Can Telehealth Help Rural Communities?
Americans in rural areas have long suffered from less access to care and worse outcomes. In this week’s blog, we ask the question: Can telehealth help rural communities? To answer this, we’ll get into why rural America suffers from less access to care, how the healthcare system has tried to make up for these disparities, and telehealth amidst the COVID-19 pandemic.
For the last five decades, the 60 million Americans living in remote parts of our country have suffered from worse health outcomes than their urban counterparts. They’re more likely to die early from the five leading causes of death; stroke, chronic respiratory infection, heart disease, cancer, and unintentional injury. In fact, Americans living in rural areas have lower life expectancies overall; about 77 years compared to 79 in metropolitan areas.
According to the 2017 U.S. Census, 1 in 5 Americans lives in a remote or rural part of the country. But this 20% has less access to primary and preventative care, with 40 physicians per 10,000 residents compared to 53 in cities.
More than three-quarters of rural areas are considered health professional shortage areas by the Health Resources and Services Administration. Between 2010 and 2020, 70 rural hospitals closed, and more than 700 were at risk of closing.
All of these factors have led us to a crisis in rural health. But what challenges make rural Americans more vulnerable to health disparities?
Why do rural health disparities exist?
According to the CDC, rural Americans have worse health outcomes for several reasons:
- Longer travel distances to hospitals and clinics. Rural Americans live an average of over 10 miles from the nearest hospital. In emergencies, EMS response times in remote areas are double that of cities.
- People living in remote communities have less health insurance than metropolitan areas.
- Rural residents experience more risk factors for illness and report having less leisure time. Rates of smoking, obesity, and high blood pressure are all higher in rural areas.
- Remote communities tend to have an older median age. In some states, more than half of those 65 years and older live in rural areas. Older adults are far more likely to need ongoing medical care, with approximately 82% having at least one chronic illness.
- Poor access to high-quality, affordable foods. “Food deserts” are areas where the nearest grocery store is more than 10 miles away. People living in food deserts have worse health outcomes and higher rates of chronic disease.
- Lower median household incomes and higher rates of poverty. Both are linked to worse health outcomes, according to the Bureau of Labor Statistics.
To add to these disadvantages, the global pandemic highlighted the weaknesses in our rural health systems. Even though they were safe from the disease’s first wave, remote areas were hit hard later in the pandemic, and the death rate continued to rise through the winter. In the first few weeks of December 2021, death rates in rural communities were nearly double those of cities.
In the second year of the pandemic, rural Americans were left wondering how they would get the care they needed and deserved. Not only are they less likely to be vaccinated, but they’re also more likely to experience complications while being further from hospitals when they need care most. What’s worse, more rural hospitals have closed in recent years due to a lack of funding.
How has the healthcare system tried to help rural Americans?
The Annals of Family Medicine journal suggests promoting medical residents from remote areas while training them in those communities. Another strategy is to broaden the scope of existing providers, essentially making a doctor a one-stop shop for mental health, obstetrics services, geriatric care, and more. Most rural doctors work in primary care, which puts more pressure on them to help their patients with a wide range of health problems.
The CDC recommends networking with community organizations, such as churches and schools, to educate residents and promote better health habits. Strategies to improve transportation to non-emergent medical appointments have been helpful for remote residents.
But the fact is that few rural Americans have seen the impact of these efforts. They still face limited access to providers, and could be in for more hardships as COVID-19 and other viruses ramp up in unvaccinated counties. People with non-emergent health issues will face longer wait times for services, if they can be seen at all. Folks with chronic conditions will experience gaps in care while their providers stretch to see their sicker patients.
Could telehealth fill the gaps for rural communities?
The concept of telehealth isn’t new. Almost since we’ve had the technology to communicate without being face-to-face, people have dreamed of remote healthcare. Early people used smoke signals to communicate disease. In 1879, the Lancet published an article about using the telephone to cut down on visits to the doctor’s office.
But telemedicine went under-utilized for a long time, held back by legislative and liability concerns. It wasn’t until the COVID-19 pandemic that providers and patients turned to telehealth en masse.
Early 2020 saw a dramatic spike in telehealth usage; up 150% in March compared to the previous year. Legislators increased access in response to need, which helped encourage providers to offer remote services. The federal government removed location restrictions while expanding the services that remote care physicians could give. They also started reimbursing telehealth visits as they had done for in-person care.
Use continued to change as case levels rose and fell. Telehealth providers filled the gaps when it wasn’t safe or necessary to come into the clinic, and many physicians had to switch to an entirely online model for care. Now, we’re turning back to our screens for non-emergent care.
Telehealth and the COVID-19 Delta wave in rural America
According to a 2020 article published by Family Medicine and Community Health, “It is critically important that changes are made to fully immerse telemedicine services into the healthcare landscape in order to be prepared for future pandemics as well as to reap the benefits of this service in the future.” As we consider how to manage future waves of COVID-19 and other infections, demand for telehealth services is expected to grow.
While people suffering from the virus may need in-person care, those with non-emergent illnesses face the choice between long wait times and going entirely without care. Beck’s Hospital Review expected two surges by the end of 2021: one of COVID cases and another of those who couldn’t access care for long-term illnesses. Many of these are older folks; one poll estimates that one in three older adults put off in-person care due to fear of the COVID-19 virus in 2020.
Our hope is that telehealth will bridge this gap. Remote care has the potential to treat non-emergent problems and prevent further illness. But even after this next wave passes, we hope that the expansion of telehealth will continue.
In July 2021, Nature Medicine noted; “Telehealth has emerged as an unexpected silver lining of the COVID-19 pandemic, improving access to care and facilitating a transition toward digital medicine. Cementing these gains now could help make healthcare more equitable once the pandemic has ended.”
Can telehealth help rural communities achieve better care access?
To answer the question, can telehealth help rural communities? Our answer is yes! The best thing we can do is continue the momentum of telehealth that started with the pandemic. Remote care has the potential to level the playing field for rural Americans, and create better outcomes and support for all.
At Telegra MD, we are proud to be making access easier for people in both rural and urban areas of the United States. While the traditional healthcare system is constantly innovating with new treatments and technologies, many people never experience these benefits because of limited access. We hope that our network of skilled providers can help change that.
As we enter this next phase of the pandemic, we hope that we can give you, your family, and your business peace of mind. Whether you’re living deep in the country or in the hustle and bustle of the city, we’ll meet you on your turf to be sure your health needs are being met.
We offer non-emergency physician consultations nationwide and 24/7 for everyone, regardless of where you live. That’s because we believe that your zip code shouldn’t determine your health. Neither should your insurance. That’s why we’ll never ask for coverage to speak with one of our providers.
Don’t wait to get your health questions answered. Schedule an appointment with one of our remote doctors.