Digital divide threatens telehealth equity in rural chronic disease management

A comprehensive new scoping review finds that telehealth technologies offer promising solutions for the complex challenge of managing multimorbidity in rural and remote regions. The study, titled “Harnessing Telehealth for Multimorbidity Management in Rural and Remote Areas: A Scoping Review of Applications, Challenges, and Gaps” and published in the Journal of Multimorbidity and Comorbidity (2025), synthesizes global evidence from 44 studies spanning two decades. 

The study assesses the use of telehealth for clinical management, patient engagement, remote monitoring, and provider collaboration, while also identifying substantial gaps in equity, infrastructure, and implementation that must be addressed for broader impact.

Why telehealth is a critical strategy for rural multimorbidity management

Multimorbidity, defined as the co-existence of two or more chronic health conditions, presents a growing challenge to healthcare systems, especially in rural and remote communities. These regions often suffer from a scarcity of healthcare providers, limited transportation infrastructure, and underdeveloped health facilities, which compound the difficulties of accessing continuous and coordinated care. For patients managing complex conditions like diabetes, cardiovascular disease, respiratory illness, and mental health disorders simultaneously, fragmented care delivery leads to poor health outcomes and high system costs.

The review highlights telehealth as a powerful alternative to traditional care pathways, particularly for rural populations who face geographic and socioeconomic barriers. Telehealth interventions analyzed in the review include synchronous video consultations, asynchronous messaging systems, mobile health apps, and wearable devices for remote monitoring. These tools facilitate frequent communication between patients and providers, enable home-based disease monitoring, and reduce the need for travel to distant clinics.

Despite the promise of digital solutions, the study finds that most existing telehealth programs were not originally designed for multimorbidity care. Many interventions were developed with a single disease focus, limiting their applicability to patients with overlapping and interacting conditions. Only a minority of studies in the review addressed integrated care approaches suitable for the complexity of multimorbidity, revealing a critical gap in both practice and research.

How are telehealth technologies being used, and what are the evident shortcomings?

The review categorizes telehealth’s application across four functional domains: clinical care, self-management support, health monitoring, and interdisciplinary collaboration.

In clinical care, video calls and phone-based check-ins allow physicians and specialists to adjust treatment plans and medication regimens for patients without requiring in-person visits. This is especially valuable in remote regions where specialist access may otherwise be delayed for weeks or months. Teleconsultations also streamline the management of polypharmacy, a key concern in multimorbidity cases.

For self-management, digital tools such as mobile apps and text-message reminders help patients track symptoms, adhere to complex medication schedules, and follow lifestyle recommendations. These platforms foster patient empowerment, which is a crucial component in managing chronic diseases. The review notes improvements in self-efficacy and adherence reported by users of telehealth platforms.

Remote monitoring solutions, ranging from glucometers to blood pressure cuffs and pulse oximeters, transmit real-time data to clinicians, allowing for timely interventions before a health issue escalates. However, the review reveals that such technologies are underutilized in rural areas due to infrastructure limitations and affordability issues.

A major benefit of telehealth cited in the study is its capacity to improve interdisciplinary coordination. Shared electronic records and virtual case conferences allow general practitioners, nurses, dietitians, mental health workers, and other professionals to jointly manage patient care, promoting continuity and reducing duplicative testing or conflicting advice.

Yet, several shortcomings persist. Most interventions lacked a lifespan approach, meaning they were too short-term to evaluate outcomes meaningfully. The review also points out the absence of tailored platforms for multimorbidity; few programs offered dashboards or interfaces that integrate care plans across conditions. Additionally, evidence of long-term cost-effectiveness, health outcomes, and patient satisfaction remains limited, especially in resource-constrained settings.

What equity and system-level barriers limit telehealth's reach?

While the technological possibilities of telehealth are expanding, the study emphasizes that systemic inequities hinder their real-world effectiveness.

One of the most prominent barriers is the digital divide. Rural and remote populations often face poor internet connectivity, lower smartphone penetration, and limited access to digital training or technical support. Older adults, who are the most affected by multimorbidity, frequently lack the digital literacy required to engage with advanced health applications, creating a risk of widening health disparities under a tech-first model.

Policy and reimbursement gaps further obstruct uptake. Variability in telehealth coverage policies, unclear billing frameworks, and lack of standard protocols for remote care reduce provider participation and limit program sustainability. The review notes that many telehealth pilots were grant-funded and lacked continuity once funding expired, making it difficult to scale successful models.

Workforce readiness also remains a constraint. Clinicians in rural areas may lack training in virtual care delivery or confidence in digital tools. Some health professionals express concerns over clinical accuracy and the inability to conduct physical exams, particularly when managing complex or high-risk patients. These concerns can delay adoption or restrict telehealth to administrative follow-ups rather than substantive care delivery.

Another challenge is the underrepresentation of low- and middle-income countries (LMICs) in the existing body of research. Most of the reviewed studies were conducted in high-income nations such as the U.S., Canada, and Australia. This leaves major gaps in understanding how telehealth can be adapted and implemented in health systems where infrastructure is weak, regulatory systems are underdeveloped, and out-of-pocket health spending is high.

Recommendations for advancing equitable, scalable telehealth solutions

To fully unlock the potential of telehealth for multimorbidity management in rural and remote settings, the study offers a set of strategic recommendations grounded in scalability, equity, and integration.

Policymakers are urged to invest in rural broadband infrastructure and to standardize reimbursement for telehealth services. Telehealth platforms should be co-designed with rural communities to ensure cultural relevance and usability across literacy levels and age groups. Flexible, multilingual interfaces and low-bandwidth options can help bridge digital accessibility gaps.

Healthcare systems should prioritize provider training in virtual care competencies, particularly around managing complex patients. Interdisciplinary telehealth models must be developed that integrate primary care, speciality services, and allied health professionals under unified digital ecosystems.

Research priorities include longitudinal outcome evaluations, implementation science studies in LMICs, and comparative analyses of digital versus traditional care models. Embedding telehealth into national multimorbidity management frameworks, rather than relegating it to pilot status, will be essential for ensuring lasting health system transformation.