Inequalities In Access Research Articles

State inequities: Gaps in planned treatment for criminal legal referrals with opioid use disorder across two decades of US treatment admissions.

Criminal-legal (CL) referrals to addiction treatment have historically had low utilization of medications for opioid use disorder (MOUD). While state differences have been reported, an in-depth longitudinal analysis of state-by-state differences is lacking. The Substance Abuse and Mental Health Services Administration Treatment Episode Dataset-Admissions 2000-2020 provided data for individuals entering their initial treatment with an opioid as their primary substance. Outcome was planned use of MOUD, assessing odds ratio (OR) of CL referrals relative to non-CL referrals cumulatively over the 21-year period and as incremental change (change in relative disparity) using effect sizes, stratified by each state. 2,187,447 cases met the criteria. Planned MOUD occurred in 37.7% of non-CL clients versus 6.5% of CL clients (OR = 0.11, 95% confidence interval = 0.11-0.12). For all clients, planned MOUD increased from 2000 (33.9%) to 2020 (44.8%). This increase was blunted within CL clients, increasing from 2000 (6.4%) to 2020 (13.3%). Rhode Island saw the greatest improvements in equity. While rates of planned MOUD increased over the 21 years, a significant disparity persisted among CL clients in most states. As opioid use disorders and opioid-related overdoses are more prevalent among those involved with the CL system, improving this has high impact. Provides the most comprehensive analysis of state-by-state inequities in MOUD access for CL relative to non-CL referrals over a 21-year period through use of a national data set. Positive outliers are used as case examples for others to follow in pursuit of more equitable care.

Modeling Gender Gap in Access to Empowerment and Agricultural Productive Resources: Evidence from Farming Households in Kaduna State

This research examined gender access to empowerment and agricultural productive resources with a gender dimension. Respondents were selected with random and stratified sampling techniques. Primary data were generated through the administration of well-structured questionnaire. Generated data were analyzed with descriptive statistics, Women Empowerment Index (WEI), Global Gender Parity Index (GGPI) and Gini Inequality Index (GII). The result shows that 37% and 60.20% of women and men had access to empowerment programmes respectively in the study area. WEI result showed that women had low access to empowerment variable (WEI = 0.67), the GGPI revealed that women (GGPI = 0.63) had low parity as against the men (GGPI = 0.77) with higher parity index. Furthermore, the Gini Inequality Index that there is inequality in access to agricultural productive resources between men (GII = 0.286) and women (GII = 0.383). The research concluded women had low empowerment and low access to agricultural productive resources as against the men. The research recommended that government programmes should be mainstreamed to ensure that more women have access to them and the extension department should design their programmes to ensure that more women have access to extension services in the study area.

Sociodemographic Differences in Nonfinancial Access Barriers to Health Care Among Adults: United States, 2022.

Nonfinancial access barriers to care describe various reasons why adults may delay or not get medical care, beyond cost. This report focuses on five access barriers to care and describes the percentage of U.S. adults who delayed or did not get medical care in the past 12 months because of 1) being too busy with work or other commitments; 2) an appointment not being available when needed; 3) not being able to get to the doctor's office or clinic when open; 4) difficulty finding a doctor, clinic, or hospital that would accept their health insurance; and 5) it taking too long to get to the doctor's office or clinic from their house or work. Data from the 2022 National Health Interview Survey were used to produce estimates of the percentage of adults who delayed or did not get medical care in the past 12 months because of those access barriers to care, overall and by selected sociodemographic characteristics. Among U.S. adults in 2022, 12.5% delayed or did not get medical care in the past 12 months because they were too busy to go to a provider, 10.6% could not find an available appointment when needed, 4.6% were unable to get to a provider when open, 4.4% had difficulty finding a doctor compatible with their health insurance, and 2.4% responded that it takes too long to get to a provider. Percentages varied by sociodemographic characteristics. This study provides nationally representative estimates of selected nonfinancial access barriers to medical care, both overall and for selected sociodemographic groups. Findings suggest that nonfinancial access barriers to care are widespread in the United States, and ongoing monitoring may help to address inequities in access to care.

Young people's views and experience of diet-related inequalities in England (UK): a qualitative study.

Inequalities in diets contribute to overall inequalities in health. Economic inequality and inequalities in access to healthy food are key drivers of poor diet and ill health among young people (YP). Despite mounting evidence of structural barriers to healthy eating, less is known about how YP view and experience these inequalities where they live, and how to address them. To explore YP's perspectives on the drivers of diet-related health inequalities, we conducted three interlinked focus groups with YP aged 13-21 years from six youth groups across three geographical areas in England. We analysed the data inductively and deductively using reflexive thematic analysis and generated themes by examining how social structure, context and agency interact and impact YP's diet. YP were aware of how inequalities in employment conditions impact their families' income and ability to eat a healthy diet. They cited the high availability of hot food takeaways in their local areas as a significant barrier to healthy eating but did not support closing or restricting these outlets. They held strong views on policies to tackle diet inequality and showed a nuanced understanding of the strengths and limitations of universal and targeted approaches. Our study showed that YP have an awareness and understanding of food as important in relation to health, and of diet-related inequalities. However, further efforts are needed to shape and promote policies that resonate with YP and address both their health and wider social concerns.

A Secret Shopper Study of Language Accessibility of Community-based Behavioral Health Services for Children in Families Who Speak Spanish and English

To compare outpatient behavioral health scheduling for children in Spanish-speaking families in Pennsylvania with that for children in families who speak English. We made paired English and Spanish telephone calls to outpatient behavioral health facilities using a standardized script, describing a simulated, stable, Medicaid-insured child. Facilities were identified using the Pennsylvania Department of Human Services Online Provider Directory for Mental Health and Substance Abuse Services, which had 288 outpatient facilities with non-duplicate telephone numbers. An English-language caller following a script made up to two call attempts per facility from December 2019 through February 2020. The 126 facilities that did not answer the phone, accept Medicaid, or see children were removed. A Spanish-language caller then made up to two scripted call attempts to the 162 remaining facilities. The primary outcome was whether the facility tried to schedule an appointment for the simulated adolescent. 125 facilities answered both English- and Spanish-language calls. For the English-language caller, 71% of facilities attempted to schedule an appointment and 100% communicated in the caller's preferred language. For the Spanish-language caller, 24% attempted to schedule an appointment (P<0.001) and 25% communicated in the caller's preferred language (P<0.001). Among outpatient behavioral health facilities for Medicaid-insured children in Pennsylvania, there were inequities in access to appointments for families who speak Spanish compared with English. This a modifiable barrier to care. Community-based behavioral health care for children should strengthen language access training, contracting, and oversight.

Stakeholder Theory, Public Engagement, and Epistemic Injustice: The Case of Covid-19 Vaccine Hesitancy in Scotland’s African, Caribbean, and Black Communities

The adoption of a stakeholder approach to public engagement within the public sector has been extensive. However, there remain critical gaps in the understanding of stakeholder participation arising from hidden disparities that contribute to unequal access to communication channels, information, and hence ultimately knowledge and decision making. The term “epistemic injustice” has been used to describe such inequality of access and consequently, the outcome that ensues. Epistemic injustice is much overlooked in stakeholder theory. This article shows how epistemic injustice can act as a barrier to effective stakeholder engagement and hence to successful public policy formulation and implementation. We use the case of vaccine hesitancy among Scotland’s African, Caribbean, and Black (ACB) communities to illustrate this problem of unequal participation. The study drew on primary data involving 85 participants and secondary data sources from extant literature and explored salient factors shaping barriers to vaccine uptake during the recent pandemic. The findings demonstrate how the failure to grasp epistemic injustice undermines the effectiveness of the stakeholder approach, even with the most well-intentioned efforts. We argue that epistemic injustice is a critical barrier to effective stakeholder approaches.

Getting It Right First Time (GIRFT) – implementation of GIRFT and MedTech Funding Mandate policy around minimally invasive surgery for BPH in the UK

The MedTech Funding Mandate (MTFM) policy was introduced in 2021 by the National Health Service (NHS) England, to facilitate the adoption of innovative, cost-saving medical technologies approved by the National Institute for Health and Care Excellence (NICE) within the NHS. This policy aligns with the objectives of the Getting It Right First Time (GIRFT) initiative, which aims to improve clinical effectiveness by reducing unwarranted variations in healthcare practices. In April 2022, the MTFM policy included four technologies for the treatment of bladder outlet obstruction (BOO). These technologies offer clinical effectiveness, resource efficiency, and affordability, as recommended by NICE. Despite the availability of NICE-approved minimally invasive surgical treatments (MISTs) for BOO, transurethral resection of the prostate (TURP) remains the commonest surgical treatment for BOO, although there is debate as to whether this remains the gold-standard of care. The inclusion of the four BOO technologies in the MTFM policy aims to address the existing inequalities in patient access to NICE-approved treatments and support the adoption of these effective alternatives to monopolar TURP. Key stakeholders, including GIRFT, Urology Area Networks (UANs), and the 15 Academic Science Networks (AHSNs), play a crucial role in implementing the MTFM policy. The policy has significant implications for clinical practice, promoting pathway transformation, resource and cost savings, and a comprehensive range of treatment options for patients with BOO.

Promise and Perils of Primary HPV Testing.

Cervical cancer screening has reduced morbidity and mortality in many countries, but efforts to optimize screening modalities and schedules are ongoing. Using data from a randomized trial conducted in British Columbia, Canada, in conjunction with a provincial screening registry, Gottschlich and colleagues demonstrated that the estimated risk for precancerous disease (cervical intraepithelial neoplasia grades 2 or worse) at 8 years following a negative human papillomavirus (HPV) test was similar to the current standard of care (Pap testing after 3 years). The study supports extending screening intervals for those with a negative HPV test beyond currently recommended 5-year intervals. In an ideal world, the resources saved through less frequent routine cervical screening could be redirected to increasing screening uptake and follow-up of abnormalities to improve equity in cervical cancer prevention. However, implementation of extending screening intervals remains less than straightforward in settings with fragmented healthcare systems that lack information systems to support patient call/recall, such as the United States. To achieve the full promise of primary HPV testing, stakeholders at every level must commit to identifying and addressing the diverse spectrum of barriers that undergird existing inequities in care access, appropriately resource implementation strategies, and improve health information systems. See related article by Gottschlich et al., p. 904.

Bringing Care Close to Home: Remote Management of Heart Failure In Partnership with Indigenous Communities In Northern Ontario, Canada

BackgroundThe Weeneebayko Area Health Authority (WAHA) is a regional, community-based Indigenous health authority in Northern Ontario, Canada. From September 2022 to March 2023, the WAHA and University Health Network engaged in a partnership that designed a collaborative model of care to address inequities in cardiology specialist access in Northern Ontario. This model implemented a digital therapeutic for heart failure, (the Medly program) and in-person cardiology clinics in the region. MethodsA WAHA-based Medly program clinical coordinator worked closely with the University Health Network team to deliver care and support patient self-management of HF. The use and effectiveness of the Medly program were tracked through app usage and rules-based algorithm alerts, based on patient self-reported data. Distribution of relevant equipment (a scale, a blood pressure cuff, and a mobile device) for the Medly program was recorded. Surveys to assess patient and provider satisfaction with the Medly program also were administered. A retrospective chart audit of electronic medical records and administrative databases was conducted. ResultsA total of 33 patients in the WAHA were enrolled in the Medly program during a 7-month period, surpassing the enrollment goal of 25 patients. A total of 93% of eligible patients were on optimized guideline-directed medical therapy or were being titrated for it. Of 15 surveyed patients, 100% agreed or strongly agreed that the Medly program facilitated delivery of care close to home, and 86% of surveyed clinicians (n = 7) agreed or strongly agreed that the Medly program addresses a gap in available care in the region. ConclusionsThe implementation of the Medly program in partnership with the WAHA has demonstrated success in terms of the volume of referrals, the quality of care, adherence to evidence-based best-practice guidelines, and satisfaction with the program.

Systemic inequalities in heat risk for greater London

The temperature rise and increases in extreme heat events related to global climate change is a growing public health threat. Populations in temperate climates, including the UK, must urgently adapt to increased hot weather as current infrastructure primarily focusses on resilience to cold. As we adapt, care should be taken to ensure existing health inequalities are reduced. Lessons can be learned from regions that experience warmer climates and applied to adaptation in the UK.We identified known indicators of heat-health risk and explored their distribution across area level income for London. Understanding these indicators and their distributions across populations can support the development of interventions that have the dual aim of improving health and reducing inequalities. An exploratory analysis was conducted for each indicator at neighbourhood level to assess existence of disparities in their distributions across London. A systems-thinking approach was employed to deduce if these amount to systemic inequalities in heat risk, whereby those most exposed to heat are more susceptible and less able to adapt. Using this information, we proposed interventions and made recommendations for their implementation.We find inequalities across indicators relating to exposure, vulnerability, and adaptive capacity. Including inequalities in urban greening and access to greenspace, physical and mental health and access to communication and support. Through a system diagram we demonstrate how these indicators interact and suggest that systemic inequalities in risk exist and will become more evident as exposure increases with rising temperatures, depending on how we adapt. We use this information to identify barriers to the effective implementation of adaptation strategies and make recommendations on the implementation of interventions. This includes effective and wide-reaching communication considering the various channels and accessibility requirements of the population and consideration of all dwelling tenures when implementing policies relating to home improvements in the context of heat.

Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity.

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.

Eliminating Health Care Access and Quality Inequities in Sickle Cell Disease: Policy Lessons from the End Sepsis Initiative

Abstract: Sickle cell disease is a prime example of the devastating impact of healthcare inequities. The End Sepsis Initiative developed after a tragic death due to sepsis, provides a powerful model for the sickle cell community. This model recognizes the importance of evidence-based protocols and policy recommendations/mandates to drive transformative systems change. We propose that the sickle cell community mirror this approach. We propose that hospital systems, healthcare organizations, and insurers implement evidence-based protocols, including personalized pain plans, stigma reduction through staff training, vaccinations, preventative screening, disease-modifying therapies, pediatric to adult transition, and connecting unaffiliated SCD patients to a medical home. We recommend state-level interventions, such as using SCD navigator in electronic health records for quality reporting, supporting community health workers' use, and ensuring rural hospitals have access to SCD specialists.

Disparities in availability of new cancer drugs worldwide: 1990-2022

IntroductionDespite progress in the development of new cancer drugs, concerns about equity of access remain. This study aimed to examine the availability and timeliness of availability of new cancer drugs...

Synergistic evaluation of energy security and environmental sustainability in BRICS geo-political entities: An integrated index framework

Research background: The increasing demand for energy, driven by economic growth and population expansion, is a critical driver of societal progress. However, the predominant reliance on fossil fuels to meet this demand presents significant challenges, particularly in the rapidly developing BRICS nations (Brazil, Russia, India, China, and South Africa). These countries are faced with a complex interplay of energy security and environmental sustainability issues, stemming from their substantial fossil fuel reserves and the associated environmental consequences. The challenges manifest as inequalities in access to clean energy, environmental degradation, and heightened vulnerability to the impacts of climate change. Addressing these multifaceted issues requires a comprehensive approach. Metrics-based strategies, which employ aggregated indices derived from a diverse set of energy and environmental indicators, have the potential to provide valuable insights into these complexities. However, the development of a universally applicable energy sustainability index is complicated by the heterogeneity of metrics, disparities between countries, and methodological challenges, emphasizing the need for an innovative and holistic analytical framework. Purpose of the article: This study aims to develop a tailored Energy Security and Environmental Sustainability Index for BRICS economies to evaluate the robustness of their energy systems and the viability of their ecological practices. The index serves as an instrument to assess the progress of these nations in the Energy and Environment domain and identify areas that require targeted interventions and improvements. Methods: The construction of the composite ESESI involves the selection of relevant parameters and the application of a Multi-Criteria Decision Analysis (MCDA) framework in conjunction with the Weighted Product Method (WPM). To ensure objectivity in the determination of optimal and least favorable weights for each indicator, the study employs the Multiplicative Data Envelopment Analysis (MDEA) model. Findings &amp; value added: The ESESI analysis reveals disparities in the progress made by BRICS nations in enhancing energy security, promoting renewable energy deployment, and mitigating environmental impacts. While some countries demonstrate substantial advancements, others face challenges in improving energy efficiency and reducing carbon emissions. The study underscores the necessity for tailored policies and targeted infrastructural enhancements that align with the unique challenges and strengths of each nation. Harnessing the abundant renewable energy potential through advanced energy trade mechanisms and fostering cross-border investments are identified as crucial strategies for ensuring environmental sustainability and long-term energy in the BRICS region. The ESESI provides a valuable tool for policymakers and researchers to evaluate the progress of BRICS nations in achieving sustainable energy goals and to inform evidence-based decision-making processes. By offering a comprehensive and scientifically rigorous assessment framework, this study contributes to the ongoing discourse on sustainable energy transitions and environmental stewardship in the context of rapidly developing economies.

Impacts of COVID-19 shelter in place across key life domains among immigrant farmworker Latina mothers and young adults

ObjectiveIndividuals and families from racial and ethnic groups experience social and economic disadvantage making them vulnerable to the disproportionate impact of the COVID-19 pandemic. This study sought to capture the impacts of Shelter in Place (SIP) across key life domains including family life, education, work, mental health, and coping strategies among a sample of Mexican-origin mothers who were currently engaged in agricultural work, or whose spouses were engaged in agricultural work, and young adults who had a parent working in agriculture.MethodDuring the summer of 2020, while California was under SIP orders, we conducted three virtual focus groups using Zoom(r). We recruited focus group participants from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), an ongoing, 20-year, longitudinal cohort study of Mexican-origin families in a predominantly agricultural area of California. Three focus groups were conducted with mothers (n = 9), mean age = 48 years, young adult women (n = 8) and young adult men (n = 5), mean age = 18 years, respectively.ResultsMothers reported high levels of stress stemming from fear of Covid-19 infection, work instability and financial concerns, children’s schooling, anxiety about an uncertain future, and the demands of caretaking for dependents. Adverse mental health impacts were particularly pronounced among participants experiencing multiple adversities pre-dating the pandemic, including unemployment, single motherhood, and having undocumented family members. For young adults, work instability and varying work hours were also a source of stress because they made it difficult to make decisions about the future, such as whether to attend college or how many classes to take. Families used coping strategies including expressing gratitude, focusing on what’s under one’s control, familismo, and community engagement to manage mental health challenges during SIP.ConclusionIn the event of future pandemics or disasters, particular attention is needed to those who experience unemployment, are undocumented and/or have undocumented family members, and/or are single parents facing economic adversity. During public health emergencies, action at the local, state, and national level is needed to support farmworkers and other vulnerable groups’ secondary major stressors stemming from inequities in access to affordable housing, childcare, living wages, healthcare, and other benefits.

Gender Relations between Men and Women in Village Government Decision-Making

study aims to examine the dynamics of gender relations in decision-making in Pesagi village, Kayen sub-district, Pati district. The main focus of this research is to understand the extent to which women are involved in the decision-making process and how to improve the role of women in line with the enactment of Law No. 6 of 2014 on Villages, which provides new opportunities for women's participation. This research uses a qualitative approach with the methods of in-depth interviews, participatory observation, and document analysis to obtain a comprehensive picture of women's participation in village decision-making. By testing the validity of the data using the Triangulation technique, namely comparing and reviewing the degree of trust in information obtained through different times and tools in qualitative research. The results show that despite formal recognition of women's role in village governance, their active participation is still limited. Women tend to be involved in domestic and community issues, such as health and social welfare, while men dominate areas of physical village development. Deep-rooted gender stereotypes and inequalities in access and opportunity are also factors inhibiting women's participation, and decision-making by women is often influenced by men. Based on the explanation from the analysis of men's and women's gender relations in decision-making in Pesagi village, to increase women's participation in village decision- making, a comprehensive strategy is needed, including training and capacity building, setting quotas for women's representation, and active support from the female village head. So that women can contribute more significantly to village development and ensure gender-equitable policies.

Examining Food Access Equity by Integrating Grocery Store Pricing into Spatial Accessibility Measures

Accessibility to food stores offering nutritious and affordable options is critical to ensure urban residents lead healthy lives. However, the uneven distribution of diverse food options in U.S. cities has raised concerns about marginalized communities’ ability to obtain affordable and nutritious food. Transportation-related issues, like car-oriented urban form and sprawl, have created food deserts in cities, making it hard for marginalized communities to access affordable and healthy food. This lack of access has recently drawn the attention of urban planners to address food access-related equity issues. Spatial interaction models can help measure food access by examining how grocery store supply, demand, and proximity affect individuals’ access to necessary food. However, these measures do not always consider the pricing of food items, which can significantly affect food access for low-income individuals and families. We use a highly disaggregated measure tailored to measuring inequitable food accessibility by factoring grocery store pricing into various types of supply and demand. Then, using regional socio-demographic thresholds, we identify target population groups and perform a series of equity analyses using our food accessibility measure. Our results show that walking is more inequitable than driving to food stores and that African American and Hispanic minorities, the elderly, and carless households are more burdened than the reference groups (whites). Using our framework, we identify food deserts and provide spatial and empirical insights for policymakers and planners to address food insecurity and promote equitable access to healthy food.

GP remote consultations with marginalised patients and the importance of place during care: a qualitative study of the role of place in GP consultations.

Since COVID-19 there been an increase in the use of remote consultations in General Practice in the UK. This leads to the displacement of the consultation outside of the physical GP practice, and its 'emplacement' elsewhere, with underexplored consequences for inequities of healthcare in marginalised groups. This paper examines the place-making demands that remote consultations make on patients, and the ways that these affect their experiences of care, with a focus on the impact on patients from marginalised groups. Ethnography and interview study (n=15) undertaken at three sites in London: a foodbank, a community development organisation, and a drop-in advice centre for migrants. Additionally, GPs (n=5) working at practices in London Digital Health Hub staff (n=4) and staff at fieldwork sites (n=3) were interviewed. Ethnographic observation (n=84 hours) and semi-structured interviews (n=27). Interviews were conducted in-person and over the phone and data were analysed through reflexive thematic analysis. The core themes emerging from the data included challenges securing privacy during remote consultations, and the loss of formal healthcare spaces as important places of care. These findings were closely tied to resource access, leading to inequities in experiences of care. Remote GP consultations are not "place-less" encounters, and inequities in access to suitable spaces may lead to inequities in experiences of care. Attention should be given to ensuring that patients without appropriate spaces for remote consultations are offered in-person care, or consultation times made more specific to allow for organisation of private space.

The Effect of Credit among Micro, Small, and Medium Enterprises on Income Inequality in Indonesia

Income inequality has become a growing global concern during the last two decades. High income inequality can hinder economic growth, and in the case of Indonesia, the Gini coefficient continues to show an increasing trend. One of the factors that increase the level of income inequality is inequality in business opportunities and access to capital. To address this issue, the government created a credit program to benefit micro, small, and medium enterprises (MSMEs). MSME loans are basically designed to increase equality through the promotion of business opportunities. The authors seek to study the impact of MSME credit on income inequality in Indonesia using panel data with random effects in 33 provinces from 2005-2016. The results of this study are expected to provide an overview of whether the existing MSME credit program has been running effectively or not.

Exploring Patterns and Disparities in E-Consult Referrals: An Analysis of Patient and Community Factors in Colorado Health Care.

Objective: Electronic consultations (e-consults) provide a strategic solution to address challenges in health care systems related to cost management and access to care. This study aims to investigate the multilevel patient characteristics associated with higher frequency of receiving e-consults and increased likelihood of completion. Materials and Methods: University of Colorado's electronic medical record were analyzed to study factors influencing referral types (e-consult vs. standard) and their completion rates from April 2018 to September 2023. Multivariate probit regression assessed the impact of patient-level and community-level factors (urban-rural classification, Social Vulnerability Index, and technology accessibility) on e-consult referrals and completion. Results: In 263,882 records, 92.5% were standard referrals, and 7.4% were e-consult referrals. Analysis showed that females were less likely than males (OR = 0.95, 95%CI[0.93, 0.96]), and Blacks were more likely than Whites (OR = 1.03, 95%CI[1.01,1.06]) to receive e-consult referrals. Medicaid patients had lower odds compared to those with Medicare only (OR = 1.04, 95%CI[1.00,1.07]), and rural residency was associated with lower odds (OR = 0.80, 95%CI[0.73,0.88]) of e-consult referral. Factors such as areas with higher population without internet subscription (OR = 1.03, 95%CI[1.01,1.04]) and higher social vulnerabilities (OR = 1.26, 95%CI[1.16,1.37]) increased e-consult odds. Black patients were less likely to have their referrals completed compared to Whites. Patients who resided in regions with limited computer and smartphone access, as well as higher social vulnerabilities, showed decreased odds of referral completion. Discussions and Conclusion: This study highlights the need for partnering with a variety of health care organizations, especially those serving low-income and disadvantaged populations, to enhance health care access equity through the use of e-consults.