Determining the Impact of Telehealth on Rural and Remote Health Care Service Delivery in Canada

Abstract

There are disparities in health status and outcomes between rural and remote residents and their urban counterparts, and these disparities are caused in part by inequitable access to health services. For decades provincial and territorial decision makers have implemented numerous health human resource policies, most commonly financial incentives, to attract health providers to rural and remote areas to alleviate the inequity of access. The effect of these policies has been temporary in that health providers responding to these incentives rarely established permanent practices in rural and remote communities. In addition, these policies rarely address the fact that specialized health services and infrastructure are highly concentrated in urban centres. In recent decades, decision makers have explored the use of information and communication technology via provincial and regional telehealth programs to provide more specialized health services that were previously unavailable in underserviced communities. Using the widely adopted Triple Aim framework developed by the Institute for Healthcare Improvement, three modes of telehealth (telemedicine, health help lines, and online mental health therapy) are evaluated for their ability to simultaneously improve population health through improved access and improve the patient experience in rural and remote areas while maintaining or decreasing the per capita costs of health care. The analysis showed that telehelath does have the ability to improve access to health services, but low utilization, especially among provinces with high percent rurality, would indicate that its impact on access has been minimal. Additionally, there is evidence that health help lines may actually increase disparities by increasing the number of unnecessary visits to physicians and emergency departments. Data on changes in health status as a result of telehealth use is not available, and health outcomes have only been assessed as part of pilot projects and thus are not generalizable to telehealth as a whole. To date studies evaluating the cost savings of telehealth have been flawed and thus no determination could be made regarding telehealth’s ability to decrease the cost of care of rural and remote residents. Although telehealth has had minimal impact on improving access to care of rural and remote residence, research does demonstrate its promise in delivering care at a distance. Policies are in place to enable its use more broadly, but most jurisdictions lack implementation strategies that elicit the growth of telehealth. Jurisdictions must work together to collectively define telehealth, determine its goals and objectives, and then assign appropriate modes of telehealth to meet the needs of the population being served. Additionally, provincial and territorial telehealth programs would benefit from rigorous program evaluations and academic research to ensure effective service provision. Most importantly, provincial telehealth programing would benefit from the creation of a centralized governance structure whereby economies of scale can be leveraged in the procurement of technology, provision of consistent training and technical support, and coordination of care across the province or territory. Telehealth programing is a mechanism by which provincial and territorial health ministries can use to improve service provision in rural and remote areas, but more work is needed to translate telehealth’s potential benefits into realized gains for rural and remote residents.