Poststroke Telehealth Utilization Patterns Across Gender, Geography, Insurance, and Age in Arkansas

BACKGROUND Stroke is a major cause of death and disability. Prior strokes increase the risk of subsequent strokes, and follow-up care is important yet underutilized for recurrence prevention.

METHODS We used data from the Arkansas All-Payer Claims Database (2017-2022) on patients with a prior stroke diagnosis. We plotted trends in telehealth use, stratified by gender, rurality, insurance (private vs. Medicaid), and age (18-44 vs. 45-64), and used chi-square tests to assess differences. We then used regression analysis to assess whether telehealth impacted overall office visit utilization through the COVID-19 pandemic era.

RESULTS Telehealth surged during the first year of the COVID-19 pandemic before settling at levels higher than baseline. Telehealth utilization patterns varied by gender, insurance, and age. Telehealth generally offset pandemic-associated loss of in-person care across all groups for the first two years of the pandemic. One exception was its use by insurance type, in which total care decreased among Medicaid beneficiaries but increased among the commercially insured.

CONCLUSION Our findings highlight four patterns: (1) telehealth utilization among poststroke patients increased sharply but then steadily declined, settling at higher-than-prepandemic levels; (2) telehealth generally staved off in-person care losses; (3) patterns and levels of telehealth use varied by demographic group; and (4) heterogeneities in use by insurance highlight both the potential benefits of telehealth in increased care utilization but also caution against its ability to completely mitigate a decrease among vulnerable populations. Overall, telehealth may serve as an effective tool to increase follow-up visits and support recurrent stroke prevention.