Assessment of Telemedicine and Access to Care in Rural Areas

Garvita Thareja, Eric Cox, Tracey Wood, and Maryssa Yarbrough

Telemedicine is essential because it addresses barriers that individuals may face in rural areas. It conveys many benefits that can be used by individuals unable to regularly commute from their homes Americans living in rural areas tend to experience higher rates of disease, such as high blood pressure and obesity, than those who live in urban areas High rates of poverty and lower rates of physical activity have also been reported among rural dwellers These factors may put rural individuals at higher risk for poor health outcomes (American Hospital Association, 2019). Telemedicine can link individuals to health care services that can prevent or treat various diseases and conveniently connect individuals to physicians. In 2022, when COVID-19 affected the healthcare industry, the growth of telemedicine was remarkable Virtual health care technology has increased health care value and affordability Patients are able to save time and money, and visits to emergency and urgent care centers are reduced with the use of telehealth services In rural America where health care services are significantly harder to access than their urban counterparts, the need for inexpensive and quality care is critical and telemedicine may be the answer to bridging the gap of accessing quality healthcare.

During the COVID-19 public health emergency, reimbursements for telehealth have continued to evolve. Telemedicine substantially increased healthcare affordability leading to many federal policy changes in 2019 and 2020 that have made it easier for healthcare providers to offer this service delivery (Persaud, 2022) The goal of telehealth is to also provide better access to health care while still maintaining medical income for health care organizations One of the most successful applications of telehealth is the reduction of health care disparities in areas where there is limited access to physicians.

Approximately 20% of the US population resides in rural areas, and only 9% of physicians serve these areas (Persaud, 2022) Telehealth aims to eliminate transportation costs, which often burden patients of low socioeconomic status In addition to improved access, it is estimated that telehealth could save the U.S. healthcare system more than $4 billion annually. The use of technology could reduce referrals and wait times, streamline medical evaluations, and decrease the burden of some preventable diseases. As an example, patients who are being treated for chronic diseases account for 75% of medical expenses. Telehealth proposes to lower these medical expenses by monitoring patients at home, ensuring medication adherence through electronic means, and providing expeditious access to a physician In this way, the financial burden of hospital readmissions can be curbed (Persaud, 2022) During the pandemic, the push to make telehealth services widely available was a temporary measure It has now become a common health care service delivery due to its potential to take down barriers in access to critical health care services. Future expansion of healthcare services in rural areas will depend on the continued evolution of telemedicine.

In 2020, social distancing due to the COVID-19 pandemic made it essential for healthcare providers to deliver healthcare services in different ways Years after the pandemic, telehealth is still a widely used service tool in healthcare and has become a permanent form of healthcare service delivery in rural areas due to its flexibility in providing services. Telemedicine can support underserved rural Americans with many health care advantages such as increased access to specialists, mental health care, and fewer hospitalizations. Americans who reside in rural areas face many disparities to health care such as the cost of treatment, availability of the physician/specialist, and access to transportation However, to improve healthcare practices, it will be important to understand and conduct research regarding the efficacy and trends of telehealth in rural areas over the years In 2022, a research study was conducted by Kolluri, et al., to understand rural dwellers' experiences with telehealth. The researchers found that participants had significantly positive experiences when using telehealth services. This study allowed researchers to understand how telehealth can bridge gaps in healthcare service delivery for those who reside in rural areas.

Telehealth may be an ideal form of healthcare delivery for rural dwellers, however, internet connectivity is essential to successfully using this service Lack of internet use has been reported in rural areas which can generate another barrier to accessing health care A research study was conducted in 2021, by Holloman, Obermier, and Burger to assess the digital divide in rural areas. Rural areas face inequality when accessing broadband services compared to urban areas. In rural areas internet costs, availability, and packages are limited. As one travels away from a populated area, internet connectivity and speed decreases. Holloman, Obermier, and Burger acknowledge the need for further scientific research to accurately understand trends associated with internet access in rural areas.

Even though the research study conducted by Kolluri, et al, saw significantly positive experiences for patients using telehealth in rural areas, other research has found that physicians face challenges when using telehealth services In 2021, a comparative qualitative research study was conducted among 42 physicians in Quebec and Massachusetts. The study found, “the negative impacts of telehealth on interprofessional work, including reported feelings of isolation due to the absence of interpersonal contacts and the loss of impromptu moments of socialization” (Breton et al., 2021). This study suggests some healthcare professionals who provide telemedicine services may have negative experiences such as feelings of isolation and loss of socialization. Thus, it is important to understand that physicians and patients may have differing perspectives concerning telehealth. Clinical appropriateness may be an essential variable to determine when telemedicine and in-person visits are suitable Despite some research studies finding negative impacts of telehealth services among physicians, it is important to understand that many surveys over the past several years have found using telehealth services to be a positive experience for patients in rural areas

Individuals living in rural areas can experience various barriers such as limited transportation, poverty, and higher rates of disease. Specialized care and access to health services are essential to breaking down disparities for those who reside in rural areas Telemedicine may be the answer to bridging many gaps and increasing health care services to underserved populations This service delivery mode can be a great option for those who belong to vulnerable populations such as older adults, children, rural dwellers, and minorities Focus group, observational, and experimental studies should be conducted to identify the strengths and weaknesses of telehealth services and delivery. Further research in this area is certainly necessary to understand how telemedicine services affect access to healthcare and health outcomes among rural Americans.