Telehealth in Oregon 7

potential barriers to telehealth technology due to the complexity of the devices or because of

their lack of training. This study therefore concluded that telerehabilitation system can have a

positive impact on issues of access to and cost of care, facilitate continuity of care, and be well-

received by both consumers and providers (Demiris, Shigaki, Schopp, 2005).

Another comparable study was conducted by Cyr, Etchin, Guthrie, and Benneyan (2019),

to assess specialty healthcare in urban versus rural US populations and explore how telehealth

reduced disparities for the rural underserved areas and vulnerable (elderly) population. The

Cumulative Index to Nursing and Allied Health Complete (CINAHL) and electronic databases

were used to search 5709 articles containing Medical Subject Headings (MeSH) and was

directed by PRISMA guidelines, of which 190 peer-reviewed, English language articles (US

based) published from 2013 to 2018 were utilized. The results concluded that both urban and

rural areas had difficulties in health care access, with rural resident having longer travel times,

delayed in diagnosis, reduced overall survival, and primary care and specialty clinicians

themselves can influence access to care by initiating integrated services such as telehealth (Cyr,

Etchin, Guthrie, and Benneyan, 2019). Six studies reviewed in North Carolina, was found to

increase care via telehealth access to the Acute Stroke access program and mental health (Cyr,

Etchin, Guthrie, and Benneyan, 2019). The limitations of this study were that only systematic

peer-reviewed articles were used, excluding grey literature, and only one investigator was used

to review titles and abstract which may have caused pertinent articles to be missed.

Healthcare Affordability

Langabeer, Champagne, Alqusairi, Jackson, Persse, Gonzalez (2017) conducted a cost–

benefit analysis of telehealth in pre-hospital care by use of a case-control quantitative study, to

assess the costs and benefits of the implementation of one large telehealth EMS (Emergency