Telehealth Use and Barriers in Non-Metropolitan Clinic Populations

To better understand the socioeconomic and technological barriers to telemedicine use in rural populations, we conducted a survey comparing non-metropolitan clinic patients to a contemporaneous cohort of metropolitan clinic patients. Rural populations are known to experience higher rates of adverse social determinants of health. During and following the COVID-19 pandemic, the expansion of telehealth offered the potential to assuage some of these disparities. Despite telemedicine's capacity to expand geographical reach and facilitate access to healthcare, rural patients often encounter technological and infrastructure limitations, creating barriers to care.

From 11/04/2023 to 03/31/2024, a survey was administered with descriptive multiple-choice questions that assessed urology clinic patient demographics and barriers to telemedicine access. Demographic data included gender, age, educational level, income level, visit type, and insurance status. Patients were asked about prior telehealth utilization, technology infrastructure limitations, access to telehealth capable devices, and their general willingness to engage in telehealth visits. Metropolitan and non-metropolitan clinic populations were compared and statistical analysis was performed.

A total of 211 patients completed the survey. Patient age and gender were similar among metropolitan and non-metropolitan clinic patients completing the survey. Non-metropolitan clinic patients were statistically more likely to report lower income and level of education and were less likely to have private insurance than metropolitan clinic patients (P <.05). Non-metropolitan clinic patients were less likely to have access to a cell phone, a smart phone, or to have access to reliable cell phone service. Non-metropolitan clinic patients were also less likely to have access to a computer with a web camera or to have personal Wi-Fi access. Despite these disparities, there was no difference between metropolitan and non-metropolitan clinic patients in their willingness to have a telemedicine visit.

Based on our results, patients who present to non-metropolitan clinics encounter greater obstacles to accessing the technology required for telehealth despite reporting an equivalent acceptance of the modality. These barriers are complex and appear to fall along socioeconomic lines. Given the capacity of telehealth to mitigate geographic barriers to care, additional effort should be made to improve internet infrastructure in rural areas, and virtual healthcare centers that facilitate multidisciplinary telehealth access should be considered.