A Forward Look: Providing Comprehensive, Physician-Led Primary Care to Patients In Remote Locations

By Troy Corley, executive vice president of service delivery, Proactive MD.

Troy Corley

In an ideal world, individuals would be able to access health care services in a quick and convenient manner — regardless of where they live. However, entirely too many residents in rural areas face a variety of barriers to access, limiting their ability to obtain the health care they need.

For many patients living in rural areas, having to drive for more than an hour just to see the nearest primary care practitioner is entirely too common. Because of this and other barriers, patients are generally not equipped to be proactive and preventive with their health due to the significant investment required to receive basic care.

Making matters worse, rural patients often face traditionally higher rates of poverty and are less likely to have health insurance than their urban counterparts. These economic challenges, in combination with higher rates of underlying chronic disease, make rural patients more likely than city dwellers to face poor health outcomes and suffer complications from heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke.

Today, about 60 million Americans, or nearly 20% of the U.S. population, live in Census-defined rural areas. And with the U.S. Department of Health and Human Services reporting only 39.8 primary care physicians are available per 100,000 people in rural populations, the gap in care between rural and urban Americans is only growing wider. The provider shortage — coupled with increased transportation challenges, social inequities, and the additional access barriers brought about by COVID-19 — makes physical access to care extremely difficult for many rural communities.

The Rise of Telehealth

While the current pandemic has forced the U.S. health care system to face numerous challenges, it has catalyzed the rapid adoption of telehealth services to safely deliver care at a distance.

As patients embrace this digital transformation, health care providers are beginning to look outside of their traditional base to reach new patients in unexpected locales. Employing telehealth services reduces access barriers for patients in rural areas, allowing them to receive basic care regardless of how far they live from a physician’s office.

The exponential growth in popularity of telehealth services can be helpful to some rural patients, but what about those at high risk or with chronic illnesses? For patients who need more than a simple phone or video consultation with the provider-in-queue, advancements in medical technology can help close geographic care gaps.

Extending Virtual Care with Digital Medical Instruments & Specialty Consults

On a mission to improve health care for patients living in rural areas, many providers are working to help slow the worsening strain on the health care system caused by chronically ill patients who can’t receive consistent care and engagement. Part of that effort involves integrating new technologies and adapting care delivery strategies to provide comprehensive, physician-led primary care that goes far beyond traditional urgent care triage.

Traditional telemedicine relies on basic phone or video calls between a patient and a provider for simple acute care triage, but the provider—unable to conduct a physical examination—is extremely limited in the care they can provide within these systems. More complex and chronic conditions simply cannot be effectively managed over the phone. New virtual clinic models have emerged, however, that greatly extend the reach of the physician and their ability to provide high-quality primary care regardless of distance.

Rural clinics use digitally-connected medical instruments controlled by an in-person nurse or medical assistant, under the virtual direction of a physician. As the in-person medical professional operates the tools, the virtual provider sees real-time otoscopic video and clinical data, allowing them to evaluate and closely monitor the patient’s health. These virtual clinics can be constructed for comparatively low cost and can be deployed throughout rural areas in a hub-and-spoke configuration, enabling a centrally-located physician team to provide primary care throughout a region.

And while primary care is the foundation of quality health care, chronically ill patients may also require specialty care — which is even more limited in rural areas. New technologies, however, allow primary care physicians to bring the specialist to the patient’s exam room—virtually—for interactive conversations among the patient, their primary care physician, and the specialist. Other platforms allow the physician to conduct virtual specialty consultations, pulling on an extensive, nationwide network of subspecialists who can provide their expertise on difficult or unusual cases.

When there’s limited to no access to care within 30-plus miles, the ability to extend advanced care offerings maximizes what rural providers can do in primary care settings, which is incredibly beneficial to rural patients.

Crossing Barriers

While most providers still operate in more populated areas, many are beginning to focus on ways they can serve rural patients and knock down the traditional barriers to care found in rural areas. Adding virtual clinics in less populated areas gives patients the ability to take advantage of digital instruments and telehealth services to improve their overall health.

Despite the myriad of obstacles to care patients in rural areas may face, providers equipped with digital tools and the ability to provide virtual specialty services are now realizing how to optimize what they can do within the walls of their health center. Building strong doctor-patient relationships with individuals and families dealing with social inequities or other barriers to care is a necessary  first step, and integrating cutting-edge digital tools to improve the quality, safety, effectiveness and delivery of health care services in rural communities truly extends the reach of primary care well beyond what is possible with telephone or video interactions.

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