Dr. Sadiq Patel’s recent webinar on Telehealth Equity – part of the Virginia Telehealth Network’s series on Equity & Telehealth – provided a great deal of insights into the statistics surrounding the use of telehealth in the country. A NIMH postdoctoral research fellow at Harvard Medical School, Dr. Patel shared some telling – and sometimes surprising – findings with respect to who has been taking advantage of telemedicine, particularly as we transition to a post-COVID environment.
Predictably, of course, the use of telehealth resources grew significantly throughout the pandemic. The increases spanned the demographic spectrum, practice areas and geography, and much of the spike in use can be attributed to a relaxation in regulations governing telemedicine. States suspended, for example, the requirement that patients had to physically travel to a medical facility for a telemedicine appointment as well as already have an existing relationship with the healthcare provider prior to the telehealth session. Reimbursements for services via telemedicine reached parity with in-person visits and states suspended the licensure requirements for treating out-of-state patients.
All of those policy changes – together with the social distancing mandates that had been put in place – propelled telemedicine to historic high levels of use across the board. But an analysis of patients taking advantage of telehealth exposed some surprises. Common wisdom would suggest, for example, that telehealth would be disproportionately popular among rural populations. After all, the convenience of telemedicine, especially for patients who need to travel dozens of miles or more to seek care, provides a compelling rationale for turning to telehealth.
And yet, the research from Dr. Patel and his colleagues found that urban populations were more inclined to use telemedicine than their more rural counterparts. In quantifying the difference, the researchers found that urban areas have 7.5 percent higher telemedicine use than in rural regions. The disparity was even more pronounced among Medicare patients. While 42 percent of Medicare enrollees in large urban areas availed themselves of telehealth from March through September 2020, only half as many did so from rural areas.
Digging deeper into potential explanations for the difference, Dr. Patel and his team created models that factored in a variety of controls, such as access to broadband, socio-economic factors, race and ethnicity and other variables in order to normalize the data. Even with this set of controls, however, the data continued to show a higher preference among urban patients to use telehealth than rural ones.
Such counterintuitive results will keep researchers looking for answers, especially in a post-pandemic world where public policies are likely to continue to evolve, where patients and providers discover what works best and where technological improvements will continue to make telehealth more and more accessible to patients throughout Virginia.