More Patients Turning To Telehealth, But Rural Communities Face Barriers

Apr 1, 2020

Coverage of novel coronavirus is supported by the Mick Hitchcock, Ph.D., Project for Visualizing Science, a science reporting project from the Reynolds School of Journalism.

As the novel coronavirus threatens health care capacity in Nevada, more doctors are turning to telehealth to stem the spread of infection. While virtual visits are recommended, there are challenges to this type of care, especially in rural communities.

In 2018, the University of Nevada, Reno School of Medicine, in partnership with Nevada Health Centers, opened up a residency program in Elko to increase access to primary care.

Dr. Daniel Spogen is a family doctor and the chair of the University of Nevada, Reno School of Medicine Department of Family and Community Medicine. He oversees the Elko clinic, which provides outpatient care services and is staffed by two primary care doctors and four residents.

“Prior to all of these issues with the virus, we had really no primary care providers out in Elko,” Spogen said. “There was one primary care provider that was totally booked and basically there wasn't any available appointments. Largely the patients in Elko kind of even forgot what a primary care physician was. They just went to the emergency room for all their primary care needs.”

Spogen said the lack of access to primary care is an issue throughout the state, but is especially acute in rural communities. Slightly more than 80% of Nevadans live in a designated Health Professional Shortage Area, according to the University of Nevada School of Medicine.

And now, amid the pandemic, public health officials are recommending people exhibiting symptoms — like fever and cough — to use telehealth for medical guidance.

Spogen said virtual visits could help alleviate some access to care issues in the long run.

“Especially in Elko, some of our patients live a hundred miles away from Elko,” Spogen explained. “So some of those visits might be better virtually.”

But there are drawbacks, too. Not all medical situations can be solved by a telehealth visit, for example, in cases when a provider needs to listen to a patient’s heart or to mend a broken bone.

“Some of my patients are very much into being able to see and touch, and recognize that someone is listening. Some of my patients are socially isolated themselves. They don't have very many people that they interact with, and so for these patients, the telemedicine can be difficult,” said Dr. Jacqueline Huynh, a family doctor at the clinic in Elko.

During this pandemic, Huynh is trying to keep high-risk patients home.

She identified her most vulnerable patients a few weeks ago and recommended patients without urgent medical needs to postpone or reschedule appointments.

This week, providers at her clinic received training in telehealth and the clinic is offering phone visits as an alternative to in-person care.

“The patients still have the same schedule and appointment time, but instead of coming in, someone from the clinic will call them,” Huynh said. “Once they’ve gone through that process, my medical assistant will get their primary story. Like, ‘Hey, what do you want to have done from your visit today, is this just medicine refills?’ ”

Huynh said virtual visits work well for chronic disease management, in which patients require straightforward follow-up care, like medication refills.

But there are roadblocks to providing this type of care. In rural communities, the lack of high-speed broadband internet hampers the ability to provide telehealth with video capabilities, because it requires more bandwidth.

According to a 2016 Nevada Broadband Task Force report, 65% of the rural population in the state lack access to broadband.

Huynh said that even with phone visits, poor cell service and the lack of financial resources for some of her patients are still barriers.

“Some of our patients don't pick up the phone because they don’t know who’s calling and they can't afford to lose the minutes. Other of our patients are living in areas that have spotty connections,” Huynh explained. “Telemedicine may or may not be the best model for our patients.”

Dr. Trudy Larson is the dean of the UNR School of Community Health Sciences and a pediatric infectious disease specialist. She said prior to the pandemic, telemedicine has been underutilized.

Since public health measures during the pandemic include an increased use in telehealth, Larson said the medical community will gain valuable lessons.

“We will learn a better way of triaging patients: who can stay home, who needs to be admitted, who needs to go to sort of an intermediate, moderate on the phone call kind of care. I think we will learn better,” Larson said, “I know we will be much better at telemedicine when we come to the end of this pandemic. And that's a real positive for being able to increase access to care for patients.”

The recent $2 trillion CARES Act, the coronavirus relief bill passed by Congress in response to the pandemic, includes several telehealth provisions. The bill expands coverage so more Medicare beneficiaries can access telemedicine. In addition, more providers at community health centers, like the one in Elko, will be able to bill for telemedicine visits. Funding is also allocated to improve broadband services.