Telehealth disparities persist among rural US adults

New research shows telehealth access barriers persist within rural populations, especially for older and minority adults and those who speak Spanish.

Published in the Journal of Medical Internet Research, the research aimed to assess the demographic characteristics of U.S. adults in rural areas and their use of telehealth. Researchers at the University of California, San Francisco, examined the telehealth utilization of 9,359 adults in rural California between December 2021 and 2022. They defined telehealth visits as synchronous video-based telehealth and audio-only telehealth.

The study shows that most rural telehealth patients (69.5%) were white, while 14.5% were Latinx and 10.2% were Asian, Black and/or Native American or Alaska Native. Additionally, a vast majority of rural telehealth patients indicated English was their preferred language (95.4%), compared with only 4.1% preferring Spanish.

Further, Medicare covered a majority of rural telehealth patients (44.8%), followed by other insurance at 35.3% and Medi-Cal at 19.9% of the study sample.

Most rural telehealth appointments (92.9%) were video visits; however, the demographic differences between video visit and audio-only telehealth users indicate similar disparities as those between rural patients who use telehealth and those who don't.

Video visit users were younger than audio-only telehealth patients. Patients 65 or older had 8.7% of their telehealth visits via the telephone compared to only 6.3% of those younger than 65.

Audio-only telehealth use was also highest among Latinx patients, those who preferred to speak Spanish and those covered by Medicare.

Researchers noted a need for policy interventions to enhance telehealth equity. They suggested targeted policies to support video visit use, including "patient digital access assessment and education, culturally tailored and language-concordant telehealth outreach and education, low-cost smart device and data plans for low-income patients, rural broadband development, and evidence-based telehealth reimbursement policy."

Lawmakers have attempted to curb telehealth access barriers in rural communities by introducinglegislation, such as the Protecting Rural Telehealth Access Act. Introduced in 2023, the act would eliminate geographic restrictions on originating sites for telehealth, give critical access hospitals the ability to bill directly for telehealth and allow rural health clinics and federally qualified health centers to serve as distance sites for telehealth.

Research also shows the positive impact expanded telehealth access could have on healthcare access for rural populations. A study published in 2022 found that telehealth can increase primary care appointment completion rates by about 20%.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.