Until access to broadband does not improve, telemedicine will not help rural communities


(Reuters Health) – Telemedicine has been touted as a solution to the shortage of doctors in rural America. But the same places where residents have to travel many miles to see a doctor often also have limited access to broadband, suggests a new study.

About 25% of Americans live in rural communities, while only 10% of doctors practice there, said the study's lead author, Coleman Drake, an assistant professor in the department of health policy and management at the University of Pittsburgh Graduate School of Public Health. And by making matters worse, people living in the country tend to be older and sicker than their urban counterparts.

"In the last decade, in particular, there has been considerable interest in the potential for telemedicine to make access to health care easier," said Drake. "We wondered if telemedicine could really help bridge the gap in access to care. And we found that in many rural areas the lack of broadband access is potentially limiting access to telemedicine."

To see if telemedicine could make the difference where doctors were scarce, Drake and his colleagues first mapped the areas where access to general practitioners or specialists might require guidance of an hour or more , according to the study published in the Annals of Internal Medicine.

So to determine broadband access, the researchers turned to data from the Federal Communications Commission to find out if people living in counties far from doctors had a way to download data at a speed of at least 25 megabits per second, which is sufficient to support video-based telemedicine visits.

Drake and his colleagues found that the percentage of broadband service subscribers declined with increasing distance from cities, with rates of 96.0% in urban counties, 82.7% in rural counties and 59, 9% in counties with extreme access considerations. Furthermore, in the counties where there was inadequate access to general practitioners and psychiatrists (for example, no primary care provider within 70 minutes of driving, for example) the enrollment rate was 38.6%.

Even if the broadband issue were resolved, it would not mean that all the barriers to telemedicine would be overcome, Drake said. "Medicare, with few exceptions, does not reimburse telemedicine visits from home," he explained.

What is needed is for "local, state and federal policy makers who are evaluating the economic effectiveness of infrastructure expansions to assume that it is not just allowing people to access social media in their time free, it could also allow people to access telemedicine that otherwise wouldn't be able to do it, "said Drake.

People often underestimate the problem of broadband access, he said. Dr. Peter Fleischut, general manager of transformation at NewYork-Presbyterian in New York City.

"Technology has no neutral value," Fleischut said. "It is crucial when any new technology emerges to make sure that the disparities are not worse. This is a problem with telemedicine if a segment of the population cannot access it because it is not broadband."

And it's not just rural counties that have this problem, Fleischut said. Some older buildings in urban areas present challenges, he added.

Broadband access is not the only problem.

"There are always challenges for any new technology," Fleischut said. "For example, there are regulatory issues when crossing state lines. If you see a supplier and then go through a status line by going home, you can't make a video visit if the provider doesn't even have a license in your state even though you can have a call with that provider. And this is true even if you are doing something as simple as a checkup. "

SOURCE: bit.ly/2HtldiU annals of internal medicine, online 20 May 2019.

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