The use of telehealth increased dramatically at rural clinics during the pandemic. But vaccination clinics like this one at Roane General Hospital in Spencer, West Virginia, on December 21, 2021, remained hands-on. (AP Photo/John Raby)

The Covid-19 pandemic hit rural health clinics hard, shutting down some cancer screenings and temporarily closing one in five clinics, according to new research.

But the use of telehealth as an alternative to in-person visits soared, the research showed.

The study from the Rural and Minority Health Research Center at the University of South Carolina surveyed rural health clinics across the country and analyzed the responses about how the pandemic had affected their operations and ability to provide cancer screenings.

Of the 153 rural health clinics across 36 states that responded to the researchers’ survey, about one fifth (19.1%) said they were forced to temporarily close due to the pandemic. More than half (57.1%) said the closure was due to clinicians and staff coming down with Covid.

“We obviously anticipated that RHCs (rural health centers) would have experienced a lot of stressors,” said Whitney Zahnd, one of the study’s authors. “But I think just seeing such a high percentage of them experiencing those kinds of stressors with regards to the impact on their staff, their finances, and the lack of [personal protective equipment]just affirms what we had anticipated.”

Other causes for temporary closures were low patient counts (42.3%). Nearly 90% of the clinics reporting had a below-average or extremely-below-average number of patient visits. When patients did come, the most frequently cited reasons were chronic conditions (19.4%) or Covid-19 (17.8%).

Financial difficulties caused about a fifth of the temporary closures (22.2%), the study found.

RHCs also reported a number of Covid-related challenges affecting their operations, such as reorganizing their practices to minimize patient exposures and limiting patient visits to reduce exposures. This led to a dramatic rise in the use of telehealth, the study found. Less than a quarter of the responding RHCs (23%) said they provided telehealth services prior to March 2020, but more than nine in 10 (92.2%) said they used telehealth since the start of the pandemic. Most of the time, researchers found, RHCs used telehealth for evaluation visits (91.5%). Other top uses were for preventative health screenings and wellness visits (39%). Only 7.8% of the RHCs surveyed said they did not provide any telehealth services.

Zahnd said that in contrast, services that were more invasive dropped precipitously. Cancer screenings that required more invasive procedures were either no longer offered by some RHCs or were referred to other health care systems. The percentage of RHCs providing procedures like sigmoidoscopies and colonoscopies, used to detect cancer in the rectum and colon, fell by half (54% and 47% respectively), while the percentage offering hepatitis C screenings and HPV vaccinations only fell by a quarter (25% and 27%).

“I guess it’s not a surprise that so many RHCs offered telehealth, but it was surprising seeing the impact of the pandemic and the magnitude of the number of clinics who saw these changes and new ways to connect with their patients that may not have been available to them for reimbursement reasons,” Zahnd said.

Researchers hope the information will help show the importance of RHCs in the rural healthcare landscape.

“We wanted to look at this because for RHCs… there’s a real opportunity for them to play an important role in providing these preventative services (for cancer),” she said. “There’s almost 5,000 of them now, so that’s something we want to assess for that reason.”

The study’s results show how important maintaining telehealth availability and coverage is to rural health care, and rural cancer care in particular, as well, researchers said.

“The fact that preventive services were provided via telehealth indicates that telehealth may be an important avenue for cancer-related preventive services that may be delivered virtually such as shared decision making for lung cancer screening and smoking cessation counseling,” researchers wrote.

However, rural patients also face challenges to using telehealth, like less access to broadband, the study found.

Only 8% of all RHCs responded to the survey, Zahnd said, but that response rate is similar to other surveys of rural health care systems in general and RHCs in particular.

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