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Study Proves Value of Telehealth in Addressing Rural Health Disparities

Analysis  |  By Eric Wicklund  
   June 17, 2022

A three-year study in rural Alaska has shown that a telehealth program can help children access specialist services for hearing issues much better than the traditional in-person referral process.

A telehealth program in Alaska that enabled rural children to access hearing specialists is proof that the platform can reduce rural disparities in access to care, according to supporters.

The Hearing Norton Sound study, conducted in 15 rural Alaskan communities from 2017-20, allowed children to connect with specialists for diagnosis and treatment of hearing problems. Roughly 1,500 children in the Bering Strait School District in the northwest part of the state participated in the study, and those using telehealth were treated to follow-up care 17.6% faster than those receiving standard primary care referrals.

“This trial has notable broad public health implications,” Susan D. Emmett, MD, MPH, director of the University of Arkansas for Medical Sciences (UAMS) Center for Hearing Health Equity, which conducted the study, said in a press release. “While we focused on school hearing screening, the model of specialty telemedicine referral is applicable to other preventable health conditions. Importantly, this novel telemedicine model promotes early access to specialists in an effort to decrease health disparities.”

According to the study, participating students were split into two groups, with one group accessing specialists via telehealth and the other group being referred for in-person follow-ups. Almost 70% of those using virtual care were able to meet with specialists, researchers said, while only 30% in the other group were able to get follow-up care.

“Childhood hearing loss has well known, profound implications for language development, school achievement and future employment opportunities,” the study reported. “Some populations experience a disproportionately high burden of childhood hearing loss, including rural Alaska Native children, among whom there is a prevalence of up to 31% compared with 1.7-5% in the general US population.”

Emmett, an associate professor in the UAMS College of Medicine Department of Otolaryngology-Head and Neck Surgery and the Fay W. Boozman College of Public Health Department of Epidemiology, partnered with Samantha Kleindienst Robler, PhD, AuD, the Center for Hearing Health Equity's associate director and an assistant professor in the UAMS College of Medicine Department of Otolaryngology-Head and Neck Surgery, on the study. Robler is also a population health researcher at the Norton Sound Health Corporation, a tribally owned and operated independent not-for-profit organization that served as the tribal health partner for the study.

The study targets a common barrier to care in rural parts of the country: a lack of specialists, many of which are clustered around urban areas and cities. To address this imbalance, health systems are setting up telemedicine platforms that allow them to connect with rural providers, such as health clinics and primary care providers, and provide specialists for virtual visits.

Emmett said the study, which was recently published in The Lancet, has implications for any rural part of the country, if not the world, where access to specialists is infrequent and challenging.

“Even if children are identified with hearing loss at school, they often never receive the care that they need," she said. "This loss to follow-up from school screening programs, as well as a dearth of specialists in rural areas, exacerbate barriers to care for rural children."

“The purpose of this study was to test whether telemedicine can address this challenge, providing a way for rural children to promptly enter the health care system to receive the specialty care they need,” she added.

Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.

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