A digital divide in the use of telemedicine between rural and urban communities has widened after the onset of the COVID-19 pandemic, particularly within inclusive mental health services, study finds Posted in Open JAMA Network.
The study evaluated 3.6 million mental health onboarding visits and 63.5 million primary care visits across 138 veterans’ health systems nationwide from March 16, 2019 through December 15, 2021.
Across the entire cohort, 6.3 million unique patients with an average age of 61 were included in the study, 90.5% of whom were men. The majority of patients (66.3%) identified as non-Hispanic white, while 17.2% were non-Hispanic black patients.
The observational study included 45 rural and 93 urban health systems.
Before the pandemic, 34% of rural VA health systems used telemedicine for primary care services, compared to 30% in urban areas. However, after the onset of the pandemic, only 55% of rural systems used telehealth for primary care, compared to 61% in urban areas.
For integrative mental health services, rural systems reported greater use of telemedicine at 29% compared to urban systems at 25% before the pandemic. When the pandemic hit, 76% of rural systems were using telehealth for this purpose, compared to 84% of urban systems.
There were few pre-pandemic video visits in rural and urban health systems, 2% versus 1%, respectively. These figures increased slightly to 4% in rural areas and 8% in urban areas after the pandemic.
“Despite a coordinated federal response, the experience of the VA health system suggests that the increasing use of telemedicine may put rural patients at risk of poor access to care. and consider adapting the technology to encourage the adoption by rural users at all levels (patients, clinicians, and health systems),” the researchers wrote.
“As health systems increasingly rely on telemedicine to deliver needed medical services, rural hospitals may be subject to greater operational challenges and rural patients may be subject to growing inequity in the access to care compared to their urban counterparts.“
WHY IS IT IMPORTANT
The researchers noted limitations, including the possibility of misclassifying some rural patients. They also lacked data on VA patients who received non-VA care in their community, which may be more common for rural veterans.
Finally, the generalizability of the study may be limited to health systems with an early telemedicine infrastructure, although the researchers noted that the implications would likely apply to most systems that have adopted telemedicine.