Study shows persistent telehealth disparities among rural US populations, highlighting need for policy reform and digital health equity efforts
(Toronto, September 9, 2025) Despite the promise of telehealth to bridge rural health care gaps, a new study published by JMIR Publications in the Journal of Medical Internet Research reveals that many rural-dwelling patients in the United States—especially those who are older, speak Spanish, or rely on public insurance—are still struggling to access virtual care.
The study, “Video and Telephone Telehealth Use and Web-Based Patient Portal Activation Among Rural-Dwelling Patients: Retrospective Medical Record Review and Policy Implications,” examined the telehealth usage patterns of over 9300 adults in rural California. Conducted by Meghan Rowe Ferrara and Susan Chapman, researchers at the University of California, San Francisco, the findings point to continued disparities in access and use of digital health tools, particularly among communities already facing health care challenges.
The research showed that patients living in rural California zip codes were more likely to be older and White compared to those in less rural areas. The use of video-based telehealth, which generally allows for more thorough care, was significantly lower among older adults, racial and ethnic minorities, Spanish speakers, and those on Medicaid or Medicare. Access to web-based patient portals was also lower for these groups, highlighting an urgent need for improved digital inclusion efforts.
“In this context, our findings contribute to a complex picture of digital access and telehealth use patterns among rural populations. We need to better understand how rural patients use telehealth, so we can effectively meet the health care needs of these populations,” says author Meghan Rowe Ferrera.
The research team calls for stronger programs to address patient-level barriers, such as better telehealth education, culturally tailored and language-specific outreach, and low-cost digital access options for low-income patients, as well as evidence-based telehealth reimbursement policy to address provider-side barriers.
The study adds critical insight to ongoing discussions about health equity, digital access, and the future of rural health care in the United States.
Original article:
Rowe Ferrara M, Intinarelli-Shuler G, Chapman S. Video and Telephone Telehealth Use and Web-Based Patient Portal Activation Among Rural-Dwelling Patients: Retrospective Medical Record Review and Policy Implications. URL: https://www.jmir.org/2025/1/e67226
DOI: 10.2196/67226
J Med Internet Res 2025;27:e67226
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About JMIR Publications:
JMIR Publications is a leading open access publisher of digital health research and a champion of open science. With a focus on author advocacy and research amplification, JMIR Publications partners with researchers to advance their careers and maximize the impact of their work. As a technology organization with publishing at its core, we provide innovative tools and resources that go beyond traditional publishing, supporting researchers at every step of the dissemination process. Our portfolio features a range of peer-reviewed journals, including the renowned Journal of Medical Internet Research.
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