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USDA Report Highlights Challenges to Rural Telehealth Adoption

A new report issued by the USDA points out that rural Americans aren't embracing telehealth as fast as their urban neighbors, even though they stand to see more benefits from connected care technology.

Source: ThinkStock

By Eric Wicklund

- New research from the US Department of Agriculture confirms what the healthcare industry has long suspected: Telehealth isn’t being used by those who need it the most.

The USDA report, Rural Individuals’ Telehealth Practices: An Overview, compares the use of telehealth and mHealth for health research, maintenance and monitoring by rural populations to those same actions by urban populations. And it finds significant decreases in adoption by rural residents, who could use connected health technologies to solve healthcare access issues.

“Rural residents were less likely than urban residents to take part in any of the three telehealth activities,” the study’s author, Peter L. Stenberg, a regional economist with the USDA, wrote.

Compiled from the Census Bureau's 2015 Current Population Survey data, the 34-page report analyzes how rural and urban populations use telehealth to research health topics, do online health maintenance (pay medical bills, communicate with care providers or maintain health records) or take part in online health monitoring (not including wearables).

According to that research, 20 percent of urban residents and 17 percent of rural residents did some sort of online health research in 2015, but only 11 percent of urban residents and 7 percent of rural residents took part in any online health maintenance – and only 2.5 percent of urban residents and 1.3 percent of rural residents used any online health monitoring tools.

READ MORE: When Its Only Doctor Retired, A Rural Town Turned to Telehealth

Stenberg says the numbers show telehealth is gaining more ground in urban areas than rural areas, a fact that points to telemedicine’s value as more of a convenience than a necessity. In addition, he found that telehealth use increased in proportion to residents’ incomes and education, again indicating that the most underserved populations aren’t accessing care online.

Stenberg took particular note of the low numbers of people using telehealth for health maintenance and monitoring.

“With only 7 percent of rural and 11 percent of urban people conducting online health maintenance, a great deal of potential for expansion remains,” he wrote, noting that newly introduced services like virtual visits could boost interest if they were supported by the payer industry.

“After we controlled for income, education, and age factors, rural people were much less likely to take part in online health maintenance than urban residents,” Stenberg added. “As new technology (which is more readily accessible in urban areas and often introduced there first) drives the demand for online health management activities, the question becomes will the rural-urban difference in use of online telehealth grow?”

With health monitoring, Stenberg noted the “statistically significant” difference between urban and rural use rates, with the former using the technology twice as much as the latter.

READ MORE: The Health Wagon: A Telehealth Resource in a Rural Wilderness

“Once we considered income, education, and age factors, rural residents were much less likely than urban residents to conduct online health monitoring,” he said. “This rural-urban divide was reflected throughout the demographics and work characteristics and contrasted with rural-urban use rates for online health research, for which rural residency was less of a barrier. Although varying broadband access explained some of the rural-urban difference, not all online health monitoring technology required the high-end Internet connections more common in urban areas.”

Stenberg’s research indicates people in both urban and rural parts of the country conducted some online health research whether they had access to the Internet or not, but the same can’t be said for health maintenance or monitoring. Access to technology was a significant factor for health maintenance, he reported, while nearly everyone engaged in health monitoring had access to a smartphone or a personal computer, or both.

For rural America, this poses a challenge. Just as rural and remote residents have limited access to healthcare providers, they also have less access to high-speed broadband needed to engage in health maintenance and monitoring, so telehealth adoption rates are lower.

This, in turn, is why federal agencies like the USDA, with its Distance Learning and Telemedicine (DLT) grants, and the Federal Communications Commission, with its new Connected Care Pilot Program and the Universal Service Fund’s Rural Healthcare Program, are highlighting telehealth and telemedicine services as a key byproduct of improved broadband access.

“Resolving the challenges to providing rural health care may be vital to ensuring continued rural growth and prosperity,” Stenberg concluded. “Rural telehealth, which has rapidly integrated with Internet technologies, may pose one solution. Although telehealth remains in its infancy with relatively low rates of regular use, those rates will likely increase as service and technology continue to improve and people become aware of the improvements.”


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