OBJECTIVES : In light of the transition to virtual healthcare, this study's aims were to (i) characterize disparities in access to virtual care services during the COVID-19 pandemic compared to conventional care and (ii) propose decision-making interventions to enhance access based on common themes identified in current literature.

METHODS : We conducted a qualitative review and thematic analysis of literature adhering to ENTREQ guidelines, utilizing PubMed/Medline, EMBASE, and Google Scholar databases to examine studies from March 2020 (defined as pandemic onset) to present evaluating disparities in accessing virtual care during the pandemic. Keywords used in our search included: "socioeconomic", "disparity", "telemedicine", "tele-health", "virtual consults", and "vulnerable populations".

RESULTS : We identified 21 studies classifying five major themes, including geographical, social, economic, generational, and racial/demographic-based. All included studies comprised of data collected through surveys or interviews of patient cohorts. Of these, many demonstrated parallels to in-person healthcare access(18/21), determining systemic racial factors(13/21), socioeconomic inequities(10/21), and limitations in rural access to care(8/21). Three determined generational gaps in digital literacy were poor predictors of access to virtual care and that geographical proximity was linked to access. Indigenous, Asian, non-English speaking, ethnic minorities, and lower socioeconomic status individuals were less likely to use virtual, compared to in-person healthcare. We noted these factors reflected complex structural systems and personal circumstances access to virtual care did not address. Based on this data, we propose (i) the formation of centralized clinical networks consisting of low-resource medical centres and larger urban centres such as tertiary care facilities and (ii) the creation of a digital decision algorithm, where vulnerable patient populations are matched with high-resource centres with the adequate support and tools required.

CONCLUSIONS : Current evidence suggests sustained disparity among already vulnerable groups owing to inherent institutional flaws present in healthcare, suggesting the need for patient- and systems-level intervention to enhance access.