Systematic literature review of telehealth use in the rural United States

Introduction: Individuals living in rural areas of the United States experience healthcare inequity, with much of it based on a lack of access to services. As rural hospitals continue to close due to lack of funding, this inequity will continue to grow unless addressed. Telehealth, a way of connecting health providers to their patients digitally, could be used to address this inequity. However, the implementation and public health significance of telehealth and other forms of eHealth are not yet fully understood due to concerns about feasibility, fidelity, and effectiveness. Objective: This literature review aimed to assess how telehealth programs have been implemented in the rural United States. This will include gathering information on state-by-state reimbursement policies for telehealth programs. Methods: The search uses the PubMed Central database to find papers between 2015 and 2019 with relevant keywords. Papers were then included based on: if they were written in the United States, if they were not a literature review, if they addressed a rural population, and if they used an eHealth intervention. Results: 47 relevant articles were analyzed. 14 were feasibility studies, 7 were qualitative analyses, 17 were randomized controlled trials, 8 were non-RCT prospective studies, and 1 was a Centers for Disease Control report. Discussion: The articles primarily focused on the feasibility and implementation of telemedicine programs and gathered information on user experience, patient satisfaction, and program implementation factors like fidelity. This leaves a gap in the literature about the actual efficacy and public health significance of recent telehealth programs and their effect on user health. However, it also shows a trend towards implementing more telemedicine programs once they are shown to be feasible. Keywords: telemedicine, rural healt