Understanding rural-urban differences in veterans' internet access, use and patient preferences for telemedicine.

Autor: O'Shea AMJ; 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.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Gibson M; Department of Human Physiology, University of Iowa College of Liberal Arts and Sciences, Iowa City, Iowa, USA., Merchant J; Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA., Rewerts K; Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA., Miell K; Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA., Kaboli PJ; 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.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Shimada SL; Center for Healthcare Organization and Implementation Research (CHOIR), The Bedford VA Medical Center, Bedford, Massachusetts, USA.; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.; Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
Jazyk: angličtina
Zdroj: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association [J Rural Health] 2024 Jun; Vol. 40 (3), pp. 438-445. Date of Electronic Publication: 2023 Nov 07.
DOI: 10.1111/jrh.12805
Abstrakt: Background: 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.
Purpose: To examine veteran-reported broadband access, internet use, familiarity with, and preferences for telemedicine stratified by residential rurality.
Methods: 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.
Findings: 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%).
Conclusions: 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.
(Published 2023. This article is a U.S. Government work and is in the public domain in the USA. The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.)
Databáze: MEDLINE
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