Will Biden’s infrastructure plan bring better telehealth options to Appalachia?
Late last year, on November 19, the House of Representatives passed Biden’s Build Back Better infrastructure plan.
Of these funds, $475 million will go to the Connected Device Grant Program to distribute tablets and computers to those in need. An additional $2 billion will support USDA’s ReConnect program, which will improve broadband access in rural communities.
In 2022, advocates anticipate these infrastructure changes will slowly begin to roll out across the United States. The road to better health care in Appalachia is a tough journey, but broadband access could be a revolutionary first step.
How Rural Infrastructure Affects Health Care
When you imagine infrastructure, you probably think of roads, bridges and architecture. But the infrastructure also includes doctors’ surgeries, affordable internet access and other tools that help people connect to essential services.
Appalachia struggles with great inequities in infrastructure, and these disparities impact how rural residents may or may not receive the health care they need. There are far fewer medical professionals working in Appalachia than in other parts of the country. In 2019, the Appalachian Regional Commission released a survey to estimate the number of primary care providers and mental health professionals working in the region per 100,000 patients. With 35% fewer mental health care providers than the national average, Appalachia has few options for counseling or psychiatric services. In some mountain communities, patients must travel for hours to reach their nearest therapist or medical specialist. Travel can be difficult if these patients do not have public transport or have to drive on broken roads.
Patients do not have easy access to mental health services, but the demand for care is overwhelming. Appalachia report high rates of mental illnesses like depression, anxiety, suicidal thoughts, and they are also at risk for developing chronic diseases like diabetes and cancer. Robert Bossarte, PhD, is the principal investigator of the Appalachian Mind Health Initiative. Bossarte explains how rural infrastructure has left many patients behind: “We have to recognize that there is a national shortage of healthcare providers. And because West Virginia is an under-resourced market, there aren’t many vendors here. With months-long waits for doctor appointments and advice, it can feel like a race against time to sort out patients who need help.
Annsley Roberts was one of the patients involved. Roberts grew up in western North Carolina, where there is a mental health center throughout her county. She tried to get counseling for coping with depression after her father’s death, but Roberts had few options: “The only mental health center near me is so busy it often pushes its patients to join group therapy. I have had friends who have stopped going to therapy altogether because they were pressured to attend group sessions. Group sessions can provide valuable support to patients. But Annsley was all too aware of how gossip can spread in a small town, and she feared revealing personal (and vulnerable) information in a group setting. She, like some of her friends, felt they needed confidential, individual sessions with a therapist.
Patients who do not have access to mental health care often turn to their primary care physician for help. However, most GPs do not have the specialist training to serve as makeshift therapists or psychiatrists. Going to see his doctor helped Roberts cope in the short term, but it was ultimately a band-aid solution. “I ended up seeing my GP. Although she may have gotten me started on medication, I still feel that I would have benefited greatly from a combination of medication and therapy,” Roberts says.
How Biden’s infrastructure plan could expand telehealth options
With these infrastructural obstacles, patients like Annsley Roberts can feel stranded. Technological barriers can make patients even more isolated. “I wish I could connect with a therapist via computer, but getting a reliable internet connection is difficult,” Roberts says. She is not alone. A survey by SSRS and the Bipartisan Policy Center found that 45% of people living in rural communities report technological issues such as spotty Wi-Fi signal as a barrier to accessing telehealth.
Expanding broadband access in Appalachia could help patients access more telehealth options, right from home. Looking ahead to 2022, health advocates hope Biden’s plan will provide federal broadband rebates for low-income families and invest federal funds in expanding internet service in areas that are currently not covered. Some healthcare professionals say telehealth is the next step in healthcare in an increasingly digital world. “The healthcare industry is moving towards monitoring systems, patient self-monitoring, computer-assisted therapy and instructional videos. Results from surveys of residents of many states have indicated that 80% of Americans use the Internet for mental health information,” the researchers explain in an article published in the journal. Acta Informatica Medica. Several medical studies have shown that telemental cognitive behavioral therapy can reduce a patient’s feelings of loneliness, anxiety, and depression.
Physicians already using telehealth in rural areas of America have reported significant positive results. 20% of patients in the SSRS and Bipartisan Policy Center survey said they would have delayed or avoided a medical appointment if they had not been able to schedule a telehealth appointment. Fortunately, 80% of these patients said their telehealth appointment was successful in resolving their health issues. 94% of respondents were satisfied with the quality of care received during their telehealth appointment. Robert Bossarte also observed these positive benefits in Appalachia. “Here, physicians using telehealth have seen fewer missed appointments.” Currently, Bossarte’s team of mental health professionals must use a variety of approaches to reach patients who do not have reliable internet. The Appalachian Mind Health Initiative schedules appointments by phone and video chat, depending on the patient’s technology access. But some patients may benefit from the ability to use videoconferencing. In a study published in Oncology time, 72% of patients preferred to communicate with their doctor face to face. Many patients find telephone or text communication to be impersonal. Other patients may appreciate being able to see their doctor’s body language. Biden’s broadband plan can help these patients have a stronger connection with Zoom and with their doctors.
Despite Bossarte’s best efforts, he knows broadband access will be a victory in a larger war for rural health care access. Some Appalachian practitioners are hesitant to embrace telehealth. “When we started the Appalachian Mind Health Initiative, we had over 100 clinicians saying, ‘Yeah, we’re really happy to work with you. But when it comes to adopting these new approaches, only a handful of these practitioners follow,” says Bossarte. These uncertain practitioners can draw inspiration from some data on the effectiveness of telehealth. For example, the Community Mental Health Association of Michigan reported that ⅔ of behavioral health providers used telehealth in 2021. 60% of these providers used videoconferencing with their patients, and 68% of physicians noted that telehealth increased satisfaction and retention of their patients. . Of these practitioners, 74% plan to permanently offer telehealth options (including video chat appointments) after the Covid-19 pandemic.
Broadband will not automatically improve Appalachian health outcomes. Biden’s infrastructure plan is no panacea for the region’s deep health infrastructure inequities. However, Biden’s proposal to expand internet access may remove a stumbling block for health care. “Times are changing. There is hope. I think about how telehealth would have helped me, and I hope this technology can help future people connect to the healthcare they need” , says Annsley Roberts.
Telehealth can help struggling patients realize they are not alone, even if they live miles from a doctor’s office.