Rural-Urban Disparities in Telehealth Services Provision Post Covid-19 Pandemic in South Carolina and Alabama.

Additional Authors

Jordan Brooke de Jong, Center for Applied Research and Evaluation in Women’s Health, Department of Health Service Management, College of Public Health, East Tennessee State University. Amy Weber, Center for Applied Research and Evaluation in Women’s Health, Department of Health Service Management, College of Public Health, East Tennessee State University

Abstract

The COVID-19 pandemic accelerated the adoption of telehealth services across the US, particularly in rural areas where access to healthcare is often constrained by distance, income, internet access, and time. This study investigates the variation in telehealth services between urban and rural health department (HD) and federally qualified health center (FQHC) clinics in Alabama (AL) and South Carolina (SC) from 2019 to 2022. The objective is to assess disparities in telehealth adoption, modalities, and sustainability disparities before and after the COVID-19 pandemic. Using survey data from HD and FQHC clinics in SC and AL on telehealth services, chi-square tests, and difference-in-differences (DiD) analysis were conducted. The DiD approach, utilizing generalized estimating equations and modified Poisson regression, assessed changes in telehealth service provision between rural and urban clinics over time. The analysis compared telehealth service provision and modalities in 2019 (pre-COVID) and 2022 (post-COVID), along with continued plans for telehealth provision. Findings indicate an overall increase in telehealth services from 2019 to 2022, with urban adopting telehealth more than rural areas (DiD: -16.8%, P=0.037). Primary healthcare services saw a greater increase in urban than in rural clinics (DiD: -20.8%, p=0.005). Mental/behavioral health services also increased, but at a slower rate in rural clinics compared to urban (DiD: -15.9%, p=0.023). While a combination of phone and video calls is the most common (53.3% in urban, 34.3% in rural), phone-only use was significantly higher in rural areas (41.1%) than in urban areas (21.5% p=0.027). Although most clinics plan to continue offering telehealth services, more rural clinics will offer limited services (36.0% urban; 41.6% rural) in the future. These findings highlight that, while telehealth expanded post-pandemic, urban clinics benefited more. Expanding telehealth infrastructure and addressing gaps in rural areas are essential for ensuring equitable healthcare access, particularly for reproductive and mental health services.

Start Time

16-4-2025 1:30 PM

End Time

16-4-2025 4:00 PM

Presentation Type

Poster

Presentation Category

Health

Student Type

Graduate Student - Doctoral

Faculty Mentor

Kate Beatty

Faculty Department

Health Services Management and Policy

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Rural-Urban Disparities in Telehealth Services Provision Post Covid-19 Pandemic in South Carolina and Alabama.

The COVID-19 pandemic accelerated the adoption of telehealth services across the US, particularly in rural areas where access to healthcare is often constrained by distance, income, internet access, and time. This study investigates the variation in telehealth services between urban and rural health department (HD) and federally qualified health center (FQHC) clinics in Alabama (AL) and South Carolina (SC) from 2019 to 2022. The objective is to assess disparities in telehealth adoption, modalities, and sustainability disparities before and after the COVID-19 pandemic. Using survey data from HD and FQHC clinics in SC and AL on telehealth services, chi-square tests, and difference-in-differences (DiD) analysis were conducted. The DiD approach, utilizing generalized estimating equations and modified Poisson regression, assessed changes in telehealth service provision between rural and urban clinics over time. The analysis compared telehealth service provision and modalities in 2019 (pre-COVID) and 2022 (post-COVID), along with continued plans for telehealth provision. Findings indicate an overall increase in telehealth services from 2019 to 2022, with urban adopting telehealth more than rural areas (DiD: -16.8%, P=0.037). Primary healthcare services saw a greater increase in urban than in rural clinics (DiD: -20.8%, p=0.005). Mental/behavioral health services also increased, but at a slower rate in rural clinics compared to urban (DiD: -15.9%, p=0.023). While a combination of phone and video calls is the most common (53.3% in urban, 34.3% in rural), phone-only use was significantly higher in rural areas (41.1%) than in urban areas (21.5% p=0.027). Although most clinics plan to continue offering telehealth services, more rural clinics will offer limited services (36.0% urban; 41.6% rural) in the future. These findings highlight that, while telehealth expanded post-pandemic, urban clinics benefited more. Expanding telehealth infrastructure and addressing gaps in rural areas are essential for ensuring equitable healthcare access, particularly for reproductive and mental health services.