- Telehealth can transform rural healthcare access for patients that face geographic barriers and their associated healthcare costs, such as transportation, child care, and taking time off from work.
Innovative telehealth services can create dramatic improvements to rural healthcare that include access to specialized intensive care teams to community hospitals and reduced care disparities for chronic conditions like diabetes.
In Iowa, a new telehealth program called TelePrEP is improving access to preventive care services by delivering PrEP (Pre-Exposure Prophylaxis, HIV preventative) medication to a growing rural population at high risk for HIV infection.
The program helps to overcome one of the region’s most significant problems: communication barriers and little flexibility for patients who may live hours from the nearest medical facilities.
“What we found is that people just simply have strong preferences when it comes to communication,” said Angie Hoth, PharMD, the TelePrEP Project Coordinator at the Signal Center for Innovation at the University of Iowa.
“For example, when I leave a patient a voicemail I may never get a response back. But when I send that same patient an email or text, I can hear from them within a day.”
Provider shortages are common in rural areas of Iowa, Hoth added. She says telehealth can make those shortages less problematic for rural healthcare delivery.
“Some patients just don’t have access to the right provider,” agreed Cody Shafer, EIS/PrEP Coordinator of the Bureau for HIV, STD, and Hepatitis at the Iowa Department of Public Health (DPH). “Our goal is to provide people a menu of options and choices for accessing PrEP.”
“When you’re living in a rural state with a highly disperse population, where most specialists are in metropolitan areas, you always are faced with issues in geographic and distance,” Shafer added. He said that patients can drive over an hour for services that can be easily delivered via telehealth and video consultation.
Shafer also said there is a social stigma in rural areas of Iowa when it comes to receiving PrEP. Open discussion of sexual behavior is uncomfortable for many patients, and that reluctance may lead them to put off or avoid necessary care.
TelePrEP offers another option that could extend preventive care to more patients in a manner that makes them more comfortable with receiving counseling and medication.
“Telemedicine is a fantastic solution for these conditions,” Hoth said. “We don’t make people check into another facility and we host the video visit in their homes.”
Shafer says expecting rural patients to go far distances can be problematic, because it creates the assumption that rural patients have a car, time available to take off from family and work, and can afford to go to a specialist. When patients don’t have these resources, they are at risk of missing necessary care consultations.
Other conditions such as harsh weather that can lead to closed bridges and blocked roads inhibit traditional care delivery, but telehealth can reach isolated communities more easily.
“I see this platform and TelePrEP specifically as a way of reducing these barriers,” Shafer noted.
Currently, 37 patients are using TelePrEP following the launch of the program’s pilot in February of 2017. While Hoth anticipates that anywhere between 100-300 people, and possibly upwards of 500 people, will join the program over time, she is satisfied with the current progress.
“Our goal isn’t necessarily numbers, but reaching the people that are having a really hard time accessing PrEP care,” Hoth said.
The Signal Center hosts TelePrEP through secure, HIPAA compliant videoconferencing for clinical telehealth visits. Patients can also communicate with TelePrEP providers through other mediums of their choice, including the Epic EHR MyChart app, email, and a texting platform.
Patients can access TelePrEP through their computer, tablet, or smartphone and use any device to schedule appointments and access a personal handbook that guides them through the PrEP program. Hoth says that troubleshooting is available if patients need it, but is not a regular occurrence.
“For the most part, our patients have no real problems, and we’ve had no problems in conducting visits,” she said.
Patients can access TelePrEP through WiFi, cellular data, or ethernet connections, because the program uses low bandwidth.
Both Shafer and Hoth believe that a program like TelePrEP can act as a blueprint for expanding other public health programs. Currently, the Signal Center is using the same software and tools for programs in oncology, nutrition, psychiatric, and pediatric psychiatry care for acute and chronic conditions.
The key for success with such initiatives is investing in strategic partnerships and effective patient outreach, both Hoth and Shafer said.
“I think the biggest things to consider are [stakeholder] partnerships, because they were really successful to our program and had a vested interested in the delivery of PrEP in general. Focus on the front end first,” Shafer said.
Listening to consumers and the needs of rural patients is critically important he added. “Don’t make assumptions, and really listen to what your consumers are saying. You’ll find out specific barriers that your patients actually face.”
Hoth agrees that communication with consumers is vital for success.
“Often times in healthcare we think we really know what people need and want, because that is what we want for them, but I really emphasize talking to the people you’re trying to help,” she said. “I think that was a really huge benefit to us.”