Examining differences in time to appointment and no-show rates between rural telehealth users and non-users.

Background: Telehealth has undergone widespread implementation since 2020 and is considered an invaluable tool to improve access to healthcare, particularly in rural areas. However, telehealth's applicability may be limited for certain populations including those who live in rural, medically underserved communities. While broadband access is a recognized barrier, other important factors including age and education influence a person's ability or preference to engage with telehealth via video telehealth or a patient portal. It remains unclear the degree to which these digital technologies lead to disparities in access to care. Purpose: The purpose of this analysis is to determine if access to healthcare differs for telehealth users compared with non-users. Methods: Using electronic health record data, we evaluated differences in "time to appointment" and "no-show rates" between telehealth users and non-users within an integrated healthcare network between August 2021 and January 2022. We limited analysis to patient visits in endocrinology or outpatient behavioral health departments. We analyzed new patients and established patients separately. Results: Telehealth visits were associated with shorter time to appointment for new and established patients in endocrinology and established patients in behavioral health, as well as with lower no-show rates for established patients in both departments. Conclusions: The findings suggest that those who are unwilling or unable to engage with telehealth may have more difficulty accessing timely care.

Trends in telehealth use among a cohort of rural patients during the COVID-19 pandemic.

Objective: Rural populations faced unique challenges to healthcare access during the COVID-19 pandemic. This analysis assesses trends in digital health technology use at the onset of the pandemic and describes digital health behaviors among a cohort of patients within a rural integrated healthcare network throughout the first 3 years of the pandemic. Methods: We used data from both the electronic health record (EHR) and a patient survey. EHR data was used to longitudinally assess change over time in patient portal use and telehealth visits. Survey responses were used to provide additional context. Results: Telehealth appointments peaked in the first quarter of 2020 at 28% of all office visits, before leveling off to 8-10% in 2022. Women and those younger than 65 were more likely to have participated in telehealth appointments. Active patient portal users increased from 34.1% in January 2019 to 63.7% in January 2022. There were no differences noted in portal use trends based on rurality. Conclusions: Our findings corroborate previous research, as well as add context regarding digital health technology use throughout the COVID pandemic in a rural patient population. Future research must focus on understanding constraints to digital health expansion in order to continue providing safe, equitable care.