Telemedicine Utilization and Preventive Services Among a Rural Population

ABSTRACT

Objective: To determine the association between telemedicine use and preventive care among a rural population.

Study Design: Retrospective cohort study with administrative claims data.

Methods: We utilized propensity score matching and multivariate logistic regressions to match rural telemedicine users with rural telemedicine nonusers to determine the relationship between telemedicine use and the utilization of preventive services.

Results: The propensity score–matched sample consisted of 2,012,290 individuals residing in rural areas between January 2019 and December 2023. The sample consisted of 1,006,145 individuals who did not use telemedicine from 2019 to 2023, 535,418 individuals who utilized telemedicine in 2020, and 730,828 individuals who utilized telemedicine between 2021 and 2023. Telemedicine use in 2020 was associated with a higher likelihood of completing a preventive care visit or service in 2021 (adjusted OR [AOR], 2.01; 95% CI, 1.93-2.09), and telemedicine use between 2021 and 2023 was associated with a higher likelihood of completing a preventive care visit or service in 2023 (AOR, 1.88; 95% CI, 1.79-1.96). Telemedicine use in 2020 and between 2021 and 2023 were both evaluated to determine whether the results remained consistent after the initial surge in telemedicine use in 2020.

Conclusions: The use of telemedicine in rural areas was associated with a higher likelihood of utilizing preventive care. The magnitude of this relationship varied depending on underlying health conditions, sex, and region of residence.

Am J Manag Care. 2026;32(1):In Press

Takeaway Points

• Use of telemedicine among a rural population was associated with a higher likelihood of receiving preventive services.
• The relationship between telemedicine use and preventive care varied depending on underlying health conditions, sex, and region of residence.
• Telemedicine may be an effective way to encourage appropriate preventive care among rural residents.

Individuals residing in rural areas are less likely to utilize primary and specialty care1 and to receive preventive health services,2 and they often have less access to health care services compared with urban residents.3 Telemedicine can facilitate access to care by removing barriers associated with transportation logistics, travel time, and cost. Following the COVID-19 public health emergency, telemedicine utilization declined but remains significantly higher than prepandemic levels.4,5 We aimed to determine whether telemedicine use among rural residents during 2020 and between 2021 and 2023 was associated with a higher likelihood of subsequent preventive care in 2021 or 2023.

METHODS

Using administrative claims data, we constructed a sample of adults with commercial or Medicare Advantage insurance residing in rural areas. We used propensity scoring to match telemedicine users to nonusers based on age, sex, Elixhauser Comorbidity Index (ECI) score, race/ethnicity, state of residence, and several indicators of preexisting conditions because prior study findings indicate that telemedicine use varies by these characteristics.6,7 The outcome of interest was whether an individual had a procedure billing code for a preventive screening exam or service (Current Procedural Terminology codes 99381-99429).

Using multivariate logistic regressions, we estimated the relationship between telemedicine use and preventive care, adjusting for preexisting conditions, age, sex, race/ethnicity, ECI score, socioeconomic status index quartile, and state of residence. Subset analysis was performed based on preexisting conditions, sex, and region of residence.

RESULTS

The matched sample consisted of 2,012,290 individuals residing in rural areas between January 2019 and December 2023. The sample matched moderately well (standardized mean difference, 0.16), with half of the study population (n = 1,006,145) comprised of those who used telemedicine during the study period: 535,418 in 2020 and 730,828 between 2021 and 2023 (Table). A higher proportion of telemedicine utilizers were women (59% vs 57%), had an ECI of 3 or greater (55% vs 50%), and had anxiety (44% vs 28%) or depression (37% vs 23%) compared with individuals who did not utilize telemedicine.

The results showed that telemedicine use in 2020 was associated with a higher likelihood of completing a preventive care visit or service in 2021 (adjusted OR [AOR], 2.01; 95% CI, 1.93-2.09) and that telemedicine use between 2021 and 2023 was associated with a higher likelihood of completing a preventive care visit or service in 2023 (AOR, 1.88; 95% CI, 1.79-1.96) (Figure). Telemedicine use in 2020 and the years 2021-2023 were both evaluated to determine whether the results remained consistent after the initial surge in telemedicine use in 2020. These results showed a slightly larger association between telemedicine use and preventive care in 2020, but the association persisted in 2021-2023.

Individuals with asthma had a greater association between telemedicine use and preventive care (AOR, 1.53; 95% CI, 1.44-1.61) than those with diabetes (AOR, 1.38; 95% CI, 1.30-1.47) or hypertension (AOR, 1.39; 95% CI, 1.32-1.46). The relationship between telemedicine and preventive care was more pronounced among women (AOR, 1.63; 95% CI, 1.55-1.71) than men (AOR, 1.45; 95% CI, 1.40-1.51), as well as for individuals residing in the West (AOR, 1.78; 95% CI, 1.58-1.99) and South (AOR, 1.66; 95% CI, 1.56-1.76) compared with the Northeast (AOR, 1.49; 95% CI, 1.38-1.60) and Midwest (AOR, 1.46; 95% CI, 1.41-1.52).

Limitations

Study limitations include that we used a cross-sectional design, which does not allow for evaluation of the timing of telemedicine and preventive service utilization. Also, although we adjusted for observable characteristics using propensity score matching and regression analysis, there may be other unobserved patient characteristics correlated with utilization that differ between telemedicine users and nonusers.

DISCUSSION

Telemedicine utilization in rural areas was associated with a higher likelihood of having a preventive care visit or service. The magnitude of this relationship varied depending on underlying health conditions, sex, and region of residence. This heterogeneity may be useful for understanding the differences in health care needs of individuals with chronic conditions living in rural areas and how the needs of rural populations in the West and South may differ from those in the Northeast and Midwest.8 Given prior research showing that regular visits with health care providers are associated with receiving recommended preventive care, telemedicine may be an effective way to strengthen the relationship between providers and patients5 and encourage appropriate preventive care. As rural residents continue to utilize telemedicine at significantly higher levels in the postpandemic era, this information may help inform future policies9 and research that promote telemedicine as a means of improving uptake of preventive health care in rural areas.

Author Affiliations: Elevance Health, Inc (DC, AMF, CL, GC, SAS), Indianapolis, IN.

Source of Funding: None.

Author Disclosures: The authors are employees of Elevance Health.

Authorship Information: Concept and design (DC, AMF, CL, GC, SAS); acquisition of data (DC); analysis and interpretation of data (DC, AMF, CL, GC, SAS); drafting of the manuscript (DC, CL, GC, SAS); critical revision of the manuscript for important intellectual content (DC, AMF, GC); statistical analysis (DC); administrative, technical, or logistic support (CL, GC); and supervision (SAS).

Address Correspondence to: Daniel Cullen, PhD, Elevance Health, 220 Virginia Ave, Indianapolis, IN 46204. Email: daniel.cullen@elevancehealth.com.

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