Using Telehealth to Disseminate Primary, Secondary, and Tertiary CVD Interventions to Rural Populations
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Purpose of Review
This study aims to review the evidence on telehealth interventions in rural communities that use primary, secondary, or tertiary strategies for the prevention and management of cardiovascular disease (CVD).
Studies focused on the reduction of CVD risk factors and mitigation of disease progression among rural populations using telehealth are limited in number but appear to be increasing in the last 5 years. These studies suggest primary-, secondary-, and tertiary-level interventions can impact CVD risk and management. The current review found more studies addressing primary CVD intervention strategies, although the evidence for efficacy at all intervention levels is in the early stages.
Leveraging prevention strategies via telehealth may be an effective vehicle to facilitate improved CVD outcomes among populations traditionally marginalized by geographic location.
KeywordsPrimary prevention of cardiovascular disease Secondary prevention of cardiovascular disease Tertiary prevention of cardiovascular disease Rural health Cardiovascular disease (CVD) Health disparities
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.National Center for Health Statistics. Cardiovascular disease Mortality rural-urban differences. Hyattsville: Centers for Disease Control and Prevention. https://www.ruralhealthinfo.org/charts/50. Accessed 16 June 2019
- 2.MacQueen IT, Maggard-Gibbons M, Capra G, Raaen L, Ulloa JG, Shekelle PG, et al. Recruiting rural healthcare providers today: a systematic review of training program success and determinants of geographic choices. J Gen Intern Med. 2018;33(2):191–9. https://doi.org/10.1007/s11606-017-4210-z.CrossRefPubMedGoogle Scholar
- 3.Rural Health Information Hub. Healthcare access in rural communities. https://www.ruralhealthinfo.org/topics/healthcare-access. Accessed 16 June 2019.
- 4.Office of Disease Prevention and Health Promotion (ODPHP). Healthy people 2020 leading health indicators, 2019. https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Access-to-Health-Services. Accessed 24 August 2019.
- 5.Giedrimiene D, King R. Abstract 207: burden of cardiovascular disease (CVD) on economic cost. Comparison of outcomes in US and Europe. Circ Cardiovasc Qual Outcomes. 2017;10(suppl_3):A207-A. https://doi.org/10.1161/circoutcomes.10.suppl_3.207.CrossRefGoogle Scholar
- 7.•• American Hospital Association. Rural report, 2019. https://www.aha.org/system/files/2019-02/rural-report-2019.pdf. Accessed 24 August 2019. This report highlight the chalenges facing rural communities and the roadmap to encure local access to high-quality, affordable care.
- 8.Centers for Disease Control and Prevention. Picture of America_Prevention. https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_prevention.pdf. Accessed 8 July 2019.
- 9.Spleen AM, Lengerich EJ, Camacho FT, Vanderpool RC. Health care avoidance among rural populations: results from a nationally representative survey. J Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2014;30(1):79–88. https://doi.org/10.1111/jrh.12032.CrossRefGoogle Scholar
- 11.Ciemins E, Coon P, Peck R, Holloway B, Min SJ. Using telehealth to provide diabetes care to patients in rural Montana: findings from the promoting realistic individual self-management program. Telemed J E Health. 2011;17(8):596–602. https://doi.org/10.1089/tmj.2011.0028.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.• Litke J, Spoutz L, Ahlstrom D, Perdew C, Llamas W, Erickson K. Impact of the clinical pharmacy specialist in telehealth primary care. Am J Health Syst Pharm. 2018;75(13):982–6. https://doi.org/10.2146/ajhp170633 This research study focused on leveraging clinical pharmacy specialist to provide primare comprehensive medication management services soley via telehealth. Since there are shortages of physicians in rural communities, leveraging other healthcare providers to help improve disease management is an important contribution to the literature on telehealth. CrossRefPubMedGoogle Scholar
- 16.Gore MO, Krantz MJ, Albright K, Beaty B, Coronel-Mockler S, Bull S, et al. A controlled trial of mobile short message service among participants in a rural cardiovascular disease prevention program. Prev Med Rep. 2019;13:126–31. https://doi.org/10.1016/j.pmedr.2018.11.021.CrossRefPubMedGoogle Scholar
- 17.Anderson ER, Smith B, Ido M, Frankel M. Remote assessment of stroke using the iPhone 4. J Stroke Cerebrovasc Dis. 2013;22(4):340–4. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.09.013.CrossRefPubMedGoogle Scholar
- 18.Lazaridis C, DeSantis SM, Jauch EC, Adams RJ. Telestroke in South Carolina. J Stroke Cerebrovasc Dis. 2013;22(7):946–50. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.11.008.CrossRefPubMedGoogle Scholar
- 20.Al Kasab S, Adams RJ, Debenham E, Jones DJ, Holmstedt CA. Medical University of South Carolina Telestroke: a telemedicine facilitated network for stroke treatment in South Carolina-a Progress report. Telemed J E Health. 2017;23(8):674–7. https://doi.org/10.1089/tmj.2016.0229.CrossRefPubMedGoogle Scholar
- 22.•• Wolf SL, Sahu K, Bay RC, Buchanan S, Reiss A, Linder S, et al. The HAAPI (Home Arm Assistance Progression Initiative) trial: a novel robotics delivery approach in stroke rehabilitation. Neurorehabil Neural Repair. 2015;29(10):958–68. https://doi.org/10.1177/1545968315575612 Access to care is a barrier for patients in rural communities. This study is the first to systematically assess the efficacy and feasibility of a robotic telerehabilitation intervention to improve post-stroke patients with limited access to rehabilitation services upper-extemity function capabilities. This is an important contribution to science. CrossRefPubMedPubMedCentralGoogle Scholar