A Rapid Review of Uses and Outcomes of Telehealth Care in Rural and Remote Regions in the United States

Abstract

As telehealth expands and becomes an increasingly important provision of palliative care and hospice services, the understanding of the uses and outcomes of this care delivery platform in rural communities is warranted. This rapid review aims to highlight the practice, policy, and research implications of telehealth in rural regions. Using a systematic approach for accessing and synthesizing available publications, this review included 22 articles published between January 2020 and January 2023. Telehealth was used with adult and pediatric populations diagnosed with serious illnesses. Acceptance of this type of care delivery was noted in adults and children, but not all found telehealth a valuable mechanism for care. Telehealth services included but were not limited to direct communication between the provider and the patient/caregiver, medication management, and a peer-to-peer consultant role for rural palliative care and hospice teams. Of those studies addressing provider-centered outcomes, noise level, interruptions, missed appointments, and challenges with providing emotional support were reported. Organizational barriers, such as the lack of financial support, were noted for pediatric hospices. Individuals living in rural communities require more frequent, immediate, and specialized attention over their illness trajectory. Practice, policy, and research implications are identified to consider the next steps for telehealth delivery of palliative care.

Community-Based Palliative Care

“…In a recent rapid review examining the uses and outcomes of telehealth palliative care in rural communities, the technology holds promise for improving access to SPC. Services include symptom management, medication adjustments, advance care planning, and care coordination 28 …”

“…Services include symptom management, medication adjustments, advance care planning, and care coordination. 28…”

Palliative Care in Rural Communities

“…The development and sustainment of rural palliative care interdisciplinary teams may be hindered by challenges related to staffing, resource availability, and reimbursement. 46 To follow is a review of palliative care models currently used in or available to rural communities beyond the acute care setting (see Table 1 43,[48][49][50][51][52][53][54][55][56] ).…”

“…48,[58][59][60] Bull and colleagues offer insight into how Four Seasons, a nonprofit organization that provides Table 1. Palliative Care Models Beyond Acute Care 43,[48][49][50][51][52][53][54][55][56]…”

“…52,54,55 Telehealth use increased exponentially during the COVID-19 pandemic and filled a void in palliative care delivery, particularly in rural communities. 53 The primary goal of palliative care telehealth models is to deliver palliative care services to more patients and caregivers and help primary care and specialty providers and hospice organizations fill gaps in service delivery. For example, a program in rural Nebraska provided pediatric palliative care telehealth visits to children with cancer who were receiving hospice care from an agency that did not have any pediatric-trained providers.…”