Is housing stability associated with telehealth utilization among emergency department patients?

Background: Housing instability is a major social determinant of health and is associated with increased reliance on emergency healthcare. Emergency departments (ED) often serve as an entry point to healthcare for people experiencing homelessness (PEH). Telehealth use has expanded rapidly since the COVID-19 pandemic. The majority of PEH own a mobile phone; many PEH perceive mobile health to be supportive and increase healthcare accessibility. However, telehealth use may be limited by a lack of awareness, inconsistent internet access, and limited access to charging. This study describes the relationship between telehealth utilization and housing stability. 

Methods: This is a cross-sectional study conducted during Summer 2024, Spring 2025, and Summer 2025 in an urban safety-net ED. Patients were included if ≥ 18 years old and spoke English or Spanish. They were excluded if altered, critically ill, intoxicated, in law enforcement custody, or on a psychiatric hold. Research associates systematically sampled patients who visited the ED using standardized questions. Telehealth use was defined as accessing healthcare via phone or video call. Housing stability was defined as having a steady place to live (AHC-HRSN). Questions were adapted from a previously tested survey instrument. Chi-square analysis and logistic regression were performed. 

Results: Of the 1,164 included patients, 39% used telehealth, 14% reported housing instability, and 89% owned a smartphone. Telehealth utilization was higher in individuals with stable housing (41% v 28%, p = 0.001), who own a smartphone (41% v 30%, p = 0.018), and with education at the college level or above (47% v 36%, p = 0.001). After adjusting for smartphone ownership, health literacy, age, and education, people with stable housing (OR: 1.65, 95% CI 1.13-2.42) and higher education (OR: 1.45, 95% CI 1.09-1.91) had statistically significantly greater odds of telehealth use. Smartphone ownership, age, and health literacy did not have significant associations with telehealth use. 

Conclusion: Housing stability and higher education level are associated with higher rates of telehealth utilization. Innovative and culturally tailored resources may be needed to increase telehealth use for individuals who are affected by social risk factors, specifically housing instability. Limitations include self-reported data from a single site.