Geographic variability in rural patient internet connectivity when accessing telehealth services from home: A retrospective analysis during the COVID‐19 pandemic

Sotzen, Jason; Stratman, Erik J.

doi:10.1111/jrh.12695

Cited by 10 publications

(12 citation statements)

References 10 publications

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“…Though it has been well documented that rural areas experience disparities in broadband coverage, digital access, and digital literacy, 10,24,25 which hinder the quality of telemedicine appointments, 26 our study did not find significant differences in access to the internet, broadband speed, or technology. Simultaneously, urban areas have experienced growing demand for video telemedicine.…”

Section: Discussioncontrasting

confidence: 82%

Understanding rural‐urban differences in veterans’ internet access, use and patient preferences for telemedicine

O'Shea,

Gibson,

Merchant

et al. 2023

The Journal of Rural Health

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BackgroundThe expansion of telemedicine (e.g., telephone or video) in the Veterans Health Administration (VA) raises concerns for health care disparities between rural and urban veterans. Factors impeding telemedicine use (e.g., broadband, digital literacy, age) disproportionally affect rural veterans.PurposeTo examine veteran‐reported broadband access, internet use, familiarity with, and preferences for telemedicine stratified by residential rurality.MethodsThree hundred fifty veterans with a VA primary care visit in March 2022 completed a 30‐min computer‐assisted telephone interview. The sampling design stratified veterans by residential rurality (i.e., rural or urban) and how primary care was delivered (i.e., in‐person or by video). Counts and weighted percentages are reported.FindingsAfter accounting for survey weights, 96.2% of respondents had in‐home internet access and 89.5% reported functional connection speeds. However, rural‐ compared to urban‐residing veterans were less likely to experience a telemedicine visit in the past year (74.1% vs. 85.2%; p = 0.02). When comparing telemedicine to in‐person visits, rural versus urban‐residing veterans rated them not as good (45.3% vs. 36.8%), just as good (51.1% vs. 53.1%), or better (3.5% vs. 10.0%) (p = 0.05). To make telemedicine visits easier, veterans, regardless of where they lived, recommended technology training (46.4%), help accessing the internet (26.1%), or provision of an internet‐enabled device (25.9%).ConclusionsThough rural‐residing veterans were less likely to experience a telemedicine visit, the same actionable facilitators to improve telemedicine access were reported regardless of residential rurality. Importantly, technology training was most often recommended. Policy makers, patient advocates, and other stakeholders should consider novel initiatives to provide training resources.

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Section: Discussioncontrasting

confidence: 82%

Understanding rural‐urban differences in veterans’ internet access, use and patient preferences for telemedicine

O'Shea,

Gibson,

Merchant

et al. 2023

The Journal of Rural Health

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“…46 Using telehealth/telemonitoring services, however, was not without its challenges. Like other research showing upwards of 19% of rural residents reporting either poor or unacceptable Internet quality, 47 our dyads also experienced problems with virtual telehealth or telemonitoring connectivity, having to revert to telephone calls with their clinicians. COVID-19 highlighted an existing problem with Internet access, 48 leading to renewed calls for government programs, which increase rural broadband Internet access.…”

Section: Discussionsupporting

confidence: 69%

Self-care Problems and Management Strategies Experienced by Rural Patient/Caregiver Dyads Living With Heart Failure

Graven,

Durante,

Abbott

et al. 2023

J Cardiovasc Nurs

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Background Rural patients with heart failure (HF) have higher mortality and hospitalization rates compared with their urban counterparts. Although research supports the inclusion of informal caregivers in daily self-care activities, data are limited regarding the problems encountered by rural patient/caregiver dyads living with HF in managing HF in the home and how these problems are managed. Objective The aim of this study was to identify and describe HF self-care problems experienced by rural dyads in the home and how these problems are managed. Methods Using a descriptive qualitative design, data were collected from rural patient/caregiver dyads living with HF via individual, semistructured, telephone interviews and analyzed using schematic content analysis. Interviews and data analysis occurred concurrently until data saturation was reached. Results Thematic data saturation was obtained with 11 dyads. On average, patients were 65.3 (±13.9) years old, and caregivers were 62 (±12.37) years old. Four themes illustrating dyadic HF self-care problems and management strategies emerged: (1) HF self-care components, namely, maintenance, symptom monitoring, and management (diet, exercise, activities, strategies); (2) environment (rural barriers, COVID-19); (3) caregiver contributors (confidence, role); and (4) dyadic contributors (dyadic relationship). Dyads described various self-care problems, with the type of relationship and presence of mutuality influencing the problem-solving process and development of management strategies. Conclusions The identified themes emphasize the self-care problems experienced by rural dyads living with HF and the contributions of both dyad members to effectively manage these challenges. Findings support the need for culturally sensitive, tailored interventions targeting self-care in rural dyads living with HF.

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“…Evaluating these visit types separately may highlight further disparities. Studies have reported that, despite interest in telemedicine, navigating technology and internet connectivity required for video visits remains a challenge in certain patient populations [25][26][27]. Our study was not designed to assess specific technology barriers and further investigation is warranted.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Telemedicine and health access inequalities during the COVID-19 pandemic

et al. 2022

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Background During the COVID-19 pandemic, health systems rapidly introduced inhome telehealth to maintain access to care. Evidence is evolving regarding telehealth's impact on health disparities. Our objective was to evaluate associations between socioeconomic factors and rurality with access to ambulatory care and telehealth use during the COVID-19 pandemic. MethodsWe conducted a retrospective study at an academic medical centre in midwestern United States. We included established and new patients who received care during a one-year COVID-19 period vs pre-COVID-19 baseline cohorts. The primary outcome was the occurrence of in-person or telehealth visits during the pandemic. Multivariable analyses identified factors associated with having a health care provider visit during the COVID-19 vs pre-COVID-19 period, as well as having at least one telehealth visit during the COVID-19 period. ResultsAll patient visit types were lower during the COVID-19 vs the pre-COVID-19 period. During the COVID-19 period, 125 855 of 255 742 established patients and 53 973 new patients had at least one health care provider visit, with 41.1% of established and 23.5% of new patients having at least one telehealth visit. Controlling for demographic and clinical characteristics, established patients had 30% lower odds of having any health care provider visit during COVID-19 vs pre-COVID-19 (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.698-0.71) period. Factors associated with lower odds of having a telehealth visit during COVID-19 period for established patients included older age, self-pay or other insurance vs commercial insurance, Black or Asian vs White race and non-English preferred languages. Female patients, patients with Medicare or Medicaid coverage, and those living in lower income zip codes were more likely to have a telehealth visit. Living in a zip code with higher average internet access was associated with telehealth use but living in a rural zip code was not. Factors affecting telehealth visit during the COVID-19 period for new patients were similar, although new patients living in more rural areas had a higher odds of telehealth use. ConclusionHealthcare inequities existed during the COVID-19 pandemic, despite the availability of in-home telehealth. Patient-level solutions targeted at improving digital literacy, interpretive services, as well as increasing access to stable high-speed internet are needed to promote equitable health care access.The United States (US) declared a public health emergency due to the COVID-19 pandemic on January 13, 2020. Subsequently, the Center for Medicare and Medicaid Services (CMS), followed by other insurance payers, expanded access to and increased reimbursement for telehealth services. Specifically, the 2020 Coronavirus Preparedness and Response Supplement Datta et al.

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Geographic variability in rural patient internet connectivity when accessing telehealth services from home: A retrospective analysis during the COVID‐19 pandemic

Cited by 10 publications

References 10 publications

Understanding rural‐urban differences in veterans’ internet access, use and patient preferences for telemedicine

Understanding rural‐urban differences in veterans’ internet access, use and patient preferences for telemedicine

Self-care Problems and Management Strategies Experienced by Rural Patient/Caregiver Dyads Living With Heart Failure

Telemedicine and health access inequalities during the COVID-19 pandemic

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