Study: Telehealth penetration in Virginia lagged behind in rural areas during COVID-19

According to the study, the digital divide in the use of telemedicine between rural and urban communities has widened since the start of the COVID-19 pandemic, especially in mental health integration services. published in JAMA Network Open.

The study evaluated 3.6 million mental health integration visits and 63.5 million primary care visits in 138 Veterans Affairs health systems nationwide from March 16, 2019 to December 15, 2021.

Across the cohort, the study included 6.3 million unique patients with a mean age of 61 years, of whom 90.5% were male. The majority of patients (66.3%) were identified as non-Hispanic white patients, and 17.2% were non-Hispanic black patients.

The observational study included 45 rural and 93 urban VA health systems.

Prior to the pandemic, 34% of rural Veterans Affairs health systems used telemedicine for primary health care, compared to 30% in urban areas. However, since the start of the pandemic, only 55% of rural systems have used telehealth for primary care, compared to 61% in urban areas.

In terms of integrative mental health services, rural systems reported higher use of telemedicine at 29% compared to urban systems at 25% pre-pandemic. Since the start of the pandemic, 76% of rural systems have used telemedicine for this purpose, compared to 84% of urban systems.

Before the pandemic, there were few video visits in rural and urban health systems, 2% versus 1% respectively. These figures increased slightly to 4% in rural areas and 8% in cities after the pandemic.

“Despite a coordinated federal response, the experience of the Virginia health care system shows that the increased use of telemedicine can put rural patients at risk of poor access to care. Future research and efforts to implement health systems should address structural disparities between rural and urban areas (eg internet bandwidth). and consider adapting the technology to encourage adoption among rural users at all levels (patients, physicians, and healthcare systems),” the researchers write.

“As healthcare systems increasingly rely on telemedicine to deliver essential healthcare services, rural hospitals may face greater operational challenges, and rural patients may face growing disparities in access to care compared to their urban counterparts.“

WHY IS IT IMPORTANT

The researchers noted limitations, including the possibility of misclassifying some rural patients. They also lacked data on VA patients who received non-VA care in their community, which may be more common among rural veterans.

Finally, the generalizability of the study may be limited by healthcare systems with early telemedicine infrastructure, although the researchers noted that the implications are likely to apply to most systems that have adopted telemedicine.