Study Uncovers Escalating Telehealth Gap Between Rural And Urban VA Patients Amid Pandemic

A recent study has shed light on the widening telehealth gap between rural and urban VA beneficiaries in the wake of the COVID-19 pandemic. The research, entitled “Rates of Primary Care and Integrated Mental Health Telemedicine Visits Between Rural and Urban Veterans Affairs (VA) Beneficiaries Before and After the Onset of the COVID-19 Pandemic,” emphasizes the pressing need to confront this inequality in healthcare accessibility.

The Veterans Health Administration (VHA) has long promoted telemedicine as a tool for expanding healthcare access, especially for nearly 5 million rural patients across 50 states. Despite the VHA’s efforts to bridge the digital divide by distributing over 100,000 tablets for video consultations, telemedicine disparities between rural and urban areas persist.

The study examined 63.5 million primary care and 3.6 million mental health integration appointments across 138 VA healthcare systems between March 16, 2019, and December 15, 2021. It found that rural VA healthcare systems had a higher percentage of telemedicine utilization than urban systems before the pandemic. However, rural systems experienced a drop in telemedicine use compared to urban systems after the pandemic began. This discrepancy suggests that broader pandemic-related initiatives to expand telemedicine use nationally may have overtaken initial investments targeting rural areas.

The research also uncovered significant findings related to telehealth delivery methods, which have implications for healthcare providers and administrators. Both rural and urban VA healthcare systems saw a considerable increase in telephone consultations during the pandemic, while video consultations experienced only a slight uptick. This trend underscores the ongoing barriers to accessing video consultation services, particularly in rural areas where broadband internet connectivity remains a challenge. It also highlights the need for healthcare systems to invest in and promote video consultations, which provide a more comprehensive and personalized care experience for patients. Enhancing video consultation capabilities and accessibility may help close the telehealth gap between rural and urban patients, ultimately improving healthcare outcomes for all.

While the study boasts several strengths, such as its large national sample of the entire VA primary care population, some potential limitations exist. The aggregation of telemedicine visits to rural and urban VA healthcare systems may have resulted in the misclassification of some rural patients. Additionally, the study’s generalizability may be limited to healthcare systems with early telemedicine infrastructure. Nevertheless, the study’s implications likely apply to most healthcare systems that have implemented telemedicine care.

The findings of this study underscore the importance of addressing rural-urban structural inequalities and adapting technology to promote adoption among rural users at all levels (patients, clinicians, and healthcare systems) to bridge the telehealth divide. As telemedicine becomes increasingly essential, policymakers and healthcare administrators must invest in infrastructure, digital resources, and comprehensive telemedicine services to guarantee equitable access for rural patients. By proactively tackling these challenges, healthcare systems can diminish disparities and enhance health outcomes for all VA beneficiaries, regardless of their geographical location.