Maine Rural Health Research Center, Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine, Portland, Maine.
J Rural Health. 2019 Jun;35(3):298-307. doi: 10.1111/jrh.12324. Epub 2018 Oct 4.
Few studies have examined telehealth use among rural Medicaid beneficiaries. This study produced a descriptive overview of telehealth use in 2011, including the prevalence of telehealth use among rural and urban Medicaid beneficiaries, characteristics of telehealth users, types of telehealth services provided, and diagnoses associated with telehealth use.
Using data from the 2011 Medicaid Analytic eXtract (MAX), we conducted bivariate analyses to test the associations between rurality and prevalence and patterns of telehealth use among Medicaid beneficiaries.
Rural Medicaid beneficiaries were more likely to use telehealth services than their urban counterparts, but absolute rates of telehealth use were low-0.26% of rural nondual Medicaid beneficiaries used telehealth in 2011. Psychotropic medication management was the most prevalent use of telehealth for both rural and urban Medicaid beneficiaries, but the proportion of users who accessed nonbehavioral health services through telehealth was significantly greater as rurality increased. Regardless of telehealth users' residence, mood disorders were the most common reason for obtaining telehealth services. As rurality increased, significantly higher proportions of telehealth users received services to address attention-deficit/hyperactivity disorder (ADHD) and other behavioral health problems usually diagnosed in childhood.
These findings provide a baseline for further policy-relevant investigations including examinations of changes in telehealth use rates in Medicaid since 2011. Reimbursement policies and unique rural service needs may account for the observed differences in rural-urban Medicaid telehealth use rates.
鲜有研究调查农村医疗补助受助人的远程医疗使用情况。本研究对 2011 年远程医疗的使用情况进行了描述性概述,包括农村和城市医疗补助受助人远程医疗使用的流行率、远程医疗使用者的特征、提供的远程医疗服务类型以及与远程医疗使用相关的诊断。
利用 2011 年医疗补助分析提取(MAX)的数据,我们进行了双变量分析,以检验农村和城市医疗补助受助人之间远程医疗使用的流行率和模式的相关性。
农村医疗补助受助人比城市医疗补助受助人更有可能使用远程医疗服务,但远程医疗的绝对使用率较低——2011 年农村非双重医疗补助受助人中有 0.26%使用了远程医疗。精神药物管理是农村和城市医疗补助受助人最常见的远程医疗使用方式,但随着农村地区的增加,通过远程医疗获得非心理健康服务的用户比例显著增加。无论远程医疗用户的居住地点如何,情绪障碍都是获得远程医疗服务的最常见原因。随着农村地区的增加,接受注意力缺陷/多动障碍(ADHD)和其他通常在儿童期诊断的行为健康问题治疗服务的远程医疗用户比例显著增加。
这些发现为进一步的政策相关调查提供了基础,包括对自 2011 年以来医疗补助中远程医疗使用率变化的检查。报销政策和独特的农村服务需求可能解释了农村和城市医疗补助中远程医疗使用率的差异。