Rural-Urban Differences in Telehealth Utilization and Delayed Care During the COVID-19 Pandemic

The Rise, Fall, and Readjustment of Telehealth: Effect of Coronavirus Disease 2019 on Its Use in an Academic Health Clinic

BACKGROUND

 The coronavirus disease 2019 (COVID-19) pandemic accelerated the adoption of telehealth. Long-term implications for continued telehealth use on a large scale in primary care are still emerging, and the key to this understanding is how telehealth adoption impacts the delivery of health care.

OBJECTIVES

 Our objective was to quantify how telehealth adoption during the pandemic impacted patients' access to health care and the usage patterns of different access modalities (in-office, audio, and video).

METHODS

 This study analyzed 2 years of deidentified electronic health record data from the ambulatory clinics at a Midwest medical school from 2020 and 2021. We focused on patient demographics, primary diagnoses, and patient preferences for receiving health care throughout the COVID-19 pandemic.

RESULTS

 Of the 105,362 patient visits analyzed across in-office, audio, and video visits, demographic data varied by gender, age, and racial composition. During the early pandemic, telehealth usage peaked in April 2020, with audio and video visits accounting for 45.8 and 18.1% of the total visits, respectively. These rates declined to averages of 12.5 and 3.6%, respectively, over the following months. Primary diagnoses during telehealth visits are often related to COVID-19 exposure or mental health or behavioral issues. Lastly, statistically significant associations exist between the visit modality and primary diagnoses.

CONCLUSION

 The COVID-19 pandemic initially saw a surge in audio telehealth visits; however, as safety measures were established, the mix of visit modalities returned to prelockdown levels. Video and audio telehealth maintained increased usage relative to prepandemic levels, potentially owing to increased awareness of the technology as a means for accessing health care and a learning curve associated with adoption. Patients preferred remote care during high COVID-19 transmission. Video telehealth has shown significant associations with psychiatric, behavioral, and neurodevelopmental diagnoses. Disparities in video telehealth use among racial groups have highlighted potential access issues.

Telehealth-An Environmentally Friendly Way to Take Care of Patients with Inflammatory Bowel Disease

Background and Objectives: On 11 March 2020, our hospital adapted to the COVID-19 pandemic by becoming a temporary COVID-19 facility, leading to the suspension or delegation of non-COVID-19 services. Among the international IBD community, there were significant concerns regarding the neglect of immunocompromised IBD patients and their increased vulnerability to COVID-19. To address these challenges, the COVID-19 ECCO Taskforce recommended the implementation of telehealth. Following this recommendation, our hospital's IT department integrated audiovisual hardware and software solutions to facilitate virtual consultations. This approach enabled patients and their local physicians to receive formal reports comparable to those issued during standard in-person care. Materials and Methods: We retrospectively analyzed data from patients diagnosed with Crohn's disease and ulcerative colitis who participated in telemedicine consultations. Average distances and time saved were calculated using Google Maps, while carbon emissions and carbon footprint reductions were determined. Results: Between 11 August 2021 and 15 June 2023, 107 telehealth consultations were completed. Patients benefited from reduced travel distances, with an average saving of 168.28 km per consultation and a total reduction of 18,006 km. Travel time savings averaged 2 h and 22 min per consultation, amounting to a total of 252 h saved. The reduction in carbon emissions was calculated at 3.26 tons, equivalent to the annual absorption capacity of 109 fully grown trees, considering that an individual tree absorbs approximately 21.77 kg of CO2 annually. These findings underscore telemedicine's role in reducing environmental impact while enhancing patient convenience. Conclusions: The adoption of telehealth successfully optimized outpatient clinic operations, maintaining high-quality patient outcomes while contributing to environmental sustainability.

Can You Hear Me Now? Patient Perceptions of Telehealth in a Rural Primary Care Population

Background: The COVID-19 pandemic significantly increased telehealth adoption. Rural communities experience challenges relating to telehealth, including a shortage of clinicians, low health literacy, mistrust of medicine, and limited technology access, yet rural perceptions have not been a subject of robust study. The setting of this study was a rural Midwestern family medicine clinic within an academic health system. Methods: Surveys were given to all patients of age 18 or older visiting the clinic over a one-week period. Those who expressed interest were contacted for a semistructured interview. Descriptive statistics and chi-square testing were used to analyze survey results for significant relationships, while interview transcripts were analyzed for themes. Results: Of respondents, 27% indicated prior telehealth use and were more likely to prefer telehealth visits (p = 0.03). Perceptions of telehealth were sorted into themes, including scope of care, convenience, and technology. Telehealth was preferred for discussing test results or mental health. Barriers such as travel time and transportation access favored telehealth. Although more convenient, telehealth was found to be less effective for relationship building. The absence of physical examination during phone visits was a concern. Phone visits were more prevalent due to failure of video-based technology. Conclusions: Despite the potential to address these unique challenges in rural communities, telehealth acceptance is poor. Barriers such as accessibility of technology can be improved through governmental and health systemwide measures. Future work can help develop interventions that counter negative perceptions of telehealth while increasing interest and uptake in rural communities.