By Troy Corley
Imagine having to travel for more than an hour to see the nearest primary care provider.
Unfortunately, that’s the reality for entirely too many patients living in rural communities across the United States. About 20% of the country’s population lives in Census-defined rural areas, 80% of which the federal government now designates as “medically underserved.” Often referred to as “health care deserts,” many rural communities don’t have a health care provider located within 30-plus miles.
These distance barriers are the result of rural provider shortages. Only 39.8 primary care physicians are available per 100,000 people in rural populations, as compared to 53.3 primary care doctors per 100,000 urban dwellers. The largely rural state of Texas is a prime example. According to the Washington Post, “159 of the state’s 254 counties have no general surgeons, 121 counties have no medical specialists, and 35 counties have no doctors at all.”
“The gray wave” is further widening this geographic care gap, with rural doctors on average being older than urban doctors. As rural physicians move toward retirement and young physicians flock to larger cities, health experts predict that the number of rural doctors is set to decline by 23% over the next decade.
While limited physical access to a small pool of providers is a serious health inequity, it is not the only barrier to care that rural populations face. Combined with low health care reimbursement rates, small patient volumes, transportation issues and economic challenges, rural Americans can too easily fall through the cracks of the health care system.
How Telehealth Helps
Telehealth can eliminate many barriers to accessing basic health care. While the current pandemic has exposed challenges with the American health care system, it has also rapidly accelerated the adoption of and ability to leverage this convenient care delivery method. Even before the novel coronavirus began its spread across the country, the market for telehealth was growing rapidly and is expected to reach $185.6 billion by 2026.
Telehealth services empower providers in rural areas to deliver health care through secure text, voice and video communications. Telehealth is an excellent solution for connecting patients with care teams when otherwise impossible or when quick care is needed in an emergency situation.
Yet despite its benefits, telehealth is not a total healthcare solution for rural populations. Chronically ill and high-risk patients especially require ongoing monitoring and management which cannot be accomplished through basic virtual consultations with the provider-in-queue. For these and many other patients, enhanced exams with a dedicated provider are essential to quality care.
Enhancing Virtual Exams with Digital Tools & Specialty Consultations
Technological advances in medical instruments and specialty consults are equipping physicians to do much more for their rural patients than they could through telehealth alone. By introducing these strategies into their rural care models, health care organizations can provide underserved populations with quality, cost-effective and convenient care.
Using digital stethoscopes, otoscopes, dermatological cameras and thermometers, virtual providers can now conduct the next-best thing to in-person physical exams. The tools, used in small rural clinics, are controlled by an in-person nurse or medical assistant under the virtual direction of a physician. As the in-person medical professional operates the tools, the virtual provider sees real-time otoscopic video and clinical data, allowing them to evaluate and closely monitor the patient’s health. Furthermore, these clinics can be constructed for comparatively low cost and deployed throughout rural areas in a hub-and-spoke configuration, enabling a centrally-located physician team to provide primary care throughout a region.
Leveraging advancements in virtual consultation practices allows primary care physicians to extend the scope of services available to patients by bringing the specialist into the patient’s exam room virtually for collaborative conversation between the providers and patient. Other platforms allow the physician to conduct virtual specialty consultations, pulling on an extensive, nationwide network of subspecialists who can provide their expertise on difficult or unusual cases.
Encouraging Physician-Patient Relationships
While enhanced virtual care services have allowed health care providers to broaden their reach and treat new patients in unexpected locales or otherwise difficult-to-reach rural areas, the question remains: can telehealth take the place of the face-to-face relationship in primary care? Because of obstacles like the need for health education and assistance through the often-complicated health care system, the answer is oftentimes “no.”
Continuity of care is essential to reducing risk and managing disease. From difficult conversations regarding complex diagnoses and drastic lifestyle changes to chronic condition management, health coaching, behavioral health and more, facilitating the patient-provider relationship is crucial.
Guidance from a trusted health care provider maximizes the results of improved access for chronically ill rural patients. For those at high risk for poor health outcomes, the University of Wisconsin’s Population Health Institute believes that engaging “professional or lay health workers [in order] to provide education, referral and follow-up, case management, home visiting, etc.” could serve as part of the solution to the rural health care challenge. Building relationships with patients allows clinicians to identify and address those social determinants of health which present barriers to care, resulting in improved patient engagement and outcomes.
Patients in rural communities need access to coordinated, proactive care from providers they trust. By enhancing doctor-patient relationships for patients dealing with social inequities and integrating advanced digital medical instruments into virtual care settings, rural providers can more effectively close the care gaps for their patients.
Troy Corley is Executive Vice President, Service Delivery at Proactive MD.