Introduction

At ATA NEXUS 2025, we’ll be sharing our insights, challenges, and ideas for advancing digital care delivery in the coming years. Equitable digital health and telehealth access remains a pressing concern as healthcare evolves in the post-pandemic era. This research round-up highlights new research exploring key challenges and opportunities in telehealth access, focusing on substance use disorder treatment, the experiences of patients with non-English language preferences, and digital health interventions for older adults experiencing homelessness. Each study lends insight into a different aspect of challenges in access and equity.

The featured studies employ diverse methodologies—including a large observational analysis of claims data, qualitative research with patients, and a comprehensive scoping review—to provide valuable insights into the barriers and facilitators of telehealth adoption. Collectively, these findings underscore the critical need to prioritize patient perspectives and lived experiences in efforts to advance health equity and improve digital healthcare accessibility for all.

Telehealth and Substance Use Disorder Treatment (SUDT)Walker LS, Cui M, Cantor J, et al. Disparities in Substance Use Disorder Telehealth Services (Walker et al, 2025) – JAMA Network Open1

Study Overview

The COVID-19 pandemic has transformed healthcare delivery, with telehealth emerging as a critical modality for substance use disorder treatment (SUDT). A recent research letter published in JAMA Network Open explores how telehealth has affected disparities in SUDT utilization across payers and rural/urban populations during this public health emergency. The researchers used nationwide claims data from January 2019 to June 2023 to assess changes in SUDT utilization. They found that while telehealth SUDT increased substantially for all populations, the overall trends varied by payer and rurality.

Disparities by Payer

Despite the rise in telehealth SUDT for Medicaid-covered individuals, the overall SUDT use per 100,000 adults decreased by 17%. In contrast, Medicare Advantage (MA) and commercially insured individuals experienced a 4% and 1% increase, respectively, in overall SUDT. This suggests that telehealth SUDT was disproportionately underutilized by Medicaid populations compared to their overall SUDT.

Disparities by Rurality

On the other hand, rural individuals saw an 89.9% increase in overall SUDT per 100,000 adults, nearly twice the 48.7% increase observed among urban individuals. Importantly, the study found no disproportionality in telehealth SUDT use between rural and urban populations.

Implications, Recommendations, and Limitations

These findings highlight the potential of telehealth to reduce disparities in SUDT for rural individuals but raise equity concerns for Medicaid populations. As policymakers define best practices for telehealth SUDT, they should consider strategies to address the observed disparities and ensure equitable access to these critical services. The study’s limitations include the voluntary nature of the data source, which may not be fully representative, and the exclusion of uninsured individuals and clinicians not accepting insurance. Additionally, the study did not differentiate by substance or assess care quality.

Summary

  • Telehealth has emerged as a crucial tool for addressing substance use disorder treatment (SUDT) disparities, especially for populations covered by Medicaid and those residing in rural areas.
  • Between 2019 and 2023, the use of telehealth SUDT services increased substantially across all populations, while in-person SUDT services only saw a slight increase.
  • Medicaid-covered individuals experienced a decrease in average monthly SUDT per 100,000 adults, whereas Medicare Advantage (MA) and commercially insured individuals saw an increase. Rural individuals experienced a greater increase in overall SUDT compared to urban individuals, indicating a potential reduction in disparities due to telehealth services for rural populations.

Telehealth and Patients with non-English language preferences
Challenges To Video Visits For Patients With Non–English Language Preference (Kong et al (2025) – JAMA Network Open2

Study Overview

Having looked at barriers in SUDT telehealth delivery, we now turn to a population that experiences a different set of challenges—patients with non-English language preferences. Another new JAMA Network Open report “Challenges to Video Visits for Patients With Non–English Language Preference” delves into the disparities in video visit participation between patients with non-English language preferences and English-speaking patients, highlighting the importance of understanding the readiness and potential benefits of video visits for the former group. The study, conducted by Dr. Marianna Kong and a team of researchers, aimed to investigate the perceptions of patients with non-English language preferences regarding the facilitators and difficulties with the technical accessibility of video visits. The qualitative analysis included 27 participants who were interviewed through semistructured phone calls.

Challenges

The study identified four major themes that emerged from the interviews:

  1. Video visits creating additional communication challenges and potentially exacerbating communication difficulties for patients who face language barriers.
  2. Video visits perceived as having some drawbacks for medical evaluations as well as appealing benefits.
  3. Limited digital literacy, device, and data access, and non-user-friendly video visit processes as important barriers to video visit use.
  4. In-person teaching, simpler technologic processes, opportunities to repetitively practice video use, and language-concordant instructions, clinicians, and clinic staff as facilitators of video visits.

Implications, Recommendations, and Limitations

The findings suggest that patients with non-English language preferences perceive various barriers to video visits, including communication quality, medical evaluation quality, and technical accessibility. The study highlights the interplay between technical accessibility, motivation, and video visit usage, emphasizing the need for health system interventions to address these barriers and ensure equitable access to telehealth services. Recommendations include enhancing language accessibility, providing targeted video visit support, and implementing patient-centered telemedicine processes to address the needs of diverse patient populations. The study was conducted in a U.S. academic health system, and participants were primarily speakers of Spanish and Cantonese. Findings could differ in other patient populations.

Summary

  • Patients with non-English language preference (NELP) experience lower utilization of video visits compared to English-speaking patients, highlighting the need to understand the barriers and facilitators for NELP patients to use this technology for their care.
  • The study conducted qualitative interviews with Spanish and Cantonese-speaking patients to identify themes such as communication challenges, perceived drawbacks of video visits for medical evaluations, limited digital literacy, device and data access barriers, and the importance of in-person teaching and language-concordant support as facilitators.
  • The findings suggest that interventions are needed to address technical challenges associated with language barriers, improve patient motivation to use video visits, and increase telehealth equity for patients with NELP. The authors emphasize the importance of simplifying technical processes, offering interactive demonstrations, providing troubleshooting support, and ensuring language concordance at every stage of communication.

Telehealth and Older Homeless Adults
Digital Interventions for Older People Experiencing Homelessness: Systematic Scoping Review (Adams et al 2025) – Journal of Medical Internet Research (JMIR)3

Study Overview

The research paper published in the Journal of Medical Internet Research sheds light on the potential benefits and challenges of digital interventions for older people experiencing homelessness, focusing on the triple disadvantage of age, homelessness, and digital exclusion. The scoping review aimed to examine the use, range, and nature of digital interventions available to older people experiencing homelessness and organizations supporting them.

Findings

The study identified a total of 10 articles reporting on digital interventions for older people experiencing homelessness, with the majority of studies conducted in the United States. The interventions covered various areas such as telecare, distributing technology for digital inclusion, text message reminders, vocational training, physical activity promotion, and cognitive behavioral therapy. The findings demonstrated evidence for the acceptability and feasibility of digital interventions for older people experiencing homelessness and reported improvements in digital inclusion and engagement among participants. Challenges identified in the study included barriers related to digital literacy, infrastructure, age-related factors, and the absence of interventions exclusively tailored to older people experiencing homelessness. The review highlighted the importance of organizational and peer support as facilitators for digital interventions. It also emphasized the need for further research to develop and evaluate digital interventions specifically designed for this vulnerable population.

Implications, Recommendations, and Limitations

The findings suggest that digital interventions have the potential to enhance the health and well-being of older people experiencing homelessness, but reports of evaluated interventions are scarce. Addressing existing digital exclusion factors and ensuring access to technology and support services are crucial for the successful implementation of interventions with this population. The study calls for tailored interventions, improved digital literacy, and collaborative efforts among stakeholders to bridge the digital divide and effectively support older homeless individuals. Limitations include the restriction to published reports in the biomedical literature. Additional digital health programming for this population may exist, but lack written evaluation in the biomedical literature.

Summary

  • The scoping review identified a lack of evaluated digital interventions specifically targeted at older people experiencing homelessness.
  • Digital interventions demonstrated evidence of acceptability and feasibility for this population group, showing improvements in digital inclusion and engagement.
  • Barriers to digital interventions for older people experiencing homelessness included issues of digital literacy, lack of access to technology, and age-related challenges, while facilitators included organizational and peer support.

What Clinicians Need to Know

  • Key Point 1: Telehealth holds transformative potential across diverse patient populations but requires proactive strategies—particularly around policy, payer support, and infrastructure—to prevent widening existing health disparities.
  • Key Point 2: Addressing cultural and linguistic barriers is critical for telehealth success; adapting technology to meet the needs of non-English-speaking patients enhances both adoption and patient satisfaction.
  • Key Point 3: Tailored digital interventions can benefit vulnerable populations like older homeless adults, but structural challenges (digital literacy, resource access) must be addressed through innovative programming and collaborative partnerships.

Conclusion

The evolving landscape of telehealth access presents both opportunities and challenges for advancing health equity, particularly for underserved populations. The research highlighted in this round-up underscores the complex factors influencing digital health access, from disparities in substance use disorder treatment among Medicaid populations to the barriers faced by patients with non-English language preferences and older individuals experiencing homelessness. While telehealth has the potential to reduce disparities, its effectiveness hinges on addressing technological, linguistic, and systemic barriers that hinder equitable access. Moving forward, policymakers, clinicians, and community organizations must collaborate to design inclusive digital health solutions that account for the diverse needs of all patients. As telehealth continues to reshape healthcare delivery, ensuring accessibility for historically marginalized populations will be key to achieving meaningful and lasting improvements in health equity. NEXUS 2025, focused on advancing digital care delivery, is the ideal venue to explore solutions.

Note: This blog incorporates content generated using ChatGPT and SciSummary. 4,5

References

  1. Walker LS, Cui M, Cantor J, et al. Disparities in Substance Use Disorder Telehealth Services. JAMA Netw Open. 2025;8(2):e2459606. doi:10.1001/jamanetworkopen.2024.59606 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2830119
  2. Kong M, Rios-Fetchko F, Olmos-Rodriguez M, Branagan L, Iott B, Chan Tack T, Yarbrough C, Grumbach K, Fernandez A. Challenges to Video Visits for Patients With Non-English Language Preference: A Qualitative Study. JAMA Netw Open. 2025 Feb 3;8(2):e2457477. doi: 10.1001/jamanetworkopen.2024.57477. PMID: 39937480; PMCID: PMC11822542. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2830117
  3. Adams E, Donaghy E, Sanders C, Wolters MK, Ng L, St-Jean C, Galan R, Mercer SW. Digital Interventions for Older People Experiencing Homelessness: Systematic Scoping Review. J Med Internet Res. 2025 Feb 21;27:e63898. doi: 10.2196/63898. PMID: 39984162. https://www.jmir.org/2025/1/e63898
  4. ChatGPT. Chatbot-generated text on digital health access and equity. March 4, 2025. Available from: OpenAI, ChatGPT platform.
  5. SciSummary [Internet]. Available from: https://scisummary.com/ [Accessed 2025 Mar 4].

Author: Mollie R. Cummins, PhD, RN, FAAN, FACMI, Doxy.me