The COVID-19 public health emergency (PHE) led to a dramatic increase in telehealth use owing to relaxed policies to facilitate healthcare access, but early studies demonstrated variability in telehealth utilization patterns across demographic groups. COVID-19 disproportionately affected communities of color and the socially disadvantaged, highlighting existing disparities in access and quality of care in the U.S. health system. In early 2023, an RTRC research team conducted a systematic review to summarize available evidence from early in the COVID-19 pandemic and concluded that most available evidence showed that telehealth did not reduce disparities in access to health care during the PHE. In December 2023, the prior systematic review was updated with contemporary data using the same search strategy and methods.
Of the 523 references in our updated search, 32 met final inclusion criteria for the study. Most studies were retrospective cohort studies using before-after methodology, and telehealth utilization was the most common study outcome. Compared to the initial search, more of the papers included in this search focused on total health care utilization (instead of telehealth-only utilization), but overall, conclusions were similar. Telehealth utilization, in aggregate, increased more slowly among disadvantaged groups, such as older, more rural, Black, and economically disadvantaged populations than in less disadvantaged populations over the course of the PHE.
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