How Telehealth Is Making Healthcare More Inclusive

New telehealth services are emerging that are specifically tailored to provide accessible, more inclusive care to women, LGBTQIA+ people, as well as Black, brown, and other marginalized communities.

Telehealth services are helping to increase access to quality healthcare for many marginalized communities. iMarko Geber/Getty Images
  • The COVID-19 pandemic has accelerated the adoption of telehealth services throughout the world for general healthcare.
  • Many health experts applaud this change, saying telehealth services can provide easier access to healthcare for a larger number of people.
  • Telehealth services have also emerged that are specifically tailored to providing accessible, more inclusive care to women, LGBTQIA+ people, as well as Black and brown communities.

In the year since the COVID-19 pandemic emerged, telemedicine — healthcare appointments and consultations provided at home through video conferencing and mobile apps — has increasingly become the norm.

To avoid long stays in waiting rooms, and out of caution over risk of possible COVID-19 exposure, people have viewed telehealth appointments as a method of maintaining contact with their health providers while staying safe.

Beyond the appeal of attending a doctor’s appointment from the comfort and safety of home, the telehealth phenomenon has, in some instances, made healthcare approachable and more accessible to people often stigmatized from the traditional medical system.

Over the past year, as more providers have embraced this kind of technology, services have emerged specifically tailored to providing accessible, more inclusive care to women, LGBTQIA+ people, Black and brown communities, among many others.

These services aim to offer alternatives to traditional — sometimes exclusionary — healthcare settings.

As we continue to navigate a world defined and reshaped by COVID-19, what role will telehealth continue to play, especially in addressing groups that have faced societal, cultural, economic, and even geographic barriers to quality care?

Meeting people where they are

“When we think about what medicine was decades ago, it was a physician and a nurse taking their bag of supplies and going to people’s homes and attending to whatever they needed, and following up on the pace of whatever it was as they had concerns. And that usually involved house calls,” said Dr. Kinjal Patel, a Los Angeles-based physician and Inlightened expert.

She told Healthline that in the past, these traditional house calls might include a follow-up “landline call to ask how things were.”

“It was a mix of services to meet the patient where they are,” Patel added.

She explained this “fundamental principle [of] meeting people where they are” is when healthcare “functions at its best,” delivering compassionate, personalized care.

Patel stressed that the current pandemic-accelerated adoption of telehealth services across the board is just another example of that crucial societal service healthcare provides.

All of that being said, Patel envisions this only functioning if telehealth “augments” rather than replaces traditional care.

“It can never take the place of the face-to-face; it’s about finding the ideal mix [of telehealth and physical appointments] for any given person,” Patel said. “That’s the most important part to determine delivery of care; to make a sustainable system.”

Patel added that for people who are young, relatively healthy, have access to smartphones and computers, and who possess “good health literacy,” perhaps telehealth could become the norm, making it unnecessary to go in as much for non-serious appointments.

For others who are older, have serious chronic health issues, and who might not be equipped with the information to feel confident about being as proactive seeking out important care, more traditional in-person appointments might need to take precedent beyond perhaps an initial telehealth video screening from the comfort of home.

That being said, Patel added that the adoption of telehealth platforms has given people who might sometimes feel excluded from or ill-at-ease with conventional doctor’s visits a new entryway to the healthcare they need.

Telehealth services are better addressing the healthcare needs of specific communities

In December, FOLX, billed as the world’s first LGBTQIA+ centered digital health platform, launched in the United States. Right now it’s only available in 11 states, with plans to expand nationwide.

The platform is a telemedicine provider for queer and trans people, planning to offer a range of customized services.

These include virtual telehealth appointments with queer and trans clinicians, and options to access everything from pre-exposure prophylaxis (PrEP) treatments for HIV prevention, to skincare, to at-home STI testing and treatment.

Still in its initial rollout, the company — which is for users ages 18 and over and doesn’t require health insurance — is offering gender-affirming hormone therapies, including estrogen pills, patches, and injectables, and testosterone injectables and gels.

FOLX Health founder and CEO A.G. Breitenstein comes to this new company with a career spanning all aspects of healthcare, working with other startups and projects aimed to provide more equitable healthcare services.

Breitenstein recalls working with queer and trans kids as an attorney in Boston and witnessing the barriers to inclusive healthcare they often ran across.

“It was evident from that time, how in some ways nothing has changed. The best we [the queer and trans community] get is a certain ‘benign ignorance,’ whether it is being misgendered or gentle ignorance of ‘oh, you’re on hormones? OK, I don’t know how to go about that, maybe we should find someone who really knows?’ That kind of thing,” Breitenstein told Healthline.

“It’s not ill-intended, but it’s ignorant in a way that is borderline neglectful,” she stressed.

The statistics are discouraging.

For instance, a survey of 6,450 transgender and gender nonconforming people from the National LGBTQ Task Force found that 1 in 5 respondents reported being refused care due to their gender identity.

Additionally, 28 percent said they experienced harassment in medical settings, while 50 percent said they had to actually teach their providers about proper care for a transgender or gender nonconforming person.

Those statistics are just a thin slice of the myriad of boundaries and examples of discrimination LGBTQIA+ individuals face when trying to access traditional health services.

Breitenstein added that it was intuitive to create a platform like this one, given the healthcare experience of members of the greater LGBTQIA+ community is one marked by “at the very least, trepidation and lack of competence in care.”

This means many might avoid medical care altogether rather than enter a healthcare environment that might feel unsafe.

She said members of the greater queer community have always been the vanguards of technology — “There was Grindr before Tinder,” Breitenstein said — and that it makes sense that something like FOLX would be out there in the front lines, hoping to provide an all-encompassing virtual healthcare experience.

While FOLX is a brand new platform, Breitenstein said the response has been overwhelming from initial users who essentially have “helped co-create” the platform.

“We’ve had people alienated from care for some time, for years, who lost access to therapy for months due to COVID-19, who did not have good experiences with healthcare, who said this might have been their first experience ever working with a queer or trans practitioner — it’s just so heart uplifting, if you will,” Breitenstein added.

Echoing Patel, Breitenstein knows brick-and-mortar clinical settings won’t go the way of the dinosaur.

However, she said that, hopefully technology in healthcare is moving to a place where the “old school experience of sitting in a strange, smelly room, wearing a weird smelly gown, and getting handed medication nobody explains to you” is replaced by something that is “easily accessible, simple, and transparent.”

A new approach to women’s healthcare

Carolyn Witte, CEO and co-founder of Tia, a startup centered on women’s healthcare, said her company sought to solve the esoteric question of “what fundamentally is ‘women’s health?'”

Witte told Healthline that often in the media — and the healthcare discussion in general — women’s health becomes synonymous with reproductive health.

She said this is an important part of women’s healthcare — but it’s a reductive way to view it.

There are countless issues impacting women that don’t involve equating “women’s health with reproductive organs.”

For instance, heart disease is the number one killer of women in the United States, according to the Centers for Disease Control and Prevention (CDC). Despite this pressing reality, the conversation often circles back to cardiovascular concerns of men.

Witte said that kind of blind spot applies to so many other areas of women’s healthcare.

She said that many women don’t have a primary care provider and many don’t receive and aren’t always given easy access to the information they need to stay on top of all aspects of their overall health.

“We’re really focused as a healthcare system on treating sickness and not preventing it and supporting wellness,” Witte said.

For example, she pointed out that maternal mortality rates in the United States are the highest in the developed world.

Also, U.S. women of color have disproportionate rates of autoimmune disorders.

Chronic disease is high as well, and mental health issues are skyrocketing among women.

“The big problem is: ‘How do we fill gaps in care from the preventive side and push for a model that prevents disease and not just treats it when it comes to women’s care?'” Witte asked.

Like Patel and Breitenstein explained, Witte stressed that the healthcare models of the past don’t always make sense for the present.

The past of house calls, of family doctors and OB-GYN care that might have been uniform from a mother to a daughter, isn’t the norm anymore.

Women don’t always remain with their family physicians through their lives. They don’t build these lifelong relationships with providers and health systems, and beyond that, we exist “on the brink of an OB-GYN shortage and crisis” in this country.

She said a medical “home model” addresses a lot of these problems, bringing the “relationship back to patient and provider.”

“Our model is to take a more integrative approach to female health and well-being and integrate multiple services into a one-stop-shop that is convenient,” she added.

Right now, Tia has an in-person clinic in New York City, one opening soon in Los Angeles, and another in San Francisco. At the moment, virtual care open to the company’s members — so far just those in NYC and LA — provides primary care, mental health, and OB-GYN services.

Witte said the benefit of this virtual care-centric era is convenience.

You can sit comfortably at home, more psychologically at ease in your surroundings without having to worry about travel and transportation.

She added that sensitive healthcare appointments can sometimes be hard for any patient, particularly women who might have experienced trauma of some kind.

She said Tia’s services all start virtually with a 40-minute meeting that will review the person’s health history and review their history of trauma, giving the patient the chance to open up in a comfortable setting.

Some communities can especially benefit from this kind of care.

Witte stressed that communities of color often face racism within the medical system, and she said her business has a commitment to “accounting for how the persons’ lived experience in the world may impact directly and indirectly their clinical outcomes.”

She explained how we see disproportionately negative health outcomes among Black women, in particular, through our traditional healthcare system — which is in many ways a byproduct of lived experiences and social determinants of their health.

“It’s important a Black woman, for instance, has a clinician who understands who she is as a person, and the challenges in life she might face from systemic racism to chronic stress to having multiple jobs or dealing with zoom schooling, the dynamics of being a working mom — all of these things are factors that build up to impacting a person’s health,” Witte added.

Telehealth services are also shedding light on men’s mental health

Matt Zerker, founder and CEO of men’s peer-to-peer mental health support app tethr, said he understands how difficult it can be for many men to open up about their mental health struggles.

He said in the past he has been “suicidally depressed” and experienced moments of being unable to leave his bed, dealing with stress over “achievement and status” while working in finance.

Zerker said he knows what it’s like to feel that kind of crushing “soul sickness,” tracing this kind of depression and anxiety back to being a child, feeling “very different from the other boys.”

“I felt everybody else had it together,” Zerker told Healthline.

This sense of being at a loss, of not knowing quite how to approach mental health as a man, is something he said is culturally engrained in many.

There’s that image of the stoic, strong male who doesn’t compromise, who doesn’t open up about or address vulnerability that he said is toxic.

A 2015 survey of 1,000 men found that 77 percent reported experiencing anxiety, stress, or depression, while 40 percent said it would take them reaching thoughts of suicide or self-harm to bring them to actually seek professional mental health counseling or help of any kind.

More recent research has also shed a light on how seriously men’s mental health has been impacted by the COVID-19 pandemic.

Zerker attributed a lot of these problems with a lack of community.

In modern society, many of us live in small apartments, or in towns and cities away from families, while social media and technology has isolated all of us, rather than kept us connected.

He said, given the conditioning men are put under in modern society to not address mental health, it makes sense that many men don’t approach traditional therapy.

It requires one to be open and vulnerable, to verbally share face-to-face deep-seated insecurities and fears with a therapist or counselor. While women might be socialized more to embrace this kind of communication, men aren’t.

In comes tethr. The service, which launched this past year, provides men a digital forum to connect with others, ask questions, or in some instances, just simply observe and listen to others.

Could this be something of a men’s mental health starter pack? Could using this platform ease a man into seeking professional help elsewhere?

“The research shows men are more likely to partake in mental health services if behavior is modeled for them by other men,” said Addison Brasil, tethr co-founder and vice president, and head of brand and impact and strategic partnerships.

“Our easiest example is going back to the age-old mechanic metaphor — you want to know who used the service before, if you can trust them. Men want the behavior modeled by other men,” Brasil said.

To that end, Zerker and Brasil said their app provides a low emotional barrier of entry for its users.

It doesn’t require you to enter a therapist’s office or discuss your private concerns with a clinician. It just requires you to sign in, make an account, and then choose how much you want to engage with conversations at hand.

The issues the app touches on are broad — from general anxiety and depression to stress with work and relationships, to sexuality and family.

It’s all about enculturating men to the idea of being visible with mental health concerns and engaging with peers about them.

Brasil said he’s witnessed users maintain a “cultural safe space” when using the app and that it’s been incredible to see communities evolve organically through it.

Zerker added that they hope this app grows to be the global go-to destination for mental health outreach for anyone who identifies as male. He wants it to be as second nature as turning on Instagram or Facebook on your phone.

“The core of our ethos as a company is ‘let every single man know that struggling doesn’t make you any less of a man, it just makes you human,'” he said.

More access to care

Baha Zeidan, the CEO of Azalea Health, an electronic health record (EHR) provider for small and mid-size practices, hospitals, and healthcare networks mostly in the rural United States, sees a future where telehealth continues to grow in adoption, especially for groups often disenfranchised by our healthcare system.

He said the realities of COVID-19 “shaved off 5 to 10 years of telehealth adoption” in our society. This has been particularly meaningful for communities underserved by our healthcare system.

He said that before the pandemic, the clients he works with were “averaging a few hundred telehealth encounters,” which jumped to 18,000 of these virtual care visits in just a few weeks after the virus hit and upended daily life.

Zeidan explained that this is meaningful to people who live in rural areas, away from major cities.

“If you need highly specialized care, say a pediatric neurosurgeon, it’s very difficult to find that kind of care in a small town in rural Kansas,” he said. “You might make the journey to see one, but then it might be hard to make multiple follow-up visits.”

Telehealth changes that completely, giving people access to specialists while even in their local providers’ office.

It makes the opportunity for medical collaboration and referrals to specialist care much easier, and eases access to top care to people in rural and low-income communities. It also boosts local economies.

“The local economies depend on providers, depends on healthcare. In a lot of rural cities the healthcare providers are the number two or three top employers in the town,” he said.

This means the shift to telehealth was crucial for keeping local health systems alive when many in-person visits dropped off the map, while also democratizing access to top care for many people in these communities.

“In the past, when you would schedule an appointment with your doctor, you would block off half of your day for an appointment and then you would sit and sit and wait and wait,” he said. “They would say ‘come in at 1:30 p.m.’ and they wouldn’t see you until 3 p.m.”

After COVID-19, Zeidan said he doesn’t want to see us “go back to old habits.”

This means the fact that insurance companies and healthcare systems were open to making coverage of telehealth services more inclusive is key moving forward.

“We want to continue to have better reimbursement for telehealth, to have a better regulatory environment; a more friendly regulatory environment for telehealth providers,” he said.

It all goes back to access.

For her part, Patel said “telehealth lowers the threshold for people to get care.”

“You can develop all the most amazing things, but if nobody shows up to use it, no service exists,” she added. “Anything you can do to help people access it, you have to capitalize on that as much as possible.”

This story originally appeared on: Healthline.com - Author:Brian Mastroianni