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. 2024 Jun;30(6):e1677-e1688.
doi: 10.1089/tmj.2023.0628. Epub 2024 Mar 8.

Telehealth Trends and Hypertension Management Among Rural and Medicaid Patients After COVID-19

Matthew Mackwood  1   2   3 , Oleksandra Pashchenko  1   4 , Christopher Leggett  3 , Constance Fontanet  5 , Jonathan Skinner  3   6 , Elliott Fisher  1   3
Affiliations

Telehealth Trends and Hypertension Management Among Rural and Medicaid Patients After COVID-19

Matthew Mackwood et al. Telemed J E Health. 2024 Jun.

Abstract

Objective: Examine the associations between rurality and low income with primary care telehealth utilization and hypertension outcomes across multiple years pre- and post-COVID-19 pandemic onset. Methods: We compiled electronic health record data from the mixed rural/urban Dartmouth Health system in New Hampshire, United States, on patients with pre-existing hypertension or diabetes receiving primary care in the period before (January 2018-February 2020) and after the transition period to telehealth during the COVID-19 Pandemic (October 2020-December 2022). Stratifying by rurality and Medicaid enrollment, we examined changes in synchronous (office and telehealth visits, including audio/video use) and asynchronous (patient portal or telephone message) utilization, and control of mean systolic blood pressure (SBP) <140. Results: Analysis included 46,520 patients, of whom 8.2% were Medicaid enrollees, 42.7% urban residents. Telehealth use rates were 12% for rural versus 6.4% for urban, and 15% for Medicaid versus 8.4% non-Medicaid. The overall postpandemic telehealth visit rate was 0.29 per patient per year. Rural patients had a larger increase in telehealth use (additional 0.21 per year, 95% CI, 0.19-0.23) compared with urban, as did Medicaid (0.32, 95% CI 0.29-0.36) compared with non-Medicaid. Among the 38,437 patients with hypertension, SBP control worsened from 83% to 79% of patients across periods. In multivariable analysis, rurality corresponded to worsened control rates compared with urban (additional 2.4% decrease, 95% CI 2.1-2.8%); Medicaid and telehealth use were not associated with worsened control. Conclusions: Telehealth expansion enabled a higher shift to telehealth for rural and low-income patients without impairing hypertension management.

Keywords: equity; medical records; telehealth; telemedicine; vulnerable populations.

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Figures

Fig. 1.
Fig. 1.
Synchronous visit rates over time by group.
Fig. 2.
Fig. 2.
Asynchronous encounter rates over time by group.
See this image and copyright information in PMC

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