If you’ve recently Zoomed in to a doctor’s appointment or conferenced into a counseling session, you’re in good company. The use of telehealth has surged during the coronavirus pandemic — especially at its start when doctors’ offices and health clinics suspended in-person appointments and subbed in a more socially distanced solution.
Experts predict these virtual visits are here to stay, and that could be good news to the nearly 60 million Americans living in rural areas of the country where health care is harder to come by. In fact, 1 in 10 rural adults have seen a nearby hospital or medical clinic shutter, according to a recent AARP report. And one-fifth do not have access to medical specialists in their community, like a heart doctor or cancer expert, despite having higher rates of chronic illness than their urban and suburban peers.
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“Right now, the status of rural health is struggling,” says Brad Gibbens, acting director and assistant professor at the University of North Dakota School of Medicine’s Center for Rural Health. “And COVID has exacerbated the situation,” he adds, pointing to staffing shortages and high rates of disease.
Telehealth, however, can help mend some of the cracks in rural health care. Here’s how:
1. It gives patients an easier way to access doctors and specialists
One of the most obvious ways telehealth can bridge the health care divide in rural America is by increasing patients’ access to providers. There are about 40 primary care physicians per 100,000 residents in rural communities, according to the National Rural Health Association. In urban areas, the ratio is 53.3 per 100,000 residents.
The disparity is even more pronounced when it comes to specialists. In rural areas there are about 30 specialists per 100,000 residents; in urban regions, that number jumps to 263 per 100,000 residents.
It’s no surprise, then, that about one-fourth of rural adults have to travel more than 31 minutes to get to a doctor’s office for specialty care, according to AARP’s report. Dialing up a doctor — even one who is hundreds of miles away — however, takes seconds.
Then there’s the convenience factor of a virtual visit, especially for adults with mobility issues and for those who live in challenging climates. “If you don't have to get in the car when it's 20 below zero to see a provider and walk on the ice, and you can have the exact same thing in your living room, people appreciate that,” North Dakota’s Gibbens says.
2. It can advance care of chronic diseases
Monitoring patients with chronic conditions, such as high blood pressure and diabetes, is another way telehealth can improve health care in rural areas, where rates of many illnesses tower over the national average, according to AARP’s research.
Patients can take their blood pressure or blood sugar readings at home, for example, and send their numbers to a team of health care providers who can then adjust medications and other treatments based on the data trickling in, explains Saurabh Chandra, chief of the Center for Telehealth at the University of Mississippi Medical Center.
This type of patient surveillance has resulted in reduced hospital readmissions and fewer emergency room visits. At the same time, remote monitoring educates patients and empowers them “to know more about their disease state” and “take more control of their disease,” which results in better outcomes for the patient, Chandra says.
“When people think about telehealth, especially during the pandemic, they think about audio-video capabilities. And that's part of it, but there are other modalities,” he adds.
3. It helps rural physicians provide top-notch care
Physicians in rural areas, many of whom are general practitioners, can also benefit from telehealth, points out Jan Probst, a professor and director emerita of the Rural and Minority Health Research Center at the University of South Carolina’s Arnold School of Public Health. If they have a patient with a complex case, for example, they can work with a specialist at an urban medical center or academic research institute to determine the best treatment course.
This approach supports the “rural practitioner’s ability to provide top-quality care for the patient,” says Probst, pointing to the successful Project ECHO model. And it’s been shown to improve both patient outcomes and physician expertise.
What’s more, rural hospitals and clinics can use telehealth to connect with specialists to provide rapid care in situations when time is of the essence and transferring a patient isn’t an option. For example, a team of neurologists can connect over video with emergency medicine doctors in a distant location to help quickly diagnose and treat a stroke, thereby reducing risk of widespread damage and long-term disability.
Telehealth isn’t the only answer to rural health challenges
While telehealth can increase access to life-saving care — and make getting that care more convenient — it isn’t a “silver bullet” for solving all of rural America’s issues, Gibbens says.
For starters, about one-fifth of rural adults don’t have access to high-speed internet, AARP’s report found, and rural adults age 70 or older with lower incomes and poorer health are least likely to have access to it.
Beyond that, “not everybody even has access to a library that would have computers,” says Teresa Keenan, director of health and health security research at AARP. “If you don't have access to a computer at home and you don't have access to a computer in your community, telehealth isn't going to be the answer for you,” she says.
What’s more, a significant share of AARP’s survey respondents aren’t sure if their doctor offers telehealth or if their insurance covers it. While geographic restrictions and reimbursement requirements for telehealth have been relaxed during COVID, “the question would be whether that continues if we ever get to the other side of the pandemic,” Keenan says. Reverting to pre-pandemic regulations could make it more difficult for patients and providers in rural areas to connect with specialists in the first place.
Other barriers to telehealth include concern over confidentiality and medical errors, AARP’s report found. Furthermore, a number of survey respondents (about 40 percent) expressed skepticism that their health issues can even be resolved virtually.
It’s unlikely that telehealth will ever trump in-person care, Chandra says. Rather, he sees the use of phone, video and other technologies as a bridge to connect gaps in the system. “I think they can both work together to bring the best outcome for the patient,” he says.
Gibbens adds, “I don't believe there's one single answer that solves everything, but I do really think telemedicine is a significant step and has a major impact on health and health access.”