Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities

Hirko, Kelly A.; Kerver, Jean M.; Ford, Sabrina; Szafranski, Chelsea; Beckett, John A.; Kitchen, Chris; Wendling, Andrea

doi:10.1093/jamia/ocaa156

Cited by 263 publications

(219 citation statements)

References 13 publications

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“…Combined with lower socioeconomic status and the higher prevalence of overweight and obesity in rural areas, attention to rural communities is important (Lakhani et al 2020). In addition, many rural areas in the US are poorly prepared to manage the pandemic, and innovative responses such as telehealth have not yet been widespread enough to combat these problems (Lakhani et al 2020;Hirko et al 2020).…”

Section: Discussionmentioning

confidence: 99%

Exploring a rural Latino community’s perception of the COVID-19 pandemic

et al. 2020

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Objectives: The purpose of our study was to understand the perception of the Latino community in a rural state regarding COVID-19. Over one third of national COVID-19 cases are among Latinos, likely due to an increased prevalence of comorbid risk factors and social determinants of health that make following precautions difficult. Design: Respondents were recruited using snowball sampling as part of a previous effort to establish an academic-community partnership with Latinos in the area. In April 2020, we conducted 14 semi-structured interviews in Spanish with participants over the phone. Interviews were audio-recorded, transcribed into Spanish, and translated to English. We employed the framework approach in a thematic analysis using NVivo 12. Results: Common themes were a wariness of news appearing on social media, generalized worry, and the use of natural medicines to maintain health. Respondents followed recommended guidelines to protect their own health, though expressed concern that members of their community were not. Conclusions: We offer insights into the perception of Latinos of the COVID-19 pandemic in a rural state. Our findings may influence communication techniques of local health departments and offer a way to understand how this often-overlooked community deals with the pandemic.

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Section: Discussionmentioning

confidence: 99%

Exploring a rural Latino community’s perception of the COVID-19 pandemic

et al. 2020

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“…This prompts health care seeking (ability to seek), followed by actually getting (ability to reach) and utilising health care, which is affected by patients’ ability to pay and ability to engage, which will lead to improvements in health, provided the health care is effective. Research pre-COVID-19 showed that telehealth can improve access to health care for those in rural areas or with restricted ability to travel but those with poor internet connections (which, perversely, may be worse in rural areas), English as a second language or privacy concerns may be disadvantaged [ 11 , 12 ]. Equitable access is foundational to good primary care [ 10 , 13 ] and relates not only to patient characteristics but also to the quality and availability of services.…”

Section: Introductionmentioning

confidence: 99%

Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences

et al. 2020

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Background During the first COVID-19 pandemic ‘lockdown’ in Aotearoa/New Zealand (March–May 2020, in which strict ‘stay at home’ measures were introduced), general practices were advised to use telephone and video consultations (telehealth) wherever possible instead of the usual in-person visits. This was a sudden change for most practices and patients. This research aimed to explore how patients accessed general practice during lockdown and evaluate their experiences with telehealth, to inform how telehealth could be most effectively used in the future. Methods Using a mixed-method approach, we undertook an online survey and in-depth interviews with adults (> 18 years) who had contact with practices during lockdown, recruited through social media and email lists. We present descriptive statistics from the survey data (n = 1010) and qualitative analysis of interview data (n = 38) and open-ended survey questions, using a framework of access to health care, from the patient’s perspective. Results In general, patients reported high satisfaction with telehealth in general practice during lockdown. Telehealth was convenient and allowed patients to safely access health care without having to weigh-up the fear of COVID-19 infection against the need to be seen. Telehealth worked best for routine and familiar health issues and when rapport was established between patients and clinicians. This was easier with a pre-existing clinical relationship, but not impossible without one. Telehealth was less suitable when a physical examination was needed, when the diagnosis was unknown or for patients who had a strong preference to be seen in-person. Conclusions Even in this disruptive lockdown period, that prompted an unexpected and rapid implementation of telehealth services in general practices, most patients had positive experiences with telehealth. In the future, patients want the choice of consultation type to match their needs, circumstances, and preferences. Technological issues and funding barriers may need to be addressed, and clear communication for both patients and clinicians is needed about key aspects of telehealth (e.g. cost, appropriateness, privacy). Maintaining telehealth as an option post-lockdown has the potential to increase timely and safe access to primary health care for many patients.

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“…Rural regions tend to have higher levels of poverty (8), fewer job opportunities (9), and heightened vulnerability to labor market shocks (10) relative to urban areas. Further, they broadly lack access to healthcare (11), now see a heightened reliance on telehealth (12), tend to have older and health-compromised populations (13,14), face serious barriers to enrollment in clinical trials (15), and have far more limited access to COVID-19 testing (16).…”

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confidence: 99%

Impacts of the COVID-19 pandemic on rural America

Mueller

McConnell

Burow

et al. 2020

Proc. Natl. Acad. Sci. U.S.A.

275

283

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Despite considerable social scientific attention to the impacts of the COVID-19 pandemic on urbanized areas, very little research has examined its impact on rural populations. Yet rural communities—which make up tens of millions of people from diverse backgrounds in the United States—are among the nation’s most vulnerable populations and may be less resilient to the effects of such a large-scale exogenous shock. We address this critical knowledge gap with data from a new survey designed to assess the impacts of the pandemic on health-related and economic dimensions of rural well-being in the North American West. Notably, we find that the effects of the COVID-19 pandemic on rural populations have been severe, with significant negative impacts on unemployment, overall life satisfaction, mental health, and economic outlook. Further, we find that these impacts have been generally consistent across age, ethnicity, education, and sex. We discuss how these findings constitute the beginning of a much larger interdisciplinary COVID-19 research effort that integrates rural areas and pushes beyond the predominant focus on cities and nation-states.

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Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities

Cited by 263 publications

References 13 publications

Exploring a rural Latino community’s perception of the COVID-19 pandemic

Exploring a rural Latino community’s perception of the COVID-19 pandemic

Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences

Impacts of the COVID-19 pandemic on rural America

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