Municipality-Funded Telehealth and Emergency Department Utilization Among Uninsured Urban Populations: A Scoping Review.

BACKGROUND: The social determinants of health (SDoH) of uninsured patients are an underlying mechanism of avoidable emergency department (ED) use, but only 28.4% of EDs across the United States routinely screen for SDoH. Municipality-funded telehealth programs have emerged as a potential strategy to expand access to primary care and reduce preventable ED visits. However, no existing review has mapped the evidence on publicly supported telehealth models targeting uninsured urban residents. The purpose of this scoping review was to examine the cost-benefits of municipality-funded telehealth services on ED utilization among vulnerable populations in the U.S. METHODS: Articles were retrieved from PubMed, Medline, and Google Scholar using concept blocks and search terms and were managed using Covidence®. This resulted in 477 articles reviewed against the inclusion and exclusion criteria. Seven articles met eligibility requirements and were included for data extraction and analysis. RESULTS: The seven included articles indicated that telehealth utilization prompts primary care access, increased appointment adherence, and less ED use. In addition, telehealth services proved to be economic and cost-beneficial and bridged the gap in health inequality by addressing SDoHs, mostly among uninsured and vulnerable populations. CONCLUSIONS: Leveraging telehealth in uninsured populations produces positive effects on primary care access and utilization and subsequent reduction in avoidable ED use. All telehealth interventions reviewed were funded by donations, hospital systems, or nongovernment organizations. To support telehealth to combat avoidable ED use, there remains untapped opportunity for municipality-funded telehealth initiatives. This multisource focus on telehealth access can provide broader and sustained access for uninsured urban residents.