Underserved Regions May Coincide With Slower Broadband for Telehealth

Medical teleconsultation with senior female patient. (Photo by: BSIP/Universal Images Group via Getty Images)
During COVID-19, patients living in medically underserved areas can lack adequate Internet speed for video visits.

The following article is a part of conference coverage from the 2021 meeting of the North American Neuro-Ophthalmology Society, being held virtually from February 20 to 23, 2021. The team at Ophthalmology Advisor will be reporting on the latest news and research conducted by these leading experts in neuro-ophthalmology. Check back for more from the NANOS 2021 Meeting.


Video telemedicine — especially for neuro-ophthalmology — substantially increased in 2020, at the height of COVID-19 restrictions, but patients who live in medically underserved regions may often be those who also lack broadband speed for virtual appointments, according to Indiana University School of Medicine researchers who presented at the 2021 North American Neuro-Ophthalmology Society Annual Meeting. The multi-center retrospective case series compared 2 periods: March 15, 2019 to June 15, 2019 and March 15, 2020 to June 15, 2020.

Investigators examined the bandwidth needed for standard and high definition online video, trends in telemedicine use, and locations of health professional shortage areas (HPSAs) and medically underserved areas and populations (MUA/P). Availability for low- and high-speed broadband was then compared with neuro-ophthalmology patient visits in Indiana at 2 academic and private practices during the 2019 study period, and 3 facilities in 2020. 

In-person office visits decreased from 100% (n=456) of appointments in spring 2019 to 71.8% (n=257) of all visits from March 2020 to June 2020. Video appointments went from 0 in 2019 to 23.7% (n=85) of all visits by June 2020. In addition to video, there were 12 telephone visits and 4 inter-professional eConsults in 2020, Drs. Lai and Chauhan added. “Data quality was the greatest perceived barrier to video telemedicine,” according to investigators..

Of the total study population, patients who lived within a designated HPSA resided an average of 65.7 miles from their physician, those who lived in MUA regions were a mean 66.8 miles from the clinic, and patients in more well-resourced areas drove 37.3 miles on average for in-person appointments. 

Importantly, patients who lived in medically underserved communities were more likely to seek telehealth — 32.1% of those who lived in HPSA areas had a virtual appointment in spring 2020 and 27.4% of those living in an MUA region visited via video. Only 25.7% of patients living in well-served proximities used telehealth. In looking at internet speed, more clinicians offered standard definition at 2 Mbps: a mean number of 5.0 served HPSA regions, 5.2 for MUA areas, and an average of 5.8 in non-HPSA/MUA locations. For broadband providers featuring high definition (HD) 10 Mbps, an average of 2.2 served HPSA-specified areas, 2.6 in MUA regions, while 3.2 offered HD in non-HPSA and MUA locales.

The research concludes that patients in locations that are sufficiently health-resourced locations lived nearer to their ophthalmologist and had more access to HD video speeds than those who lived in underserved regions. This brings about an incongruity, as those living in ophthalmology-underserved areas also used telehealth more than those in well-served communities, according to the investigators.

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Chauhan D, Ko MW, Moss HE, Mackay DD, Lai KE. Broadband access in tele-neuro-ophthalmology. Presented at: North American Neuro-Ophthalmology Society Annual Meeting; February 20-23, 2021. Abstract Poster 80.