Understanding Barriers to Access and Opportunities for Telemedicine in Underserved Urban Communities.

Introduction: Loss to follow-up and decreased access to timely care have health consequences that often lead to increased emergency service utilization for benign, treatable, and preventable conditions. As such, significant medical intervention is necessary. Specifically in the District of Columbia (DC), the health of Medicaid beneficiaries of Wards 7 and 8, overwhelmingly underserved communities, necessitates alternative means for more accessible, convenient, and consistent care, which can be achieved by integrating telemedicine services into current care modalities. Methods: Utilizing survey responses from the pre-COVID-19 pandemic, we identified a need for a community-based telemedicine service centered at the Pennsylvania Avenue Baptist Church, designing a threefold project to build knowledge, capacity, and to test feasibility. To build knowledge, we assessed demographics, telemedicine knowledge, current and past telemedicine use, health care utilization, access and improvement issues, telemedicine layperson utilization, and opinions and desire for telemedicine services. Results: A total of 223 responses were gathered from residents residing in Wards 7 and 8 as well as in the neighboring DC communities. An array of data results demonstrates that integrating telemedicine services into community care centers ultimately satisfies identifiable needs in DC's low-income communities for mental health resources, better coordination of care, more convenient and culturally attuned care, and greater health literacy. Discussion: Integrating telemedicine services into community care centers satisfies the need to decrease costs of care and improve the access and quality of care. Effective evaluation strategies and outcome measures that indicate benefits beyond cost savings could provide useful information on how to integrate sustainable telehealth systems in health care delivery models.