Comfort With Telehealth Among Residents of an Underserved Urban Area.

BACKGROUND: Deployment of telehealth has been touted as a means of reducing health disparities in underserved groups. However, efforts to reduce regulatory barriers have not been associated with greater telehealth uptake. The goal of this study was to examine engagement with technology among low-income people of color living in Newark, New Jersey. METHODS: Using surveys and focus groups, we examined study participants' daily use of technology (eg, Internet) and comfort with telehealth services (eg, use of teleconferencing for medication refills) before and after COVID-related social distancing mandates went into effect. RESULTS: Use of technology was significantly lower in the pre-COVID period. However, prior months' use of technology had a weak but significant correlation with comfort with telehealth (r = .243, P = .005) in bivariate analyses and was the only significant predictor in multivariate analyses. Analyses of focus group discussions confirmed that lack of experience with technology and distrust of the security and privacy of digital systems were the most important barriers to comfort with telehealth in our sample. CONCLUSION: Our study found that approximately 20% of people in this under-resourced community lacked access to basic technologies necessary for successful deployment of telehealth services. The study's timing provided an unexpected opportunity to compare experiences and attitudes relating to telehealth in 2 regulatory environments. Although uptake of telehealth services increased with the Federal governments' relaxation of regulatory barriers, there was not a similar increase in comfort with telehealth use. Investments in broadband access and equipment should be accompanied by educational programs to increase day-to-day use of and comfort with associated technologies which would improve consumer confidence in telehealth.

Stopping Covid-19: A pandemic-management service value chain approach.

A logical strategy to contain the Covid-19 pandemic is to completely isolate everyone for 2 weeks (the incubation period of the virus). However, such a strategy can have prohibitive economic and social costs and, therefore, will be difficult to implement. At the same time, the current situation is leading to an expanding humanitarian, health and economic crisis. Based on principles of the Theory of Constraints, we propose in this article the "Shutting-down Transmission Of Pandemic" (STOP Covid-19) plan that would reliably contain the pandemic, mitigate its economic consequences, and boost societal confidence. This plan requires the implementation of four strategies over 90 days: (a) stop all international, domestic passenger air and intercity bus/train travel; (b) create administrative zones of about 1 million people; (c) stop all non-emergency cross-zonal travel except for transportation of goods, and (d) deploy an information-driven service value chain to control the spread of the pandemic within a zone.