March 7, 2022
Based on previous research on access to telehealth services for inpatient populations, a new study by Kimberly Shoenbill, MD, MPH, and colleagues considers how access to telehealth services is impacted by Social Determinates of Health using five-digit zip codes mapped to the CDC’s Social Vulnerability Index.

A recently published study, Evaluating a Tobacco Treatment Program’s Transition to Telehealth Using a Social Determinants of Health Lens, considered how access to telehealth services was impacted by Social Determinates of Health (SDOH), using five-digit zip codes mapped to the CDC’s Social Vulnerability Index (SVI) and driving distance to the hospital.
The study found that with access to telehealth technology provided, the percentage of inpatients at each SVI vulnerability level who participated in tobacco cessation treatment remained stable from in-person to telehealth delivery of care. While other recent studies have shown that outpatient telehealth may exacerbate disparities in care, these inpatient telehealth findings suggest that improving access to telehealth infrastructure and technology may correlate to expanded reach and benefits to care that telehealth services provide.
Lead author Kimberly Shoenbill, MD, MPH, Director of the UNC Tobacco Treatment Program in the Department of Family Medicine; Michael Baca-Atlas, MD; Caleb Smith; Stephanie Wilhoit-Reeves, MDiv, MSW; Stefanie Baca-Atlas, MSW; and Adam Goldstein, MD, MPH; expanded the new study from their previous research, which found that access to telehealth services resulted in expanded participation in tobacco cessation counseling.
The new study’s novel method of measuring SDOH points toward an opportunity for future researchers to evaluate a composite metric for SDOH when only zip code or address data is available.
“I’m excited about this work and the two major findings it provides,” Shoenbill said. “From a clinical perspective, we have shown that more inpatients across the vulnerability spectrum, including those at the highest vulnerabilities per the CDC’s SVI metric, engage in telehealth delivery of tobacco cessation when compared to in-person delivery of cessation treatment. This supports the need for improved access to outpatient telehealth connectivity, tools, and training so patients can continue their tobacco cessation journeys, even when living far from tobacco treatment programs. From a research perspective, we have used existing point-of-care data routinely collected and the CDC’s validated SVI metric to assess SDOH. This approach provides a novel method to assess SDOH, reach, and effectiveness in any tobacco treatment program to assist in reducing care disparities.”
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