers need to be thoroughly trained in these communication techniques, along with language etiquette and condition dialects, to optimize the patient’s health outcomes.
Language etiquette in healthcare is when a provider shows consideration for a patient by using preferred terms to reduce stigma and improve the patient’s perceptions.29 When thinking of preferred terms, providers should use simple words and practice plain language instead of clinical or medical terminology to ensure clarity and understanding by the patient. Plain language removes jargon, acronyms, abbreviations, and any other technical terms that may be less known outside of the healthcare field.30
Audience-centered messaging helps providers evaluate the patient to determine the content and language usage needed to communicate effectively.31 Whenever potentially sensitive topics arise in a patient discussion, using condition dialects will help keep the conversation comfortable and open. Condition dialects are available for discussing sensitive topics such as mental health, suicide, substance use, HIV, age, weight, sexual orientation, grief, and many others.23,32 Utilizing these critical communication techniques optimizes the virtual or telehealth visit for the patient while reducing burnout of our practitioners.
ConclusionCommunications-educated healthcare providers utilizing telehealth can alleviate inequitable access to healthcare and improve health disparities surrounding language and culture. Pharmacist-provided services, including telehealth and virtual visits, have been shown to improve patient outcomes in medication adherence, medication management, and control of chronic conditions while reducing unnecessary healthcare expenditures.33 Pharmacists have been ranked as one of the topmost trusted healthcare professionals for the past 17 years, and they see patients 1.5 to 10 times more than their primary care doctor. Given these facts, an avenue for bridging gaps in healthcare becomes apparent.34,35 The increased use and reimbursement of telehealth and the expansion of those capabilities to pharmacists, mental health providers, and other practitioners beyond physicians can improve patients’ health in the U.S.
Dr. K. Ashley Garling would like to record her gratitude and profound thanks to her experiential academic student, PharmD Candidate 2022 Gabriela Segovia, for her interest and contributions to editing this pharmacy practice review article.
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