Abstract
BackgroundThe COVID-19 pandemic has led to a notable increase in telemedicine adoption. However, the impact of the pandemic on telemedicine use at a population level in rural and remote settings remains unclear.ObjectiveThis study aimed to evaluate changes in the rate of telemedicine use among rural populations and identify patient characteristics associated with telemedicine use prior to and during the pandemic.MethodsWe conducted a repeated cross-sectional study on all monthly and quarterly rural telemedicine visits from January 2012 to June 2020, using administrative data from Ontario, Canada. We compared the changes in telemedicine use among residents of rural and urban regions of Ontario prior to and during the pandemic.ResultsBefore the pandemic, telemedicine use was steadily low in 2012-2019 for both rural and urban populations but slightly higher overall for rural patients (11 visits per 1000 patients vs 7 visits per 1000 patients in December 2019, P<.001). The rate of telemedicine visits among rural patients significantly increased to 147 visits per 1000 patients in June 2020. A similar but steeper increase (P=.15) was observed among urban patients (220 visits per 1000 urban patients). Telemedicine use increased across all age groups, with the highest rates reported among older adults aged ≥65 years (77 visits per 100 patients in 2020). The proportions of patients with at least 1 telemedicine visit were similar across the adult age groups (n=82,246/290,401, 28.3% for patients aged 18-49 years, n=79,339/290,401, 27.3% for patients aged 50-64 years, and n=80,833/290,401, 27.8% for patients aged 65-79 years), but lower among younger patients <18 years (n=23,699/290,401, 8.2%) and older patients ≥80 years (n=24,284/290,401, 8.4%) in 2020 (P<.001). There were more female users than male users of telemedicine (n=158,643/290,401, 54.6% vs n=131,758/290,401, 45.4%, respectively, in 2020; P<.001). There was a significantly higher proportion of telemedicine users residing in relatively less rural than in more rural regions (n=261,814/290,401, 90.2% vs n=28,587/290,401, 9.8%, respectively, in 2020; P<.001).ConclusionsTelemedicine adoption increased in rural and remote areas during the COVID-19 pandemic, but its use increased in urban and less rural populations. Future studies should investigate the potential barriers to telemedicine use among rural patients and the impact of rural telemedicine on patient health care utilization and outcomes.
Highlights
Access to health care services in rural communities has proven challenging among individuals for many reasons
We conducted a population-based, repeated cross-sectional study of monthly and quarterly rural ambulatory telemedicine visits in Ontario, Canada, beginning prior to the COVID-19 pandemic (January 1, 2012) and extending to June 30, 2020, using data from the following administrative databases: (1) Ontario Health Insurance Plan (OHIP), which records all health services delivered by physicians to Ontario residents and (2) Registered Persons Database, which contains demographic information of all patients covered under OHIP
Our findings are concurrent with those of a similar study we conducted, which focused on the rates of telemedicine visits in the entire patient population in Ontario, and we previously reported that the increase in telemedicine usage rates from before the pandemic to during the pandemic was similar across age groups, with older adults showing the highest rates of telemedicine use during the pandemic [3]
Summary
Access to health care services in rural communities has proven challenging among individuals for many reasons. The Ontario Telemedicine Network (OTN) is an organization funded by the provincial government, which aimed to initially increase health care access among the rural population by facilitating 2-way videoconferencing between patients and care providers [2]. Prior to the COVID-19 pandemic, telemedicine adoption was modest in Ontario [3], in part owing to strict requirements for both the patient and the physician, such as attending a virtual visit at an OTN facility, and using an OTN-approved communication platform [4]. A prepandemic study from Ontario revealed that Northern Ontario, a predominantly rural region in the province, saw markedly higher annual rates of telemedicine use than the mostly urban Southern Ontario, and even within Northern Ontario, rates of telemedicine use were higher in the “very rural” than in the “less rural” populations [5]. The impact of the pandemic on telemedicine use at a population level in rural and remote settings remains unclear
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