Digital divide and health professional shortages: telehealth access for chronic disease management in rural Florida

Abstract

Background: This study examines telehealth utilization among Medicare and Medicaid beneficiaries with chronic diseases in geographically vulnerable areas of Florida during COVID-19. Methods: Using a retrospective design, we retrieved visit-level data from a State of Florida Medicaid and Medicare Managed Care Organization from 2019 and 2020; we included 54,927 unique patients. We aggregated telehealth use at the county level and calculated the percentage of patients who used video telehealth in each county during the study period. We used data from the Digital Divide Index (DDI), Health Professional Shortage Area Designations (HPSA), and Florida Health Outcome Rankings to investigate the intersectionality of rurality, digital divide, health professional shortage, health outcome, and telehealth utilization during the pandemic. T-test and regression analyses were used to examine the study objectives. Results: Our results suggested that telehealth visits in non-metro counties were higher than in metro counties before the pandemic (2.84 % vs. 0.61 %, p < 0.001). However, telehealth usage in non-metro counties was lower during the pandemic than in metro counties (35.17 % vs. 40.6 %, p < 0.001). The digital divide was higher in non-metro counties (p-value < 0.001) and negatively associated with telehealth usage in 2020 (p < 0.001). The analysis of health outcomes shows that the digital divide (p < 0.001) and health professional shortage (p = 0.042) were negatively associated with county health outcome rankings. Conclusion: Enhancing telehealth usage in rural regions requires a holistic approach that includes multilevel collaborations, incentives to providers, digital literacy programs, and broadband subsidies.