Scaling-Up Telehealth During the COVID-19 Pandemic: Missed Opportunities to Leverage Spatial Data to Ascertain the Rural Reach of Services.

To the Editors:

In their recent article, Wood et al [1] described the first month of telehealth scale-up for adolescent medicine at an academic medical center during the novel coronavirus disease 2019 (COVID-19) pandemic. They reported that telehealth patients were most concentrated in the ZIP codes surrounding their urban clinic and concluded that the need for adolescent telehealth services will be greatest in low-resource clinical settings, including rural areas.

We applaud the efforts of Wood et al [1] to rapidly expand telehealth services during the COVID-19 pandemic and agree that rural residents are among the low-resource, medically underserved populations that could benefit from telehealth expansion. Unfortunately, the authors did not present data specific to rural adolescents in their study, which would have been valuable for gauging the rural reach of their telehealth scale-up. Assessing the rural reach was possible given that the authors used ZIP code data to map the “geographic range and density” of their telehealth scale-up. Reporting level of rurality at the ZIP code level—an appropriate and feasible approach suggested by rural health researchers [2]—would have enabled Wood et al [1] to identify rural-urban differences in visit completion rates. This would have provided insight about whether their telehealth scale-up was successful across different geographic settings. It is possible that their study was based on an exclusively urban sample, which is contextually important and has implications for the authors’ conclusions.

As researchers continue to report on telehealth expansion during the COVID-19 pandemic and into the future, we encourage them to collect and report data on rural populations. Such data will inform the development and implementation of telehealth services for rural patients who more often lack timely and convenient access to health services compared with their urban counterparts. Findings originating from exclusively urban samples are inadequate for determining how telehealth can be used to address the needs of rural residents and may risk exacerbating existing disparities in healthcare access and outcomes among rural populations. It is imperative that rural youth, who die by suicide at nearly double the rate of urban youth, [3] not be overlooked as telehealth is expanded and evaluated at an unprecedented rate in the wake of the COVID-19 pandemic.