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Published on: April 19, 2019
Variation in Telehealth Use in a National Home Test-to-Treat Program for Acute Respiratory Infections
Wojciech R Losos1,2, Biqi Wang1,2, Kim Fisher1
1Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
Summary
Home test-to-treat programs show distinct telehealth access patterns. Understanding how care is delivered, not just if it occurs, is crucial for evaluating health equity in respiratory infection treatment.
Area of Science:
- Digital Health
- Health Services Research
- Public Health
Background:
- Home test-to-treat (HTTT) programs provide timely antiviral treatment for acute respiratory infections like COVID-19 and influenza.
- Traditional access metrics may overlook variations in care delivery timing and processes within HTTT programs.
- This study investigates distinct process-based patterns in telehealth access within HTTT programs.
Purpose of the Study:
- To identify and characterize distinct phenotypes of telehealth access within a national Home test-to-treat program.
- To analyze how sociodemographic and digital access attributes influence these telehealth access patterns.
- To assess the relationship between telehealth access phenotypes and subsequent healthcare utilization.
Main Methods:
- K-means clustering was used to derive phenotypes from de-identified encounter data (n=6,213) from a national HTTT program.
- Variables included encounter timing, modality preference, process duration, and sociodemographic/digital access.
- Ten-day surveys assessed symptom duration and healthcare utilization among respondents (n=1,023).
Main Results:
- Three distinct telehealth access phenotypes were identified: Delayed/Disrupted Access (24.7%), Digitally Engaged but Socioeconomically Vulnerable (23.5%), and Mainstream Access and Efficient Utilization (51.8%).
- Significant differences in process duration (p < 0.001) and emergency department/urgent care utilization (p = 0.02) were observed across phenotypes.
- Antiviral prescribing rates were high across all groups (88.6-91.9%), and symptom duration did not differ.
Conclusions:
- Telehealth utilization in HTTT programs forms distinct phenotypes based on timing, modality, and efficiency.
- Equitable access evaluation necessitates examining the nuances of care delivery, beyond mere occurrence of service.
- These findings highlight the importance of process-oriented analysis for understanding health equity in digital health interventions.
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