Rural telemedicine use before and during the COVID-19 pandemic: a repeated cross-sectional study

Background — The COVID-19 pandemic has led to a notable increase in telemedicine adoption. Its impact on telemedicine utilization at a population level in rural and remote settings remains unclear.

Objective — We aim 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.

Methods — We conducted a repeated cross-sectional study on all rural telemedicine visits monthly and quarterly from January 2012 to June 2020 using administrative data from Ontario, Canada. We compared changes in utilization for residents of rural and urban regions of the province prior to and during the pandemic.

Results — Before the pandemic, telemedicine utilization was steadily low between 2012-2019 for both rural and urban populations, but slightly higher overall for rural patients (11 visits per 1000 rural patients versus 7 visits per 1000 urban patients in December 2019). The rate of telemedicine visits among rural patients significantly increased to 147 visits per 1000 in June 2020. A similar but steeper increase was seen among urban patients (220 visits per 1000). The increase in use was prevalent across various age groups, with the highest rates reported in older adults aged 65 and above (77 visits per 100 patients in 2020). The proportions of patients with at least one telemedicine visit were similar across age groups in 2020 (28.3% for ages 18-49; 27.3% for ages 50-64; and 27.8% for ages 65-79). There were more female users than male users of telemedicine (54.6% vs 45.4% in 2020). There was a significantly higher proportion of telemedicine users residing in comparatively less rural than more rural regions (90.2% vs 9.8% in 2020).

Conclusions — Telemedicine adoption grew in rural and remote areas during the COVID-19 pandemic, but higher growth in utilization was seen in urban and less rural populations. Future research on the potential barriers to telemedicine among rural patients and the impact of rural telemedicine on patient healthcare utilization and outcomes is warranted.