December 11, 2024 | Erin Bluvas, bluvase@sc.edu

A new study from the Rural and Minority Health Research Center has found continuing disparities in telehealth usage despite the push to adopt alternative health care methods during the COVID-19 pandemic. The researchers found that while the use of hybrid prenatal care (i.e., telehealth and in-person visits) increased among Black and Hispanic groups, rural communities still lag behind urban populations in uptake.

“We looked at the electronic health records of nearly 350,000 pregnancies in the U.S. from 2018 to 2022,” says Peiyin Hung, lead author on the study and co-director for the center. “Hybrid care increased from nearly none in 2018, peaking at 8.1 percent in 2020 before decreasing to 6.2 percent in 2022. This was a significant increase – particularly for Black and Hispanic individuals – but overall rates remain low, and the rural-urban gap persists.”

 

Urban residents were nearly twice as likely to utilize hybrid prenatal care compared to rural individuals. Hispanic, Asian and Black pregnant people were more likely to receive this type of care than their white peers.

Published in JAMA Network Open, this research built on findings from a 2023 study where the authors described the dual barriers to maternity care for socially disadvantaged communities: travel burden and digital access. The new paper extends this work by looking at the use of telehealth and in-person prenatal care services for different groups.

The team analyzed data from the National COVID Cohort Collaborative Data Enclave, which included health records from 75 health institutions across all 50 states. They found that urban residents were nearly twice as likely to utilize hybrid prenatal care compared to rural individuals. Hispanic, Asian and Black pregnant people were more likely to receive this type of care than their white peers.

“Prenatal care is crucial for the nearly four million individuals who give birth each year in the U.S.,” Hung says. “Barriers to accessing this care can adversely impact maternal and neonatal health.”

Nationally, Black and Hispanic individuals are more likely to receive no prenatal care compared to white birthing individuals. Across all groups, those living in rural areas face additional barriers such as traveling longer distances for appointments – leading to delayed prenatal care, lesser care and poorer outcomes compared to those living in urban areas.

While some prenatal care is best provided in person, multiple federal agencies (e.g., U.S. Department of Health and Human Services) and professional associations (e.g., American College of Obstetricians and Gynecologists) have endorsed telehealth as a viable option for certain aspects of prenatal care (e.g., counseling patients, monitoring chronic conditions, offering social/mental health support, interpreting ultrasound/laboratory results). Telehealth can also connect rural patients with specialists who are less likely to be locally accessible.

During the COVID-19 pandemic, the relaxation of insurance and medical practice policies and the encouragement of government and professional agencies led to more widespread availability of telehealth. However, rural residents may have lagged in their uptake of telehealth due to insufficient broadband infrastructure, limited device access and lower acceptability of using telecommunication for health care.

“Our findings reveal the limited use of hybrid prenatal care, suggesting that the full potential of telehealth for prenatal care has not been achieved, particularly in bridging the rural-urban divide in access,” Hung says. “With this in mind, there is an urgent need to develop strategies that improve equitable access to telehealth for rural communities to address these disparities and optimize prenatal care across diverse populations.”

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