Assessing Telehealth Feasibility in an Urban Safety-Net Emergency Department: Technology Access and Barriers

Telehealth may help expand access and reduce Emergency Department (ED) crowding, yet adoption remains low in underserved communities. Understanding digital access, literacy, and patient perceptions is essential for designing feasible interventions. We hypothesized that telehealth readiness in an urban safety-net ED population would be influenced by multiple factors—including technology access, digital literacy, and prior exposure to telehealth—although the relative impact of these factors remained unclear.

We conducted a cross-sectional survey of 301 adult ED patients assessing demographics, technology access, digital literacy, prior telehealth use, attitudes, and barriers. Descriptive and comparative analyses were performed.

Of 326 patients screened, 301 completed the survey (92% response rate). Median age was 45.5 years (IQR 34–61). Overall, 42.9% reported prior telehealth use (video or phone). In multivariable analysis, absence of a primary care provider (adjusted OR 0.32; 95% CI 0.18–0.58; p < 0.001), lack of home internet access (adjusted OR 0.33; 95% CI 0.12–0.88; p = 0.027), and male sex (adjusted OR 0.42; 95% CI 0.25–0.70; p < 0.001) were independently associated with lower telehealth utilization. Age, race/ethnicity, Medicaid insurance, and technology comfort were not independently associated with telehealth use.

Among patients presenting to a large urban safety-net emergency department, telehealth utilization was associated with structural access factors—particularly primary care engagement and internet availability—rather than age or race. Efforts to expand telehealth as a strategy to improve outpatient access and reduce ED utilization must address digital infrastructure and primary care linkage to ensure equitable implementation.