Rural and remote health最新文献

Purpose: Maintaining a robust healthcare workforce in underserved rural communities continues to be a challenge. To better meet healthcare needs in rural areas, training programs must develop innovative ways to foster transition to, and integration into, these communities. Mountain Area Health Education Center designed and implemented a 12-month post-residency Rural Fellowship program to enhance placement, transition, and retention in rural North Carolina. Utilizing a '6 Ps' framework, the program targeted physicians and pharmacists completing residency with the purpose of recruiting and supporting their transition into the first year of rural practice.

Method: To better understand Rural Fellows' experiences and the immediate impact of their Fellowship year, we conducted a semi-structured interview using a narrative technique and evaluated retention rates over time. Interviews with the eight participants, which included Fellowship alumni and current Fellows, demonstrated the impact and influence of the key curricular '6 Ps' framework.

Results: An early retention rate of 100% and a long-term retention rate of 87%, combined with expressed clarity of curricular knowledge, skills, and attitudes related to the '6 Ps', demonstrate the potential and effectiveness of this Rural Fellowship model. Participants indicated the Rural Fellowship experience supports the transition to rural practice communities and expands their clinical skills.

Conclusion: The Rural Fellowship program demonstrates an effective model to support early career healthcare providers as they begin practice in rural communities in western North Carolina through academic opportunities, personal growth, and professional development. Implementation of this model has demonstrated the success of a rural retention model over a 6-year period. This model has the potential to target an array of clinical providers and disciplines. We started with family medicine and have expanded to psychiatry, obstetrics, pharmacy, and nursing. This study demonstrated that this model supports clinical providers during the critical transition period from residency to practice. Targeting the most important stage of one's medical training, the commencement of professional practice, this is a scalable model for other rural-based health professions education sites where rural recruitment and retention remain a problem.

Introduction: Low back pain is a significant global public health issue affecting over half a billion people and contributing to disability worldwide. The impact of disability related to low back pain is growing, particularly in low- and middle-income countries. In contrast with previous research, current evidence shows Indigenous Peoples also experience low back pain's disabling effects. A clinical ethnographic can contribute by attempting to understand the data through the perspective of Indigenous Peoples.

Methods: A clinical ethnographic study was conducted in Galibi, a Kalinya rural Indigenous village in Suriname, with support of the local traditional authority. The main objective was to explore the impact of low back pain and care-seeking behavior from the perspective of Indigenous Peoples with low back pain.

Results: The findings were that low back pain had a significant physical and emotional impact. Despite aggravating their low back pain, participants continued many of their activities of daily life since these were essential for their (economic) survival. Furthermore, participants expressed anxiousness, financial worries, and concerns about the cause and future of their low back pain. To address their low back pain, the Kalinya Indigenous Peoples used both western and traditional care. Visits to western healthcare practitioners were limited due to logistical challenges and travel costs, and the experience was often negative.

Conclusion: The study highlights the experiences of Kalinya Indigenous Peoples dealing with low back pain. Low back pain is a burden within Indigenous Peoples of Galibi but accepted as an integral part of their life. When in pain, Indigenous Peoples face many barriers to access western health care and visits to healthcare practitioners were often unhelpful. This contributed to a long-lasting negative impact on the Indigenous people with low back pain. Further research is needed to develop strategies that improve health outcomes related to low back pain while reducing its associated disability in Indigenous Peoples.

Introduction: Community paramedicine is a field in its infancy. The use of community paramedics has expanded in recent years as an alternative or adjunct to home health in the continued drive to decrease health disparities and complications. In current practice, they function in a position like a home healthcare nurse with an expanded scope of practice, such as providing specialized follow-up care, for example with postoperative care for patients who have undergone major surgery or recent hospitalization. This study assesses if community paramedics are a valid option in reducing rehospitalization of patients who underwent a coronary artery bypass grafting (CABG) procedure.

Methods: A retrospective chart review between 2021 and 2022 was performed on all patients who underwent CABG in Bismarck, North Dakota, along with obtaining a referral for the community paramedics spanning urban and rural areas. A comparison was made between individuals who saw the community paramedics in their post-care versus those who continued with the standard of care.

Results: There were 80 participants and 38 location-matched controls. All variables were found to be statistically insignificant except for the number of walk-in visits (urgent care), in which 7 out of 38 sought medical attention in the controls and 4 out of 80 sought medical attention in the participants. The proportions of inpatient readmission rates and emergency department (ED) visits were similar.

Discussion: Given that paramedicine is in its infancy, the emergence of other variations of the community paramedic certification has brought a discussion of their scope of practice. While walk-in visits, even with the limitations, showed significant improvement with the addition of community paramedics, more research is still needed to show their effectiveness in reducing readmission to hospital. Additionally, the patients who sought help from community paramedics may be more likely than the controls to seek help from medical professionals.

Conclusion: This study provided a novel look into the effect that community paramedics can have on patients in urban and rural areas in regard to reducing postoperative complications and minimizing unnecessary advanced healthcare utilization.

Introduction: Limited health literacy - the ability to access, process, and use health information and services - contributes to persistent health inequities. Yet little is known about associations of limited health literacy with impacts from the COVID-19 pandemic, particularly for US adults in rural areas. This study sought to determine associations of limited health literacy with impacts from the COVID-19 pandemic among a diverse sample of adults in rural Northern Arizona.

Methods: A cross-sectional, interviewer-administered survey was conducted with 119 adults from June 2020 to August 2021. Participants were recruited from two federally qualified health centers and by word of mouth. The Newest Vital Sign was used to measure health literacy, and the Epidemic-Pandemic Impacts Inventory was used to measure the effects of the COVID-19 pandemic on various aspects of personal and family life (eg spent more time on screens and devices, had family celebrations canceled or restricted). Descriptive, bivariate, and multivariable linear regression statistics were computed.

Results: Nineteen percent of participants had limited health literacy, and participants had an average of 22 individual impacts and 2 household impacts of the 92 COVID-19 impacts assessed. Multivariable regression model results showed that being male versus female or having public only versus any private insurance was significantly associated with fewer individual COVID-19 impacts on average. Being black, Indigenous, people of color versus White or being Hispanic, Latino, or Spanish versus not were each associated with significantly more individual COVID-19 impacts on average. Limited versus adequate health literacy was significantly associated with more household COVID-19 impacts on average. Sensitivity analysis results further showed that limited versus adequate health literacy was associated with significantly higher adjusted rates of household social, emotional, and infection COVID-19 impacts.

Conclusion: This study's findings highlight the importance of assessing and accounting for health literacy in clinical practice and health services research addressing the impacts of the COVID-19 pandemic and future emergency events.

Introduction: Limited access to psychological treatment is a pressing problem in the US, especially in more rural areas. One potentially underutilized resource is informal care from friends and family members. Although those in rural areas rely on informal care more than those in urban areas, there is little to guide interested caregivers in how they can be most effective.

Methods: In this study, we conducted a pilot test of the Friends and Family for Mental Health Program, a mental health skills program we developed to enhance informal care and reduce psychological symptoms among informal caregivers. To provide an initial test of the potential benefits of this program, we evaluated the impact of the program on informal care skills, hope, psychological symptoms, and mental health skills.

Results: Informal care skills and hope improved. Participants also reported reduced anxiety. We considered intervention feedback to inform intervention development.

Discussion: Overall, findings provided preliminary support for the program and provide directions for future refinements.

Conclusion: Though further research is needed, initial evidence suggests mental health skills programs directed at informal caregivers are both desired and beneficial in rural areas.

Introduction: There is limited published data on the burden of cardiac disease among patients requiring emergency medical evacuation from the Great Barrier Reef, a popular tourist destination in Far North Queensland, Australia. The aim of this study was to examine the characteristics and outcomes of patients with cardiac conditions who were retrieved from the northern Great Barrier Reef to Cairns Hospital.

Methods: This observational study was a planned substudy of a broader analysis of medical retrievals from the Cairns/Cooktown section of the Great Barrier Reef. It included all patients retrieved to Cairns Hospital between July 2016 and January 2020 who were assigned a cardiac diagnosis during their hospital stay. Data were collected about electrocardiograph, cardiac troponin blood test and invasive coronary angiography results as well as final hospital diagnosis.

Results: During the study period, 120 patients were retrieved from the Great Barrier Reef to Cairns Hospital, of which 46 (38%) were subsequently diagnosed with a primary cardiac condition(s) or other disease process with clinically significant cardiac involvement. The most common diagnoses were type 2 myocardial infarction (20; 16.7% of all retrievals), primary cardiac arrhythmia (14; 12.5%) and acute coronary syndrome (5; 4.2%). An elevated troponin was recorded in 30% of all retrievals and in 78% of those with a cardiac diagnosis. A total of 14 (30.4%) of patients with a cardiac diagnosis died during their hospital admission. Invasive coronary angiography was performed in 18 cases, of which six patients had obstructive coronary artery disease. Four patients required percutaneous coronary intervention.

Conclusion: A high proportion of patients retrieved to Cairns Hospital from the Great Barrier Reef were diagnosed with a primary cardiac condition. This data may assist tourism operators, retrieval organisations and health services to plan for, and respond to, cardiac events among visitors to the reef.

Introduction: The objective of this study is to evaluate severe maternal morbidity (SMM) of rural parturients delivering at rural compared to urban hospitals in the US.

Methods: We identified patients aged 18-40 years in a multi-institutional claims database who lived in a rural ZIP code and delivered at a rural or urban hospital between October-December of 2015 and October-December of 2022. The primary outcome was SMM, and the secondary outcome was SMM exclusive of blood transfusions. We combined exact ZIP code matching and propensity score matching to compare SMM risk among patients living in the same rural community and delivering in urban as compared to rural hospitals.

Results: A total of 214 296 patients from 571 ZIP codes were identified, including 47% delivering at rural facilities and 53% delivering at urban facilities. The SMM rate was 1.1% (0.3% excluding blood transfusions). After matching, urban versus rural delivery was associated with increased odds of SMM other than blood transfusion (odds ratio 2.44; 95% confidence interval 1.81-3.28), but was not associated with differences in risk of any SMM.

Conclusion: There was no evidence of reduced SMM for rural patients delivering at an urban rather than a rural hospital. SMM exclusive of blood transfusions was increased for rural patients delivering at urban hospitals after matching on ZIP code and predictors of urban hospital delivery. Our findings undermine the assumption that delivery at a rural facility has inherently greater risks relative to delivery at an urban facility. As some health systems face challenges to maintain rural labor and delivery units, patient safety must be considered if confronted with the possibility of unit or hospital closures.

Introduction: Harms arising from alcohol and other drug (AOD) use are disproportionately felt by men living in rural locations. The detrimental impact of AOD use is compounded by a range of barriers to help-seeking. Online recovery support services (including mutual-help groups) are increasingly used to reach people who might not otherwise seek support for AOD use. Scant research examines the experiences of men attending online mutual-help groups, with the little available evidence focused on 12-step approaches and people living in urban areas. This short communication compared the characteristics and experiences of rural and urban men attending online Self-Management and Recovery Training (SMART Recovery) mutual-help groups in Australia.

Methods: A link to a voluntary online questionnaire was automatically provided at the end of each online group as part of routine data collection. Questions assessed participants' demographics, main reason for attending, engagement, experiences and perceived utility of the group. This study is a secondary analysis examining data provided by male attendees located in rural (n=259) and urban (n=996) areas.

Results: Alcohol use for both rural and urban attendees (73% v 66.8%) was the most frequently reported reason for attending SMART Recovery groups. Rural attendees were older than their urban counterparts (p<0.001) and were less likely to endorse 'other' drug use as a reason for attending (28.6% v 16.6%, p<0.001). Participants reported a high level of satisfaction with online SMART Recovery groups. No significant differences were found between the two groups. Rural and urban men reported that they felt welcome (93.1% v 95.1%) and supported (90% vs 92.5%), had the opportunity to contribute to discussions (91.5% v 92.1%), and felt the group was well facilitated (91.1% v 94.4%). Rural and urban attendees also experienced the groups as helpful (88.8% v 91.8%), took away practical strategies (86.5% v 85.2%) and planned to continue to attend the groups in the future (91.1% v 92.3%). Around a quarter of rural (20.8%) and urban (27.0%) attendees experienced technical difficulties during the meeting.

Discussion and conclusion: This study contributes new knowledge regarding similarities and differences in the experience of online SMART Recovery groups from the perspective of men living in rural and urban areas. Despite around a quarter of participants experiencing technical difficulties, their self-reported engagement, experience and perceived utility of the online group were highly rated. Online recovery support services provide a promising option for reaching men who experience issues with their AOD use, particularly in rural areas where access to face-to-face services is limited.