Background

About one-fifth of all people in the United States live in rural areas. Health disparities continue to be a pressing issue for rural communities, where there are increased mortality rates, a higher prevalence of diseases, and lower life expectancy than in urban areas.

While the underlying causes of such disparities are complex, social determinants of health (e.g., access to care, education, and income) play an important role. An estimated 22.2 million rural residents live in areas with a shortage of health care providers. A national survey of rural health stakeholders highlighted access to emergency services, primary care, and health insurance as high-priority needs within rural populations.

Telehealth—the use of information and telecommunications technology to provide care across time and distance—has enormous potential to enhance rural health and health care over the coming decades. Telehealth-guided collaboration between health care providers can increase access to certain services and improve health outcomes. Provider-to-provider telehealth supports clinicians through consultations, mentoring, continuing medical education, and other services to improve the overall delivery and quality of health care to patients, especially in underserved rural populations.

Challenges

Nationwide acceptance of telehealth has accelerated over the years, particularly during the COVID-19 pandemic. However, more research is needed to better understand how provider-to-provider telehealth affects patients, populations, health care providers, and payers in rural areas. We need to explore the effectiveness of telehealth-guided clinical decision-making, as well as its timeliness for improving health outcomes for rural patients. It is also important to identify barriers and facilitators to the implementation and dissemination of telehealth-guided provider-to-provider communication and develop evidence-based delivery strategies to ensure that the use of telehealth in rural areas is sustainable. Generating additional evidence on the practicality of provider-to-provider telehealth will help identify new approaches to expand and improve telehealth in rural areas where it will have the greatest impact nationally and globally. 

Key Questions

Speakers in this P2P workshop assessed the scientific evidence to better understand what is and is not known about the effectiveness of telehealth-guided provider-to-provider communication to improve health outcomes in rural settings by addressing the key questions listed below.

1. What is the uptake of different types of provider-to-provider telehealth in rural areas?
2. What is the effectiveness of provider-to-provider telehealth for rural patients?
3. What strategies are effective and what are the barriers and facilitators to implementation and sustainability of provider-to-provider telehealth in rural areas?
4. What are the methodological weaknesses of studies of provider-to-provider telehealth for rural patients and what improvements in study design (e.g., focus on relevant comparisons and outcomes) might increase the impact of future research?

Sponsoring Organizations

• National Center for Advancing Translational Sciences, NIH
• National Heart, Lung, and Blood Institute, NIH
• Office of Disease Prevention, NIH
• Federal Office of Rural Health Policy, Health Resources & Services Administration
• Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention