Rural telemedicine use before and during the COVID-19 pandemic: repeated cross-sectional study.
Open accessPublished version of a preprint
Abstract
Background: The COVID-19 pandemic has led to a notable increase in telemedicine adoption. However, the impact of the pandemic on telemedicine use at a population level in rural and remote settings remains unclear. Objective: This study aimed to evaluate changes in the rate of telemedicine use among rural populations and identify patient characteristics associated with telemedicine use prior to and during the pandemic. Methods: We conducted a repeated cross-sectional study on all monthly and quarterly rural telemedicine visits from January 2012 to June 2020, using administrative data from Ontario, Canada. We compared the changes in telemedicine use among residents of rural and urban regions of Ontario prior to and during the pandemic. Results: Before the pandemic, telemedicine use was steadily low in 2012-2019 for both rural and urban populations but slightly higher overall for rural patients (11 visits per 1000 patients vs 7 visits per 1000 patients in December 2019, P<.001). The rate of telemedicine visits among rural patients significantly increased to 147 visits per 1000 patients in June 2020. A similar but steeper increase (P=.15) was observed among urban patients (220 visits per 1000 urban patients). Telemedicine use increased across all age groups, with the highest rates reported among older adults aged ≥65 years (77 visits per 100 patients in 2020). The proportions of patients with at least 1 telemedicine visit were similar across the adult age groups (n=82,246/290,401, 28.3% for patients aged 18-49 years, n=79,339/290,401, 27.3% for patients aged 50-64 years, and n=80,833/290,401, 27.8% for patients aged 65-79 years), but lower among younger patients <18 years (n=23,699/290,401, 8.2%) and older patients ≥80 years (n=24,284/290,401, 8.4%) in 2020 (P<.001). There were more female users than male users of telemedicine (n=158,643/290,401, 54.6% vs n=131,758/290,401, 45.4%, respectively, in 2020; P<.001). There was a significantly higher proportion of telemedicine users residing in relatively less rural than in more rural regions (n=261,814/290,401, 90.2% vs n=28,587/290,401, 9.8%, respectively, in 2020; P<.001). Conclusions: Telemedicine adoption increased in rural and remote areas during the COVID-19 pandemic, but its use increased in urban and less rural populations. Future studies should investigate the potential barriers to telemedicine use among rural patients and the impact of rural telemedicine on patient health care utilization and outcomes.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
During the COVID-19 pandemic, video telehealth was generally used less frequently among older adults, rural residents, and racial and ethnic minority patients.
“Notably, during the COVID-19 pandemic, video telehealth was generally used less frequently among older adults, rural residents, and racial and ethnic minority patients.50,51”
From Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial (2023) · cites this paper as [51]
The Results report lower overall telemedicine use among rural than urban patients during the pandemic (147 versus 220 visits per 1,000 patients in June 2020). But the Discussion’s Limitations state that the data do not distinguish video from telephone visits. The Discussion also reports the highest overall telemedicine-use rates among older adults, and the cited passages do not address racial or ethnic minority patients. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
COVID-19 transforms health care through telemedicine: Evidence from the field
Mann, D. M., Chen, J., Chunara, R., Testa, P. A., & Nov, O. (2020) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocaa072 · Cited by 1,361 · see citing works
Virtual health care in the era of COVID-19
Webster, P. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30818-7 · Cited by 769 · see citing works
Lam, K., Lu, A. D., Shi, Y., & Covinsky, K. E. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.2671 · Cited by 648 · see citing works
Fisk, M., Livingstone, A., & Pit, S. W. (2020) · Journal of Medical Internet Research · doi:10.2196/19264 · Cited by 486 · see citing works
Reducing the Cost of Frequent Hospital Admissions for Congestive Heart Failure
Jerant, A. F., Azari, R. S., & Nesbitt, T. S. (2001) · Medical Care · doi:10.1097/00005650-200111000-00010 · Cited by 311 · see citing works
Fortney, J. C., Pyne, J. M., Mouden, S. B., Mittal, D., Hudson, T. J., Schroeder, G. W., Williams, D. K., Bynum, C. A., Mattox, R., & Rost, K. M. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12050696 · Cited by 296 · see citing works
Morland, L. A., Greene, C. J., Rosen, C. S., Foy, D., Reilly, P., Shore, J., He, Q., & Frueh, C. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05604blu · Cited by 274 · see citing works
Virtual care use before and during the COVID-19 pandemic: A repeated cross-sectional study
Bhatia, R. S., Chu, C., Pang, A., Tadrous, M., Stamenova, V., & Cram, P. (2021) · CMAJ Open · doi:10.9778/cmajo.20200311 · Cited by 272 · see citing works
Self-citationMarcin, J. P., Ellis, J., Mawis, R., Nagrampa, E., Nesbitt, T. S., & Dimand, R. J. (2004) · PEDIATRICS · doi:10.1542/peds.113.1.1 · Cited by 244 · see citing works
Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review
Batsis, J. A., DiMilia, P. R., Seo, L. M., Fortuna, K. L., Kennedy, M. A., Blunt, H. B., Bagley, P. J., Brooks, J., Brooks, E., Kim, S. Y., et al. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15959 · Cited by 204 · see citing works
Novara, G., Checcucci, E., Crestani, A., Abrate, A., Esperto, F., Pavan, N., Nunzio, C. D., Antonio Galfano, A., Giannarini, G., Gregori, A., et al. (2020) · European Urology · doi:10.1016/j.eururo.2020.06.025 · Cited by 200 · see citing works
Utilization of Telemedicine Among Rural Medicare Beneficiaries
Mehrotra, A., Jena, A. B., Busch, A. B., Souza, J., Uscher-Pines, L., & Landon, B. E. (2016) · JAMA · doi:10.1001/jama.2016.2186 · Cited by 187 · see citing works
Pediatric critical care telemedicine in rural underserved emergency departments*
Heath, B. W., Salerno, R. A., Hopkins, A., Hertzig, J. S., & Caputo, M. P. (2009) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0b013e3181a63eac · Cited by 149 · see citing works
Telemedicine for rural cancer care in North Queensland: Bringing cancer care home
Sabesan, S. S., Larkins, S., Evans, R., Varma, S. C., Andrews, A., Beuttner, P., Brennan, S., & Young, M. (2012) · Australian Journal of Rural Health · doi:10.1111/j.1440-1584.2012.01299.x · Cited by 149 · see citing works
ICES: Data, Discovery, Better Health
Schull, M. J., Azimaee, M., Marra, M., et al. (2020) · International Journal for Population Data Science · doi:10.23889/ijpds.v4i2.1135 · Cited by 131 · see citing works
Impact of an Intensive Care Unit Telemedicine Program on a Rural Health Care System
Zawada, E. T., Herr, P., Larson, D., Fromm, R. E., Kapaska, D., & Erickson, D. (2009) · Postgraduate Medicine · doi:10.3810/pgm.2009.05.2016 · Cited by 112 · see citing works
Telemedicine During the COVID-19 Pandemic: Impact on Care for Rare Cancers
Smrke, A., Younger, E., Wilson, R., Husson, O., Farag, S., Merry, E., Macklin-Doherty, A., Cojocaru, E., Arthur, A., Benson, C., et al. (2020) · JCO Global Oncology · doi:10.1200/go.20.00220 · Cited by 107 · see citing works
Jaglal, S. B., Haroun, V. A., Salbach, N. M., HAWKER, G. A., Voth, J., Lou, W. Y. W., Kontos, P., Cameron, J. E., Cockerill, R. W., & Bereket, T. (2013) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2012.0197 · Cited by 98 · see citing works
Inpatient Transition to Virtual Care During COVID-19 Pandemic
Jones, M., Goley, A. L., Alexander, B. E., Keller, S. B., Caldwell, M. M., & Buse, J. B. (2020) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2020.0206 · Cited by 95 · see citing works
Telemedicine Reduces Discrepancies in Rural Trauma Care
Ricci, M. A., Caputo, M. P., Amour, J. L., Rogers, F. B., Sartorelli, K. H., CALLAS, P. W., & Malone, P. T. (2003) · Telemedicine Journal and e-Health · doi:10.1089/153056203763317602 · Cited by 83 · see citing works
The Ontario Telemedicine Network: A Case Report
Brown, E. M. (2013) · Telemedicine and e-Health · doi:10.1089/tmj.2012.0299 · Cited by 78 · cited 1× · see citing works
“The Ontario Telemedicine Network (OTN) is an organization funded by the provincial government, which aimed to initially increase health care access among the rural population by facilitating 2-way videoconferencing between patients and care providers [2].”
BackgroundLow-bandwidth, low-cost telemedicine consultations in rural family practice.
Norris, T. E., Hart, G. L., Larson, E. H., Tarczy-Hornoch, P. Z., Masuda, D., Fuller, S. S., House, P. J., & Dyck, S. M. (2002) · PubMed · Cited by 38 · see citing works
Cost of contact: redesigning healthcare in the age of COVID
Bhatia, R. S., Shojania, K. G., & Levinson, W. S. (2020) · BMJ Quality & Safety · doi:10.1136/bmjqs-2020-011624 · Cited by 36 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial
Gerber, B. S., Biggers, A., Tilton, J. J., Smith Marsh, D. E., Lane, R., Mihailescu, D., Lee, J., & Sharp, L. K. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.33629 · Cited by 61 · see citing works
Virtual care with digital technologies for rural Canadians living with cardiovascular disease
Buyting, R., Melville, S., Chatur, H., White, C. W., Légaré, J.-F., Lutchmedial, S., & Brunt, K. R. (2022) · CJC Open · doi:10.1016/j.cjco.2021.09.027 · Cited by 42 · see citing works
Li, M., Patel, J., Ibrahim, S., & Katapally, T. R. (2025) · doi:10.1101/2025.08.20.25334071 · Cited by 2 · see citing works
- Authors
- Chu, C., Cram, P., Pang, A., Stamenova, V., Tadrous, M., & Bhatia, R. S.
- Affiliations
- Women's College Hospital (CA)
- University Health Network (CA)
- Institute for Clinical Evaluative Sciences (CA)
- University of Toronto (CA)
- Corresponding author
- Bhatia, R Sacha
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2021-04-05
- Volume
- 23
- Issue
- 4
- Pages
- e26960
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC8023379
- OpenAlex
- W3139107611
- Cited by
- 183
- References
- 23
- Citations by year
- 2026: 17 · 2025: 23 · 2024: 29 · 2023: 48 · 2022: 49 · 2021: 16
- FWCI
- 30.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Ontario Ministry of Health and Long-Term Care
- National Institute on Aging (R01AG058878)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Demography › Technology Use by Older Adults
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- telemedicine use, COVID-19 pandemic, rural health, remote care, telehealth adoption, urban-rural differences, Ontario, health care utilization trends, older adults, health care costs, health care access
- MeSH terms
- COVID-19, SARS-CoV-2, Aged, Cross-Sectional Studies, Female, Humans, Male, Ontario, Rural Population, Telemedicine, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
