Telehealth Service Utilization Among Individuals Living in Rural Communities

Background and Purpose:In response to health access barriers, telehealth has emerged as an alternative approach to improving access to specialty care providers. Telehealth entails the utilization of technology (e.g., videoconferencing) to enable patients to meet with providers whom are typically inaccessible in their geographic regions. This treatment delivery method has been found to be associated with increased healthcare encounters, comparable quality and satisfaction, at reduced cost. Despite the importance of telehealth, little is known about the factors associated with use of telehealth among individuals living in rural communities. Thus, guided by Andersen’s behavioral model of health care utilization, this study examined the extent to which predisposing, enabling, and need factors were associated with use of telehealth among individuals living in rural communities.

Methods:The current study used data obtained from the 2015 California Health Interview Survey (CHIS), which is the nation’s largest state health survey. The study sample consisted of 3618 adults, who reported residing in rural communities. As the dependent variable, a dichotomous measure of telehealth service use was used (yes/no). To examine the factors associated with telehealth service use, logistic regression analysis was conducted after controlling for predisposing, enabling, and need factors. To account for the CHIS’s complex sampling designs, the survey procedures of SAS were employed in all statistical analyses.

Results:The multivariate model found that study respondents who were insured were more likely to use telehealth services when compared to those who were not insured. In addition, those who reported that their health status was excellent, very good, or good, were more likely to use telehealth services than those who reported their health status was fair or poor. None of the predisposing factors were associated with the use of telehealth among individuals living in rural communities. 

Conclusions and Implications: While telehealth has the potential to overcome a number of health care access barriers, lack of insurance appears to remain a main barrier, even when using telehealth care. Further, telehealth may not address the access challenges of individuals who have the greatest need for health care services- those with poorer health status. Providers utilizing telehealth services should consider specific strategies to engage individuals without insurance and those with poorer health status in order to strengthen outreach to these populations, whom might be more vulnerable to low service utilization.