Grace Abbott School of Social Work, University of Nebraska Omaha, Omaha, NE, United States.
Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States.
J Med Internet Res. 2024 Nov 28;26:e53320. doi: 10.2196/53320.
Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients' access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address health care access barriers and enhance health outcomes, there are still disparities in the accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated.
This study aims to identify factors associated with ever use of telehealth in Nebraska, a primarily rural state with a significant portion of its population living in nonmetropolitan areas.
A stratified random sample of Nebraska households (n=5300), with oversampling of census tracts with at least 30% African American, Hispanic, or Native American populations, received a mailed survey (English and Spanish) with web-based response options about social determinants of health and health care access (October 2020-March 2021). Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes or no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence odds ratios (POR) with 95% CIs of telehealth use after controlling for socioeconomic, demographic, and health conditions.
The overall response rate was 20.8% (1101/5300). About 25.5% of Nebraska adults had ever used telehealth (urban 26.4%, rural 20.8%), despite 97% of respondents reporting internet access (98.3% urban, 90.5% rural). In the chi-square analysis, telehealth use was statistically significantly more common (P<.05) among those who are aged <45 years (32.4%), female (30.7%), and non-Hispanic (25.9%); with at least a bachelor's degree (32.6%); who had a routine checkup (30.2%) or health care visit other than a routine checkup (34.2%); and with any chronic health conditions (29.6%) but did not differ (P≥.05) by race, marital status, income, insurance, having a primary care provider, or 1-way travel time for medical visits. In univariate models, internet access, age, sex, ethnicity, education, any health care visit in the past year, and no chronic health condition were significant (P<.05). When adjusted, education (POR 1.87, 95% CI 0.33-10.63) and sex (1.38, 0.93-2.04) were not significant, but internet access (5.43, 1.62-18.16), age <45 (5.33, 2.22-12.81) and 45-64 years (9.05, 2.37-34.62), non-Hispanic ethnicity (7.40, 2.39-22.90), any health care visit (2.43, 1.23-4.79), and any chronic condition (1.73, 1.09-2.76) were significantly associated with having ever used telehealth.
This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of the digital divide in telehealth access and use. Telehealth use was significantly less prevalent among older adults, people without chronic health conditions, and Hispanic individuals. Targeted interventions that address barriers to telehealth use and improve health care access are warranted.
在全国范围内，COVID-19 推动了远程医疗的采用，以方便患者获得医疗服务，尤其是在居住在地理位置偏远地区的人群中。尽管远程医疗在解决医疗服务获取障碍和改善健康结果方面具有潜在益处，但在远程医疗服务的可及性和利用率方面仍存在差异。因此，应优先确定远程医疗的促进因素和障碍，以确保差异得到缓解而不是加剧。
本研究旨在确定内布拉斯加州使用远程医疗的相关因素，该州主要为农村州，其相当一部分人口居住在非大都市地区。
对内布拉斯加州的家庭（n=5300）进行分层随机抽样，对至少有 30%非裔美国人、西班牙裔或美洲原住民人口的普查区进行过抽样，通过邮寄调查（英语和西班牙语）和基于网络的回复选项，了解健康状况和医疗保健获取的社会决定因素（2020 年 10 月至 2021 年 3 月）。所有计算均使用调查权重。卡方检验用于比较参与者的社会人口统计学、健康和获取变量的远程医疗使用情况（是或否）。在控制社会经济、人口统计学和健康状况后，使用稳健泊松回归模型计算远程医疗使用的患病率比值比（POR）及其 95%置信区间。
总响应率为 20.8%（1101/5300）。约 25.5%的内布拉斯加州成年人曾使用过远程医疗（城市 26.4%，农村 20.8%），尽管 97%的受访者报告他们使用互联网（城市 98.3%，农村 90.5%）。在卡方分析中，远程医疗的使用在以下方面具有统计学意义（P<.05）：年龄<45 岁（32.4%）、女性（30.7%）、非西班牙裔（25.9%）；至少拥有学士学位（32.6%）；有常规检查（30.2%）或除常规检查以外的健康保健访问（34.2%）；以及患有任何慢性健康状况（29.6%），但在种族、婚姻状况、收入、保险、有初级保健提供者或医疗访问的单程旅行时间方面没有差异（P≥.05）。在单变量模型中，互联网访问、年龄、性别、族裔、教育程度、过去一年中的任何医疗保健访问和没有慢性健康状况是显著的（P<.05）。调整后，教育程度（POR 1.87，95%CI 0.33-10.63）和性别（1.38，0.93-2.04）不再显著，而互联网访问（5.43，1.62-18.16）、年龄<45 岁（5.33，2.22-12.81）和 45-64 岁（9.05，2.37-34.62）、非西班牙裔（7.40，2.39-22.90）、任何医疗保健访问（2.43，1.23-4.79）和任何慢性疾病（1.73，1.09-2.76）与曾使用过远程医疗显著相关。
本研究强调了远程医疗使用的差异。尽管覆盖面很高，但互联网访问是远程医疗使用的重要预测因素，这突显了数字鸿沟在远程医疗获取和使用方面的作用。远程医疗的使用在年龄较大的成年人、没有慢性健康状况的人和西班牙裔个体中明显较少。需要采取有针对性的干预措施，以解决远程医疗使用的障碍并改善医疗保健的获取。
