Differences in Telemedicine Use Between Rural and Urban Medicare Beneficiaries With Kidney Failure

Telemedicine offers a potential solution to address disparities in health care access among rural and urban patients with kidney failure. This study examined telehealth utilization patterns and urban-rural differences before and during the coronavirus disease 2019 (COVID-19) pandemic.

Retrospective observational cohort study.

Medicare beneficiaries (with both parts A and B) with kidney failure, on kidney replacement therapy of any modality (excluding transplant) from the United States Renal Data System, totaling 787,959 patients (2017-2021).

Urban versus rural residence, before (January 2020) and during (January 2021) the COVID-19 pandemic.

Telehealth utilization, defined as any claim for telemedicine services, including mental health, primary care, nephrology, and other services.

Multivariable logistic regression assessed predictors of telehealth use. Geographic variation was analyzed using county-level data.

Rural patients were more likely to use telehealth prepandemic (OR, 4.61; 95% CI, 4.11-5.28; P < 0.01), but urban patients had higher utilization during the pandemic (OR, 139.55; 95% CI, 128.33-153.94; P < 0.01). The relative increase in telehealth use was greater among urban patients (urban-rural interaction: OR, 0.16; 95% CI, 0.14-0.18; P < 0.01) than before pandemic. African American (OR, 0.73; 95% CI, 0.72-0.75; P < 0.01) patients were less likely to use telehealth than White patients. Telehealth use was more common among patients receiving peritoneal dialysis (OR, 1.37; 95% CI, 1.34-1.41; P < 0.01) or in-center self-hemodialysis (OR, 1.59; 95% CI, 1.26-1.97; P < 0.01) compared with in-center hemodialysis. Minimal differences in service types were observed between rural and urban patients.

Exclusion of Medicare Advantage and private insurance data may limit generalizability. The study did not assess outcomes associated with telehealth use.

Telehealth use considerably increased for patients with kidney failure during the pandemic, particularly in urban areas, but racial, ethnic, and social disparities persist. Efforts to promote equitable telehealth use and access are essential to advance health equity for patients with kidney failure.