Many patients living in rural areas of the U.S. are still facing difficulties accessing telehealth support—despite promises to help bridge this gap.

Examining the telehealth usage patterns of more than 9,300 adults in rural California, researchers discovered those who are older, speak Spanish or rely on public insurance are particularly struggling to access virtual care.

The findings point to continued disparities in access and use of digital health tools, particularly among communities already facing healthcare challenges, the team from the University of California noted.

"In the United States, rural populations experience worse outcomes related to the most common health conditions as well as a higher burden of morbidity and mortality compared to urban populations," the researchers wrote in their paper.

"These rural health disparities are often more pronounced among rural populations of color, who make up about 20 percent of rural U.S. residents. Rural health disparities negatively impact rural social systems and prevent rural communities from thriving.

"A major contributor to rural health disparities is limited healthcare access, a chronic issue with multifaceted causes, including structural factors that constrain the overall availability of healthcare in rural areas."

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—intended to allow 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, according to the researchers.

"For older adults, factors such as lower digital access and digital comfortability may limit their ability or desire to use telehealth," University of California researcher Meghan Rowe Ferrera told Newsweek.

"For patients who are Latino, perceived discrimination may discourage video visit use. Other research showing that Hispanic or Latino individuals have lower video use despite having higher telehealth use overall may substantiate this connection."

Rowe Ferrera also said that discrimination is likewise a factor for patients with limited English proficiency, in addition to structural barriers like a lack of language-concordant staff and challenges with bringing interpreters on video-chat platforms.

Meanwhile, for patients with public health insurance options, the links between lower digital access and lower income or older age may influence their lower video use, while insufficient broadband capacity is generally something to consider in rural areas.

"While our findings were limited to a population within a specific rural area, commonalities between rural regions in factors related to health care access, geography, broadband access and demographics mean that similar disparities may be found in other rural regions," Ferrera added.

The authors added that the digital delivery of healthcare using communication technologies may improve rural healthcare access by connecting rural patients to remote healthcare providers where they already practice.

"Despite this promise, widespread scale-up of telehealth provision was not realized until the COVID-19 pandemic, which necessitated an abrupt shift away from in-person care in March 2020," they noted.

"Subsequent telehealth reimbursement expansions by both the Centers for Medicare and Medicaid Services (CMS) and private insurers resulted in rapid, dramatic increases in the share of healthcare encounters conducted via telehealth.

"Since the declaration of the COVID-19 Public Health Emergency (PHE), however, a picture has emerged of the mixed impact this rapid expansion has had on telehealth access."

In the new study, the researchers conducted a retrospective medical record review of adults who lived in rural California zip codes and used telehealth at an urban medical center from December 2021 to December 2022.

"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 healthcare needs of these populations," Ferrera said in a statement.

The team is calling for stronger programs to address patient-level barriers like better telehealth education, culturally tailored and language-specific outreach and low-cost digital access options for low-income patients. They are also calling for "evidence-based telehealth reimbursement policy to address provider-side barriers."

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Update 09/11/25, 11:57 a.m. ET: This article was updated with additional comments from Meghan Rowe Ferrera.

Reference

Ferrara, M. R., Intinarelli-Shuler, G., & Chapman, S. A. (2025). Video and Telephone Telehealth Use and Web-Based Patient Portal Activation Among Rural-Dwelling Patients: Retrospective Medical Record Review and Policy Implications. Journal of Medical Internet Research, 27(1). https://doi.org/10.2196/67226