JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic dramatically increased telehealth use, however, it simultaneously widened the digital health divide. Several studies in New York City (NYC) demonstrated those communities with the highest COVID-19 prevalence also had the lowest telehealth use. Moreover, social distancing measures used to curb COVID-19 led to isolation, loneliness, and avoidance of needed in-person care. Mobile integrated health (MIH) programs utilizing both in-person and virtual components can overcome social determinants that limit access to telehealth. Our MIH program, Community Tele-Paramedicine (CTP), employs care managers and community paramedics to engage patients with chronic illness and facilitate telehealth visits with emergency physicians.

Objective:

(1) Describe the CTP cohort with respect to demographics and self-reported loneliness, and (2) compare CTP visit locations to COVID-19 case rates by zip code.

Methods:

Demographics were collected at CTP enrollment and patients completed the UCLA Loneliness Scale (a summed score of 7 or higher indicates significant loneliness). Patient experience with CTP was assessed on a 5-point Likert scale using anonymous post-visit surveys. We present descriptive statistics of survey results. CTP patient home addresses were compared to modified zip code tabulation area data on cumulative rates of COVID cases per 100,000 (NYC Department of Health’s COVID-19 GitHub repository).

Results:

From January 2021 to February 2022, 275 patients enrolled in CTP. These patients had an average age of 70, 49% were female, 53% were non-white, 16% Hispanic or Latino, and 42% resided in Manhattan, 30% Brooklyn, 20% Queens and 8% Bronx. One-in-five patients reported significant loneliness, 37% lived alone, 61% were single, divorced, or widowed, and 70% did not have a home health aide. Only 8% did not own a computer, 4% did not have internet access, and 23% did not use a smartphone. Between April 2019 and October 2021, nearly 25% of NYC zip codes with CTP usage were among the top 50 zip codes with the highest cumulative rate of COVID cases. CTP patients were satisfied with this hybrid model of virtual care: at least 95% of patients found it easy to connect to the physician, were satisfied with the care provided, felt less anxious they would need to return to the hospital, and agreed CTP was easier than going to the hospital.

Conclusions:

The hybrid in-person/virtual CTP program, specifically designed to address known barriers to accessing telehealth, successfully reached NYC communities that traditional telehealth programs did not, many of which experienced the highest rates of COVID-19. Initial results suggest positive patient experiences, however further qualitative research is needed to fully understand if facilitated telehealth also reduces isolation and loneliness as well as improves health and well-being.