Patient and Provider Perceptions of COVID-19-Driven Telehealth Use From Nurse-Led Care Models in Rural, Frontier, and Urban Colorado Communities

Abstract

The purpose of this study was to characterize the patient and provider engagement in the sudden telehealth implementation that occurred with the onset of the COVID-19 pandemic. Patients and providers from 3 nurse-led models of care (federally qualified health centers, nurse midwifery practices, and the Nurse-Family partnership program) in Colorado were surveyed. Data from the Patient Attitude toward Telehealth survey and Provider Perceptions about Telehealth were collected. Patient respondents (n = 308) who resided primarily in rural or frontier communities were female, white, and Hispanic. Patients in urban areas used telehealth more frequently than in rural or frontier areas (P < .001). Rural/Frontier patients had significantly lower attitude scores than urban patients across each of 5 domains assessed. Telehealth modality differed across location (P < .023), with video calls, used more frequently by urban providers, and phone calls used by rural/frontier providers. Our data highlight differences in telehealth access and attitudes across rurality. These findings may contribute to future policy while addressing barriers to telehealth access and delivery.

Keywords: nurse models of care; practice patterns; rural health services; telehealth; vulnerable populations.

Figure 1.

Patient perceptions regarding trust in telehealth services provided by nurse-led sites by place of patient's residence (location). Each P value tests if the urban distribution is significantly different than the rural/frontier distribution for each PATAT score using the Kruskal-Wallis test. Missing data due to lack of self-reporting varied by item. Actual counts per paired variable score are frontier/rural (N = 186-191) and urban (N = 77-88). Presented P values were corrected for multiple comparisons using the Benjamini-Hochberg False Discovery Rate (FDR) method.

Figure 2.

Clinician perceptions—percent of providers who thought office versus virtual visit was better for each visit feature. Given P values test if the proportion of providers (N = 83) who prefer Virtual Visits is significantly different than the proportion of providers who prefer Office Visits for each question. A χ² goodness-of-fit test assuming a multinomial distribution, conditioned on the number of providers who reported “No Difference,” was used to test this hypothesis for each question. *P values were conducted as post hoc analyses so were not corrected for multiple testing.