农村远程医疗服务的差异可能是由于远程医疗获取方面的差异，而不是服务使用意愿的差异。
Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities.
机构信息
Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.
University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, San Francisco, California, USA.
出版信息
J Rural Health. 2023 Jun;39(3):617-624. doi: 10.1111/jrh.12759. Epub 2023 Apr 12.
PURPOSE
Although telehealth access and utilization have increased during the pandemic, rural and low-income disparities persist. We sought to assess whether access or willingness to use telehealth differed between rural and non-rural and low-income and non-low-income adults and measure the prevalence of perceived barriers.
METHODS
We conducted a cross-sectional study using COVID-19's Unequal Racial Burden (CURB) online survey (December 17, 2020-February 17, 2021), which included 2 nationally representative cohorts of rural and low-income Black/African American, Latino, and White adults. Non-rural and non-low-income participants from the main, nationally representative sample were matched for rural versus non-rural and low-income versus non-low-income comparisons. We measured perceived telehealth access, willingness to use telehealth, and perceived telehealth barriers.
FINDINGS
Rural (38.6% vs 44.9%) and low-income adults (42.0% vs 47.4%) were less likely to report telehealth access, compared to non-rural and non-low-income counterparts. After adjustment, rural adults were still less likely to report telehealth access (adjusted prevalence ratio [aPR] = 0.89, 95% CI = 0.79-0.99); no differences were seen between low-income and non-low-income adults (aPR = 1.02, 95% CI = 0.88-1.17). The majority of adults reported willingness to use telehealth (rural = 78.4%; low-income = 79.0%), with no differences between rural and non-rural (aPR = 0.99, 95% CI = 0.92-1.08) or low-income versus non-low-income (aPR = 1.01, 95% CI = 0.91-1.13). No racial/ethnic differences were observed in willingness to use telehealth. The prevalence of perceived telehealth barriers was low, with the majority reporting no barriers (rural = 57.4%; low-income = 56.9%).
CONCLUSIONS
Lack of access (and awareness of access) is likely a primary driver of disparities in rural telehealth use. Race/ethnicity was not associated with telehealth willingness, suggesting that equal utilization is possible once granted access.
目的
尽管在大流行期间远程医疗的可及性和使用率有所提高，但农村和低收入人群的差距仍然存在。我们旨在评估农村和非农村以及低收入和非低收入成年人在获得远程医疗或使用远程医疗的意愿方面是否存在差异，并衡量感知障碍的普遍程度。
方法
我们使用 COVID-19 的不平等种族负担（CURB）在线调查进行了一项横断面研究（2020 年 12 月 17 日至 2021 年 2 月 17 日），该调查包括两个具有全国代表性的农村和低收入的黑/非裔美国、拉丁裔和白人成年人队列。来自主要全国代表性样本的非农村和非低收入参与者与农村与非农村和低收入与非低收入进行了匹配。我们衡量了远程医疗可及性、使用远程医疗的意愿和感知的远程医疗障碍。
结果
与非农村和非低收入成年人相比，农村（38.6% 比 44.9%）和低收入成年人（42.0% 比 47.4%）更不可能报告获得远程医疗。调整后，农村成年人报告获得远程医疗的可能性仍然较低（调整后患病率比 [aPR] = 0.89，95%CI = 0.79-0.99）；低收入成年人与非低收入成年人之间未见差异（aPR = 1.02，95%CI = 0.88-1.17）。大多数成年人表示愿意使用远程医疗（农村 = 78.4%；低收入 = 79.0%），农村与非农村之间没有差异（aPR = 0.99，95%CI = 0.92-1.08）或低收入与非低收入之间（aPR = 1.01，95%CI = 0.91-1.13）。在使用远程医疗的意愿方面，没有观察到种族/民族差异。感知远程医疗障碍的流行程度较低，大多数人报告没有障碍（农村 = 57.4%；低收入 = 56.9%）。
结论
缺乏获取（和对获取的认识）可能是农村地区远程医疗使用差异的主要驱动因素。种族/民族与远程医疗意愿无关，这表明一旦获得远程医疗，就有可能实现平等利用。
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