Telemedicine access down in rural, non-metropolitan regions

When the COVID-19 pandemic led to mass shutdowns and limitations of where people were allowed to travel and visit, the world of medicine seemed to mirror the world around it — by adapting.

Telemedicine delivers a virtual, technology-oriented option in place of in-person visitations to a physician’s office. The United States saw a 154% increase in telemedicine visits during the last week of March 2020, according to the Centers for Disease Control and Prevention (CDC).

“When COVID began, emergency rooms experienced as much as a 40% drop in volume,” said Dr. Susan Tout, medical director of emergency services at Southwest General Health Center in Middleburg Heights, Ohio.

Tout said this can likely be attributed to telemedicine services and of a general sense of concern about visiting a medical site during the pandemic. Telemedicine services provide an additional option for patients who are concerned with coming into contact with COVID-19, which is a potential reason for its real-time increase.

Bruce Elliott, chief of fire for the city of Mayfield Heights, Ohio, shared a similar sentiment.

“Our call volume initially, dropped significantly during the first six months of COVID, and it makes sense,” Elliott said. “I mean, people didn’t want to go to the hospital people, didn’t want to leave their homes, people didn’t want to go into a medical facility thinking that they might get COVID, if they go into those places. So, our call volume dropped over 10% during the first six months.”

Telemedicine, by nature, is intended to expand access to communities and demographics unable to or uncomfortable with making the visitation to an in-person office. However, studies conducted through the CDC show signs of inequitable access to telemedicine services in non-metropolitan, rural communities — and higher rates of access in metropolitan, urban communities surveyed.

Data collection took place in two separate rounds, with the second round taking place in August 2020. According to the data from the CDC, 38% of surveyed participants living in metropolitan regions said “yes” when asked if they had access to telemedicine services. 30% of non-metropolitan respondents said “yes” to the same question.

When respondents were asked about whether they had scheduled one or more telemedicine appointments, a greater number of metropolitan respondents stated that they had, compared to their non-metropolitan respondent counterparts. Non-metropolitan respondents also shared a higher rate of inaccessibility in their particular demographic regions.

With the same data, metropolitan respondents also had higher rates of access to telemedicine services pre-pandemic.

So why is this?

The World Health Organization (WHO) surveyed respondents from a number of different countries, developed and undeveloped, inquiring about barriers to telemedicine access. Developing countries proved to have more concern with factors like cost than those in developed countries.

According to a second study conducted through the CDC, national health centers were surveyed and asked whether they had a volume of greater than 30% of medical appointments scheduled through telemedicine as opposed to in-person visits.

The lowest presenting regions in the United States were the Midwest (second lowest) and the South (lowest). This includes the Rust Belt, Appalachia and other known working-class and poverty-stricken regions. Other regions (the Northeast, West, and U.S. territories and freely associated states) had higher rates of acceptance of this question.

With these barriers taken into account, what are their implications?

The WHO says telemedicine policy implementation and adoption are one of the first steps in ensuring equitable access. The next is advocacy.

At the Ohio Department of Health (ODH), Public Information Officer Megan Smith said access discrepancies between urban and rural regions may exist primarily due to decreased lack of access to internet services and technology in rural areas.

The ODH is committed to ensuring equitable healthcare access, including through telemedicine services, Smith said. In late 2020, Gov. Mike DeWine appointed Jamie Carmichael to the position of chief health opportunity advisor for the ODH. Her role centers on ensuring equitable access to vaccines, testing and anything COVID-19-related. Smith said the ODH also partners with hospitals who provide workshops and information about accessing telemedicine care.

Moving forward, it appears that telemedicine services aren’t going away for good. They’ve provided access to a number of patients who may otherwise not have had access to care, or access to the care they felt safe and comfortable receiving. Equitable access is a conversation physicians across the country are having, as the nature of telemedicine evolves.