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Overview

Telehealth refers to the use of technology to provide a wide range of clinical health services, patient and professional health education, public health and more. It is the larger “umbrella” that telemedicine falls under, which refers to clinical services often involving diagnosis or treatment from a distance.

Aside from being more convenient and often more cost-efficient, telehealth is also a necessary part of the health system for millions of Americans in rural and medically underserved populations. In this Basic, we break down telehealth, its successes, and its challenges.

Rural Health Challenges

Community Trends

One in five Americans, or roughly 60 million people, live in rural America. The census bureau defines these areas as sparsely populated with low housing density and far from urban city centers. For perspective, 97 percent of landmass in the United States is rural, yet only 19.3 percent of the population lives there. According to the Centers for Disease Control and Prevention (CDC) they also face numerous health disparities compared with their urban counterparts.

For example, rural Americans tend to be older and sicker than those in urban communities and are more likely to die from heart disease, cancer, and stroke. Rural communities report higher rates of cigarette smoking, high blood pressure, and obesity as well as lower health insurance enrollment and less access to health services. Children also experience specific health challenges, including more community and family challenges in addressing mental, behavioral, and developmental disorders.

Provider and Hospital Shortages

To make matters worse, more than 100 rural hospitals have closed in the U.S. since 2010 and another 430, roughly 21 percent of rural hospitals, are at risk of shuttering. To be clear, this trend is only getting worse. Twenty of those closures occurred in 2019 alone, more than any other year in the last decade.

The numbers of physicians practicing in rural areas are just as grim. In the U.S. at-large, there is one primary care physician (PCP) per 1,300 individuals, which is slightly higher than the recommended model of one PCP for every 1,200 people. In rural America, the ratio is significantly higher with one PCP for every 1,910 individuals. Additionally, one study shows only one percent of doctors in their final year of medical school reported wanting to live in communities with fewer than 10,000 people. The number of rural hospitals on decline coupled with the debt many medical students face has led to fewer graduating physicians building their practices in rural America.

Telehealth Successes

Rural communities rely on telehealth to alleviate some of this disparity. While there are relatively few primary care doctors in rural areas, there are even fewer specialists. When a patient needs specialty care for a condition, rural providers will sometimes use telehealth technology to virtually consult with a specialist on the patient’s care or treatment options. A physician can electronically transmit notes, test results, x-ray images and more to a specialist for review and a patient can have a video conference appointment with the specialist from their community clinic if need be.

Traveling to receive care is incredibly burdensome and sometimes prohibitive for those living far away from their doctor, so doctors also use telehealth to remotely monitor their patients when necessary. For instance, telehealth now allows doctors to view their diabetes patients’ sugar levels in real time to track trends and evaluate if their treatment protocol is effective — all without forcing the patient to travel a great distance, miss work, or potentially find childcare. Another important aspect of telehealth is reaching patient populations that are unwilling or less likely to seek care. A prime example is young men and the stigma surrounding mental health. Virtual visits with psychiatrists allow someone a more comfortable interaction who would otherwise avoid discussing their feelings face to face. The Department of Veterans Affairs (VA) has taken notice and begun programs such as Telemedicine Outreach for PTSD (TOP) to meet veterans in need of help where they are.

Telehealth can also be more convenient and less time-consuming for patients everywhere, including in urban areas. Simply using health applications on mobile devices to schedule appointments, store important health information and records, request prescription refills, or ask questions of nurses/doctors are all less costly to the system and save time on both ends.

Challenges  

Like anything, there are challenges in expanding telehealth and chief among them is ensuring the people it could help the most will actually have access to it. The likelihood a family has access to broadband internet service capable of supporting video technology decreases the further they are located from a city center. According to a recent study published in the Annals of Internal Medicine, the number of subscribers to broadband services was 96.0 percent in urban counties but averaged 82.7 percent in rural counties and as low as 59.9 percent in counties with extreme access considerations. For those living in places where the closest PCP was a 70-minute drive away, the subscription rate was significantly lower at 38.6 percent.

Federal agencies such as the Federal Communications Commission (FCC) and the U.S. Department of Agriculture (USDA) offer grant funding for telehealth services and offer programs directly to households to encourage broadband adoption; however, the problem still continues.

Looking Ahead

Healthcare access issues affect Americans in rural areas as well as urban cities. In urban areas, according to MACPAC, there are more primary care physicians than in rural areas; however, physicians in rural areas are more likely to accept new Medicaid patients than those in urban communities. Barriers to access such as travel distance persist in rural communities, but physician and appointment availability plague urban patients. The bottom line is access to healthcare is a multifaceted problem that both rural and urban communities face. No one solution will fix the entire system, but telehealth is an important piece of the puzzle. At the very least, as fast as technology is evolving, patients are demanding it be integrated into their healthcare just as it is in most aspects of their lives like banking, shopping, education, and business. As more companies innovate in the health space, whether it be in care delivery, workforce training, or anything else, telehealth will only become more vital across the board and the healthcare system will need to be prepared to absorb the changes.

Health Care Glossary

A full glossary of common health care terms can be found HERE.

Additional Resources

AAFP – Rural Practice, Keeping Physicians In

CDC – Rural Health

Census Bureau – What is Rural America?

CRS – Demand for Broadband in Rural Areas

CRS – Telehealth and Telemedicine: Description and Issues

CONNECT Act of 2019

HRSA – Shortage Areas

MACPAC – Access in Brief: Rural and Urban Health Care

Mayo Clinic – Telehealth: Technology Meets Health Care

NBC – Rural Hospital Closings Cause Mortality Rates to Rise

NPR – Rural Hospitals Continue to Close

NPR – The Struggle to Hire and Keep Doctors in Rural Areas

Reuters – Until Broadband Access Improves, Telemedicine Won’t Help Rural Communities

VA – Telemedicine Outreach for PTSD