The Heart of the Heartland: Bridging the Rural Care Gap with Telehealth
Heart Health and Hospital Closures in God’s Country…
Cardiovascular disease is a pervasive problem in rural communities and rural hospital closures further threaten these communities. Over 180 rural hospitals have shuttered their doors since 2005 and hundreds more are at risk. Rural hospitals provide vital life-saving emergency, inpatient, and even outpatient care. It is also important to consider this reality within context to the greater problem of rural residents being at increased risk for morbidity and mortality related to cardiovascular disease. One study by the Centers for Disease Control and Prevention (CDC) revealed that 40.0% of rural-dwelling adults reported having hypertension compared to only 29.4% of urban-dwelling adults, with hypertension medication use being higher in rural populations than in urban populations (Samanic et al., 2020). Several factors pertaining to lack of available care and inequitable resource distribution contribute to this health disparity, and rural hospital closures are a key driver in this phenomenon (Heindl et al., 2023). Mullens et al., (2023) conducted a scoping review using PRISMA guidelines to examine recent literature on the impacts of rural hospital closures, and found that they are associated with longer emergency medical service transport times, reduced access to hospital and outpatient services, and workforce strain.
Hospital Closures- Who is At the Greatest Risk
Rural residents are at the highest risk of suffering poor health outcomes due to rural hospital closures, because these hospitals are often the only point of access for emergency (and other) care within the vicinity of their communities. Older rural adults have higher rates of chronic illness and may have limited capacity to travel far for routine care and doctor's appointments due to mobility limitations. Low socioeconomic status (SES) members of rural populations may lack transportation and financial means to travel long distances for care. Persons of color within rural populations are also disadvantaged by the rural hospital closures, because of increased risk for morbidity and mortality related to cardiovascular disease risk factors and other health disparities like those related to maternal-fetal medicine (i.e., preeclampsia adverse effects being highest in black women). Communities of color in the South and Southeast United States already experience health disparities that are disproportionate to other racial groups and ethnic groups. Each of these groups within rural populations are impacted by longer emergency transport times due to EMS resources having to commute farther to both get critical patients and transport them to hospitals farther away due to hospital closures in rural areas. Additionally, rural hospital closures means fewer local providers and reduced services being offered, further contributing to economic decline in rural communities.
Upstream Approaches
Addressing the root causes of rural hospital closures and not just the downstream effects involve financially strengthening the existing rural healthcare resources and hospitals to make them more solvent and fiscally viable through options like Medicaid expansion and more governmental subsidies. Loan repayment programs should be enhanced to incentivize providers, nurses, and other healthcare workers to work in rural communities. Other investments into the rural healthcare workforce should be explored as well from both the national and state levels, given that the problem of rural hospital closures has broad-sweeping macroeconomic and microeconomic consequences. Therefore the NIMBY ("Not In My Backyard") approach is both inappropriate and serves no one. Everyone stands to lose when rural hospitals close; no community is a monolith.
Telehealth- Key Example of Bridging the Gap
Telehealth is an innovative approach to healthcare provision that is an example of how to mitigate the problems associated with rural hospital closures until more viable policy and economic shifts can be actualized. Telehealth, and more specifically remote patient monitoring (RPM) uses sensors and devices that facilitate continuous vital sign monitoring and medication adherence of patients, allowing real-time updates to providers and patients themselves about their care (Abraham et al., 2024). RPM, with telehealth, is a "bottom-up" and not "top-down" approach, as patients have increased better management of their own care and can reach out to their providers should problems arise. Additionally, improved blood pressure medication adherence has been a positive outcome of telehealth through remote patient monitoring, which has the potential for long-term positive impacts on improving rural health outcomes and reducing emergency services strain.
References
Abraham, C., Jensen, C., Rossiter, L., and Hale, D. (2024). Telenursing and remote patient monitoring in cardiovascular health. Telemedicine and e-health, 30 (3). https://doi.org/10.1089/tmj.2023.0187
Heindl, B,. Howard, G., Clarkson, S., Mukaz, D., Lackland, D., Muntner, P., & Jackson, E. (2023). Urban-rural differences in hypertension prevalence, blood pressure control, and systolic blood pressure levels. J hum hypertens 37, 1112–1118. https://doi.org/10.1038/s41371-023-00842-wLinks to an external site.
Mullens, C. L., Hernandez, J. A., Murthy, J., Hendren, S., Zahnd, W. E., Ibrahim, A. M., & Scott, J. W. (2023). Understanding the impacts of rural hospital closures: A scoping review. Journal of Rural Health, 39(2), 227–237. https://doi.org/10.1111/jrh.12801Links to an external site.
Samanic, C., Barbour, K., Liu, Y., Wang, Y., Fang, J., Lu, H., Schieb, L., & Greenlund, K. (2010). Prevalence of self-reported hypertension and antihypertensive medication use by county and rural-urban classification–United States. MMWR morb mortal wkly rep 69, 533-539. http://dx.doi.org/10.15585/mwr.mm6918a1
TL;DR: The Quick Recap
The Crisis is Real: Since 2005, 180+ rural hospitals have closed, leaving communities in the lurch. We aren’t just losing buildings; we’re losing golden-hour trauma care and local access.
The Stats are Wild: Rural adults have a 40.0% hypertension rate compared to 29.4% in cities. More risk + fewer doctors = a recipe for poor outcomes.
Who’s Feeling the Heat? Older adults with mobility issues, low-SES families without transport, and Black women in the South (who already face the highest preeclampsia risks) are hit the hardest by these closures.
Fix the Root (Upstream): We need Medicaid expansion, government subsidies, and loan repayment vibes to keep rural healthcare workers on the map. The "NIMBY" approach helps zero people.
Enter Telehealth & RPM: Remote Patient Monitoring (RPM) is the ultimate bridge. Sensors and real-time data help patients manage their own health from home, reducing the strain on overworked EMS crews.