Jan 13, 2025
RTRC Telehealth Policy Brief Highlights Need for More Health Equity Focused Research
Center for Connected Health
In December 2024, the Rural Telehealth Research Center (RTRC) released a Research and Policy Brief titled, The Role of Relaxed Telehealth Policy on Health Equity in Telehealth Utilization and Outcomes During the COVID-19 Public Health Emergency: A Living Systematic Review. The brief underscores the significant telehealth policy changes that have occurred since the beginning of the COVID-19 pandemic as the foundation for enabling the ability to better understand the variety of implications of increased telehealth use, such as access to care, health outcomes, and cost. For this study in particular, the RTRC sought to conduct a systematic review of the ways in which telehealth has been shown to address health disparities.
The RTRC research builds upon a 2022 Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth (OAT) funded project related to living systematic reviews (LSRs) describing the current evidence to determine the relationship between telehealth use during the COVID-19 PHE and health equity. The brief outlines the LSR findings and describes its LSR process, including convening an expert panel to determine the questions and research priorities to include in its systematic review searches. Overall, RTRC conducted three systematic reviews with a primary and secondary (“living”) follow-up search to summarize the best evidence available related to the following three focus questions:
- How did telehealth clinical and operational effectiveness during the COVID-19 PHE compare in rural vs. urban areas and in other underserved communities (racial/ethnic, socioeconomic status, etc.) among patients with behavioral health and substance use disorder needs?
- How did telehealth access or utilization during the COVID-19 PHE compare in rural vs. urban areas and in other underserved communities (racial/ethnic, socioeconomic status, etc.)?
- How did telehealth costs to health systems and insurers during the COVID-19 PHE compare in rural vs. urban areas and in other underserved communities (racial/ethnic, socioeconomic status, etc.)?
The RTRC brief acknowledges several limitations impacting its findings, such as a lack of health equity studies summarizing the clinical effectiveness of telehealth as a modality of care delivery, though such studies did increase over the course of the pandemic. RTRC’s search conclusions found that while increased telehealth use did occur for mental health/substance use disorder, widening disparities in use were also shown, and in terms of overall access to care, telehealth use was not found to be associated with reduced disparities for socially vulnerable populations. In addition, RTRC found that most cost-focused studies did not directly assess health equity issues, though cost studies did determine that during the PHE patient telehealth costs were greatly reduced and overall health care costs were largely unchanged. Overall, the RTRC brief suggests that studies focusing on health equity should be prioritized to increase the data available related to social determinants of health and health equity. Any assessment of the role of relaxed telehealth policy on health equity also should potentially consider the delayed release of claims-based data sets that telehealth research is typically based upon, as well as the delayed release of research in peer-reviewed journals. Additionally, the ability to decipher other significant changes and existing disparities that may also be occurring at the same time within studied health systems will be critical to building a better research landscape and understanding around the interaction between telehealth policy and health equity.
For more information on the RTRC study, please read the Research and Policy Brief in its entirety. |
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