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

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. The Administration for Community Living provides additional information about telehealth use among people with disabilities during the COVID-19 pandemic.

People with Substance Use Disorders and/or Mental Health Conditions

Challenges with accessing care to address rural mental health include lack of accessible services and stigma surrounding behavioral health. 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. However, urban-rural disparities in access to mental health care grew during the COVID-19 pandemic, likely due to lack of broadband access in rural areas.

The Rural Mental Health and Substance Use and Misuse in Rural Areas topic guides, the Mental Health in Rural Communities Toolkit, and the Rural Prevention and Treatment of Substance Abuse Toolkit provide additional information about behavioral health in rural communities.

People Who Are Incarcerated

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. For example, Arizona's rural prisons participate in the Arizona Telemedicine Program. 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.

For additional information, see Implementation Considerations for Telehealth Programs Serving People Who Are Incarcerated.

Older Adults and the Medicare Population

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 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.

For additional information, see Implementation Considerations for Telehealth Programs Serving Older Adults.

Children

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 long travel distances to emergency care and 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. 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.

Research conducted during the COVID-19 pandemic highlighted disparities in telehealth use between urban and rural children. Data from the National Health Interview Survey from July–December 2020 showed that children aged 0–17 years who lived in large metropolitan areas were more than twice as likely to have received care via telehealth because of the COVID-19 pandemic than children who lived in nonmetropolitan areas.

For additional information, see Implementation Considerations for Telehealth Programs Serving Children.

Veterans

The 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 U.S. 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, and challenges with aging in place. Veterans in rural areas may also struggle with lack of housing and substance use disorders, which can pose additional challenges to seeking care.

Telehealth has helped veterans who live in rural areas access care for a wide range of behavioral and specialty care. For example, the Indiana Veterans Behavioral Health Network provides telehealth services to rural veterans by partnering with community mental health centers. However, veterans also face some barriers to accessing telehealth. The FCC found that in 2019, 15% of veterans lived in households with no internet connection.

For additional information, see Implementation Considerations for Telehealth Programs Serving Veterans.

Tribes

Approximately half of the American Indian/Alaska Native (AI/AN) population live in rural areas. Disparities between AI/AN populations and other racial and ethnic groups include 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 additional information, see Implementation Considerations for Tribal Telehealth Programs.

Island Populations

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. In addition, prompt treatment from telehealth specialists helped prevent health conditions from becoming worse and requiring emergency services. The Pacific Basin Telehealth Resource Center can help address the telehealth needs of rural communities in Hawaii, Guam, American Samoa, Commonwealth of the Northern Mariana Islands, Freely Associated States of the Republic of Palau, Republic of the Marshall Islands, and Federated States of Micronesia.

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 and telehealth in rural areas. 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 Remote 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 occur 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.