Equity in the development of telemedicine sites in an Arkansas high-risk pregnancy programme

Abstract

We investigated where telemedicine sites were placed in a telemedicine network to assist high-risk pregnancies in Arkansas. There were 14 telemedicine sites in 75 counties, excluding the central site in Pulaski county. Logistic regression was used to examine site placement. Five potential predictors of site placement were examined: (1) the logarithm of the number of births in the county (LOGBIRTHS); (2) an indicator of whether a county had an abnormal rate of low birthweight babies (HIGHLBW); (3) the proportion of the county population below the government's poverty level; (4) the ratio of black to white births; (5) an indicator of whether the county bordered the telemedicine hub site county. The results suggested that telemedicine sites were placed where there were more births (LOGBIRTHS, P = 0.001) and more low birthweight babies (HIGHLBW, P = 0.004). After controlling for these variables, the county poverty level did not reduce the likelihood of site placement. Thus telemedicine sites had been established in those areas where the need was great both in terms of immediate risk (rate of low birthweight babies) and in terms of the continuing pressure of large numbers of births. This is significant in view of the concentration of poor minorities in certain areas, which historically have not been matched by past distribution of resources.