VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.
Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA.
J Rural Health. 2024 Jun;40(3):438-445. doi: 10.1111/jrh.12805. Epub 2023 Nov 7.
The expansion of telemedicine (e.g., telephone or video) in the Veterans Health Administration (VA) raises concerns for health care disparities between rural and urban veterans. Factors impeding telemedicine use (e.g., broadband, digital literacy, age) disproportionally affect rural veterans.
To examine veteran-reported broadband access, internet use, familiarity with, and preferences for telemedicine stratified by residential rurality.
Three hundred fifty veterans with a VA primary care visit in March 2022 completed a 30-min computer-assisted telephone interview. The sampling design stratified veterans by residential rurality (i.e., rural or urban) and how primary care was delivered (i.e., in-person or by video). Counts and weighted percentages are reported.
After accounting for survey weights, 96.2% of respondents had in-home internet access and 89.5% reported functional connection speeds. However, rural- compared to urban-residing veterans were less likely to experience a telemedicine visit in the past year (74.1% vs. 85.2%; p = 0.02). When comparing telemedicine to in-person visits, rural versus urban-residing veterans rated them not as good (45.3% vs. 36.8%), just as good (51.1% vs. 53.1%), or better (3.5% vs. 10.0%) (p = 0.05). To make telemedicine visits easier, veterans, regardless of where they lived, recommended technology training (46.4%), help accessing the internet (26.1%), or provision of an internet-enabled device (25.9%).
Though rural-residing veterans were less likely to experience a telemedicine visit, the same actionable facilitators to improve telemedicine access were reported regardless of residential rurality. Importantly, technology training was most often recommended. Policy makers, patient advocates, and other stakeholders should consider novel initiatives to provide training resources.
退伍军人事务部（VA）远程医疗（例如电话或视频）的扩展引起了人们对农村和城市退伍军人之间医疗保健差距的关注。阻碍远程医疗使用的因素（例如宽带、数字素养、年龄）不成比例地影响了农村退伍军人。
根据居住的农村或城市地区，检查退伍军人报告的宽带接入、互联网使用情况、对远程医疗的熟悉程度和偏好。
2022 年 3 月，350 名在退伍军人事务部接受初级保健就诊的退伍军人完成了 30 分钟的计算机辅助电话访谈。抽样设计按居住农村地区（即农村或城市）和初级保健提供方式（即面对面或视频）对退伍军人进行分层。报告了计数和加权百分比。
在考虑调查权重后，96.2%的受访者家中有互联网接入，89.5%的受访者报告了功能连接速度。然而，与城市居住的退伍军人相比，农村居住的退伍军人在过去一年中接受远程医疗就诊的可能性较小（74.1%与 85.2%；p=0.02）。在将远程医疗与面对面就诊进行比较时，农村与城市居住的退伍军人对其评价不如面对面就诊（45.3%与 36.8%），与面对面就诊一样好（51.1%与 53.1%），或者更好（3.5%与 10.0%）（p=0.05）。为了使远程医疗就诊更容易，无论居住在哪里，退伍军人都推荐提供技术培训（46.4%）、帮助获取互联网（26.1%）或提供启用互联网的设备（25.9%）。
尽管农村居住的退伍军人接受远程医疗就诊的可能性较小，但无论居住在农村还是城市，都报告了相同的改善远程医疗获取的可行措施。重要的是，技术培训是最常被推荐的。政策制定者、患者权益倡导者和其他利益相关者应考虑提供培训资源的新举措。
