The use of telehealth in pediatric neurosurgery for rural patients of Appalachia

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OBJECTIVE: The authors' objective was to assess the impact of telehealth on pediatric neurosurgical care access for underserved and rural populations in West Virginia. The authors explored how telehealth utilization varied over time, the socioeconomic benefits it provided to families, and its effect on visit completion rates compared with in-person appointments. METHODS: Clinic visits from January 1, 2017, to May 31, 2023, at the sole pediatric neurosurgery clinic in West Virginia were retrospectively reviewed. The data included three types of outpatient visits: in-person, telemedicine satellite clinic, and MyChart video appointments. Initial statistical analysis focused on visit completion rates, distance traveled, and time and cost savings for families. Additional geospatial analysis used heat density mapping to recognize regional utilization patterns, and community-level socioeconomic variables were analyzed for correlation with visit type utilization. RESULTS: Telehealth usage (telemedicine and MyChart) increased significantly during and after the COVID-19 pandemic. MyChart visits demonstrated the highest completion rates postpandemic. Telehealth visits saved families substantial travel time and cost, especially for those living more than 100 miles from the clinic. Geospatial analysis revealed that telemedicine usage was clustered in specific Appalachian regions, and in-person visits were more common among patients from economically distressed communities. Correlation analysis showed that higher poverty and unemployment rates were associated with in-person visit reliance, while telehealth adoption was lower in these populations. CONCLUSIONS: Telehealth significantly enhances access to pediatric neurosurgical care for rural and economically disadvantaged families, reducing travel-related burdens and increasing visit adherence. However, economically distressed communities in Appalachia are less likely to use telehealth, possibly due to digital access issues or skepticism about remote care. Addressing these barriers is crucial to ensure equitable healthcare access. Further research should investigate structural and personal obstacles to telehealth uptake to improve service delivery for at-risk populations, ultimately fostering more inclusive and accessible healthcare options in remote areas.

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