Letter to the Editor Concerning “Telemedicine Improves Access to Care for Spine Patients with Low Socioeconomic Status.” by Ye et al.

To the Editor,

We read the recent study by Ye et al. ¹ with considerable interest, which investigated the impact of telemedicine on appointment attendance among spine patients, particularly focusing on the socioeconomic status. The study undoubtedly offers persuasive findings, yet we believe certain aspects warrant additional discussion.

Firstly, the study reported a reduced frequency of missed appointments with telemedicine visits compared to in-person appointments. These findings, however, were drawn from a time when the COVID-19 pandemic was prevalent, necessitating many healthcare practices to transition towards telemedicine to maintain care provision. ² This extraordinary circumstance induced a heightened fear and anxiety among patients, thereby increasing their propensity to choose telemedicine visits to evade potential virus exposure in healthcare environments. ³ Notably, during the pandemic, numerous hospitals and clinics restricted in-person visits to only urgent or necessary cases. This might have resulted in an inflated rate of missed in-person appointments, as patients possibly decided to defer non-urgent visits. Furthermore, significant changes in patient behavior, including increased adherence to scheduled appointments due to heightened health consciousness, have been observed during the pandemic. ⁴ This could be another contributing factor to the lower rate of missed telemedicine appointments. Accordingly, it would be advantageous to reproduce this study in a non-pandemic context to corroborate these findings.

Secondly, the study utilized the Area Deprivation Index (ADI) as the primary SES measure. Although ADI is a recognized and extensively applied measure, it is an area-level metric that might not fully capture the wide spectrum of individual-level SES characteristics. ⁵ Individual-level SES factors such as education, income, and employment status significantly impact health behaviors and healthcare service access. For instance, higher education and income levels have been linked with greater health literacy and improved health outcomes. Full-time employment status can influence a person’s ability to schedule and attend healthcare appointments due to time restrictions. Additionally, individual-level SES factors can impact a person’s ability to access and use telemedicine services. Higher income and education levels have been associated with greater digital literacy, crucial for telemedicine utilization. Conversely, individuals with lower income and education levels may encounter telemedicine barriers due to unreliable Internet access or inadequate technology. ⁶ Therefore, while ADI offers a valuable comprehensive perspective on SES’s role in healthcare access and utilization, future research should contemplate incorporating individual-level SES measures to offer a more nuanced understanding of the factors influencing telemedicine utilization.

In conclusion, while the study offers valuable insights into telemedicine’s potential in enhancing healthcare access, additional research is required to validate these findings and investigate the factors influencing telemedicine utilization.