Evidence suggests that the novel coronavirus disease 2019 (COVID-19) could have a disproportionate impact on rural areas; rural populations tend to be older, have more chronic health conditions, and have a weaker healthcare infrastructure than urban places.1 An unintended consequence of the novel coronavirus pandemic may be a rapid scale-up of telehealth in rural areas.2 Expanding telehealth in rural areas could have positive long-term effects beyond COVID-19, including assisting with chronic disease prevention and management efforts.
As part of two 5-year cooperative agreements, the South Carolina Department of Health and Environmental Control Division of Diabetes and Heart Disease Management is collaborating with statewide partners to expand telehealth for lifestyle change programs in underserved areas of the state. Among 21 rural health centers in South Carolina counties with the highest burden of diabetes mellitus and heart disease, only 23.8% deliver or receive telehealth services. Most health centers in these counties are interested in delivering telehealth for lifestyle change programs; 62.5% of health centers not offering telehealth services were interested in delivering programs through telehealth such as the National Diabetes Prevention Program, diabetes mellitus self-monitoring education and support, and blood pressure coaching.
Scaling up telehealth in rural areas will require not only buy-in from healthcare facilities but also greater investment in broadband services. Although rural areas have much to gain from telehealth, inaccessible or unreliable Internet access creates a connectivity gap in many places.3 One-fourth of the counties that the Department of Health and Environmental Control is targeting have <65% broadband coverage.4 Rural health centers also may need to partner with facilities that have the capacity to support telehealth infrastructure for lifestyle change programs. For example, the Division of Diabetes and Heart Disease Prevention has found that 61.9% of rural health centers do not have a partnership with a facility where telehealth education can be provided to the public.
COVID-19 will have far-reaching implications for health both globally and locally. As healthcare decision makers look to telehealth to support disease management during the pandemic, we may also leverage these technological innovations to reduce the burden of chronic diseases such as diabetes mellitus and heart disease in rural areas.
Acknowledgments
The author thanks Shauna Hicks, MHS, CHES, and Kristian G. Myers, MPH, CHES, for their assistance with manuscript preparation.
Footnotes
This work was supported by the Centers for Disease Control and Prevention (CDC-RFA-DP18-1815 and CDC-RFA-DP18-1817).
The author did not report any financial relationships or conflicts of interest.
References
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- 4.BroadbandNow. Broadband Internet in South Carolina. Internet access in South Carolina. https://broadbandnow.com/South-Carolina. Updated February 6, 2020. Accessed April 4, 2020.