Telehealth for rural Veterans in the United States: A systematic review of utilization, cost savings, and impact of COVID-19

Abstract: Veterans living in rural areas of the United States face various health challenges that demand timely access to care to improve their well-being and quality of life. Telehealth (i.e., the use of telecommunications technology to connect people with care providers remotely) has become vital in addressing the accessibility gap for people constrained by vehicle ownership, income, geographic isolation, and limited access to specialists. This study aims to examine the current evidence on rural veterans' use of telehealth for their healthcare needs, evaluates the cost savings associated with telehealth, as well as veterans' use of telehealth during COVID-19. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted on three databases (Google Scholar, PubMed, and Scopus) to select relevant articles published from 2017 to 2023. A total of 36 articles met the inclusion criteria and were categorized into three objectives: veterans' medical conditions managed through telehealth (n = 24), veterans' transportation cost savings using telehealth (n = 4), and telehealth use during the COVID-19 pandemic (n = 8). The results indicated that telehealth is a viable option for managing various medical conditions of rural veterans, including complex ones like diabetes and cancer. Additionally, telemedicine was a useful platform in bridging the healthcare accessibility gap during disasters or pandemics like COVID-19 evident from its increased usage during the pandemic. Lastly, telehealth was associated with cost and time savings between USD 65.29 and USD 72.94 per visit and 2.10 and 2.60 h per visit, respectively. However, the feasibility of telehealth for veterans' medical conditions such as rheumatism, cancer, HIV, and diabetes is underexplored and calls for further investigation post-COVID-19. Lastly, the limited literature on rural veterans' transportation cost savings using different mobility options-taxi, Uber, public transportation, and rides from friends and family-is another critical gap.

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