Specific Rural Populations that May Benefit from Telehealth
Rural telehealth programs can be designed to create solutions to rural community challenges. These programs can help serve specific rural populations including:
People with Disabilities
In the United States, the 17.1% percent of rural people report having a disability, compared to 11.7% of people living in urban areas. People with disabilities who live in rural areas may face additional barriers to accessing care. For example, some people with disabilities may have complex health needs or physical limitations that can make it difficult to travel to specialized healthcare providers. The Access to Care for Rural People with Disabilities Toolkit describes how telehealth can help overcome these barriers and eliminate the need to travel for care. For example, South Dakota eResidential Facilities Healthcare Services Access Project provides telehealth services to rural long-term care, assisted living, and rehabilitation facilities.
People with Substance Use Disorders and/or Mental Health Conditions
Research describes higher rates of some substance use and mental health conditions in rural communities compared to metropolitan areas. For example, the Centers for Disease Control and Prevention reports that there is a higher suicide rate in less densely populated areas as compared to more densely populated areas. The 2017 National Survey on Drug Use And Health describes higher rates of tobacco and methamphetamine use among rural adults. Rural communities have also been heavily affected by opioid abuse and are implementing strategies to prevent misuse and overdose and to provide treatment. The Substance Use and Misuse in Rural Areas topic guide and the Rural Prevention and Treatment of Substance Abuse Toolkit provide additional information about substance use disorders in rural communities.
A challenge with rural mental health is that services are less accessible and available in rural communities, and stigma creates barriers to care. Telehealth can be an important way to increase access to mental health and substance use treatment in rural communities, which have fewer treatment facilities and mental health providers than urban areas.
People Who Are Incarcerated
Prison facilities are frequently located in rural communities. In addition, the rate of incarceration in local rural jails increased by 436% between 1970 and 2013, despite lower rates of crime in rural areas compared with urban areas. In 2011-2012, approximately 40% of prisoners and jail inmates in the U.S. had a chronic health condition. Further, one in seven prisoners has a mental health condition of major depression or psychosis, based on a 2012 systematic review. Correctional institutions in rural areas face similar challenges to providing care as other rural providers. In particular, lack of specialty care — especially psychiatric care — can require corrections staff to coordinate expensive and time-consuming visits to external providers.
Rural prison and jail facilities are using telehealth to address these challenges and provide timely and cost-effective care. A 2016 study of prison healthcare conducted by the Centers for Disease Control and Prevention found that among the 28 states that used telehealth in prisons, the most frequently provided service was telepsychiatry, followed by cardiology, orthopedics, and oncology.
Older Adults and the Medicare Population
As described in RHIhub's Rural Aging in Place Toolkit, the U.S. population is aging, and rural areas have a disproportionately high number of older adults when compared to urban areas. According to 2010 U.S. Census data, one-quarter of all adults 65 years and older lived in rural areas. Older adults are more likely to have special healthcare needs related to multiple chronic conditions that may require specialty care. Older adults may also require additional support in order to stay in their own homes as they age. The telehealth/home health model, which is described in the Rural Aging in Place Toolkit, provides an overview of the benefits of telehealth services for older adults. Rural programs have found that integrating telehealth into the care of older adults has helped reduce admissions to emergency services and skilled nursing facilities.
Children who live in rural areas face certain physical, economic, and social barriers to accessing healthcare and living healthy lives. For example, the percentage of families with children who live in deep poverty is higher in rural areas than in urban areas. In addition, rural children have a higher risk of disability and death from injuries when compared to urban children because of limited access to pediatric emergency medical services. Rural children are also more likely to be overweight or obese when compared to urban children. Telehealth is a key strategy to connecting rural children and their families to primary and specialty care. Rural communities are using telehealth to respond to urgent health needs of children, manage complex conditions, and educate providers on pediatric care, among many other applications. For example, the HEALTH-COP Obesity Prevention program helps rural providers manage and treat childhood obesity. Schools also partner with healthcare facilities to deliver healthcare services to students in schools. One example of a school-based telemedicine program is Health-e-Schools in rural North Carolina.
In the U.S., approximately 25% of veterans live in rural areas. RHIhub's Rural Veterans and Access to Healthcare topic guide describes some of the key health issues that affect rural veterans. In addition to service-connected disabilities such as post-traumatic stress disorder (PTSD) and hearing loss, veterans also seek care for a range of chronic conditions, including high blood pressure and diabetes.
The majority of veterans receive care from the Veterans Health Administration (VHA). However, many rural veterans have to travel long distances to reach VHA facilities often located in urban areas. The Department of Veterans Affairs also reports that rural veterans may face other barriers to care specific to rural areas, including hospital closures, limited economic opportunities, lack of housing options, and challenges with aging in place. Veterans in rural areas may also struggle with homelessness and substance use disorders, which can pose additional challenges to seeking care.
In 2014, about 12% of the veteran population who were enrolled in healthcare through the Department of Veterans Affairs received care through telehealth. Telehealth has helped veterans who live in rural areas access care for a wide range of behavioral and specialty care, including PTSD, HIV, multiple sclerosis, depression, and intensive care. For example, the Indiana Veterans Behavioral Health Network provides telehealth services to rural veterans by partnering with community mental health centers. Veterans visit their local community mental health center to receive telehealth sessions from the VHA's mental health providers. This program allows veterans to receive care from professionals who are knowledgeable about their unique struggles without needing to travel long distances.
Approximately half of the American Indian/Alaska Native (AI/AN) population live in rural areas. Researchers have documented significant health disparities between AI/ANs and other racial and ethnic groups, including higher rates of mortality from diabetes, alcohol-related conditions, and assault. In addition, AI/AN veterans are more likely to live in a rural setting and to experience medical complications from their services, including PTSD, compared to other veteran populations. Geographic isolation can require residents of reservations to travel long distances to receive specialty care services, which are often underfunded at Indian Health Service facilities. Telehealth can help ensure that rural AI/AN populations receive appropriate care in community settings. For example, the Alaska Native Tribal Health Consortium, as of 2013, has had 60,000 patient cases that have benefited from telehealth services.
People who live in island communities often experience extremely limited access to on-island care. Rural island communities can also struggle with severe workforce shortages, lack of training for the existing workforce, limited specialty care services, and outdated infrastructure and equipment. In addition, the high cost of transporting patients off-island for specialty care can further strain the often limited resources of island health systems.
Island communities can substantially benefit from telehealth interventions that reduce the need to travel for services. For example, telehealth has increased access to care for Tribal members who live in rural Savoonga on Saint Lawrence Island in Alaska. The Savoonga Clinic, which is staffed by Community Health Aides, relies on telehealth to provide patients with timely specialty care. Predicted savings are $10 million in one year from decreased use of small aircraft to transport patients to the mainland. In addition, prompt treatment from telehealth specialists helped prevent health conditions from becoming worse and requiring emergency services.
People with Limited English Proficiency
Patients who have a limited ability to understand, read, write, or speak English may face additional barriers to accessing healthcare in rural areas. The Office for Civil Rights Compliance Review Initiative suggests that oral language assistance services are an effective strategy to provide language access in Critical Access Hospitals. Some rural programs offer interpretation services via telehealth, including via telephone or video remote interpreting units. For example, hospitals in central Nebraska use a Video Medical Interpreting program to ensure that Spanish-speaking patients receive appropriate care. The interpreting program uses the same telehealth program that connects Nebraska hospitals and public health departments.
People Living in Areas Affected by Disasters
When disasters occurs in rural areas, residents often face additional challenges related to travel and distance. Telehealth can help provide care to individuals affected by disasters. For example, some rural facilities are integrating telehealth into emergency departments and trauma care in order to better serve patients with severe injuries. In the aftermath of disasters, some medical providers may experience a surge in patients due to injuries and closure or destruction of health facilities. In addition, patients with chronic conditions may face barriers to managing their conditions during disasters and may require additional care.