Journal of Rural Health最新文献_第10页

Exploring telehealth adoption and financial outcomes for rural hospitals during the COVID-19 public health emergency 探讨农村医院在2019冠状病毒病突发公共卫生事件期间远程医疗的采用和财务结果

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-05-27 DOI: 10.1111/jrh.70038

Saleema A. Karim PhD, J. Mick Tilford PhD, Cari A. Bogulski PhD, Corey J. Hayes MPH, PharmD, PhD, Hari Eswaran PhD

Purpose

To examine factors associated with rural hospital telehealth adoption during the COVID-19 public health emergency (PHE), and evaluate its relationship with rural hospital financial performance before and during the PHE.

Methods

This panel study used retrospective data (2017–2021) from the American Hospital Association Annual Survey, the Centers for Medicare & Medicaid Services Healthcare Cost Report Information Systems, and the Area Health Resource File. Rural hospitals were categorized as persistent adopters, persistent nonadopters, or switchers based on telehealth adoption status. Bivariate analyses assessed differences in subgroup means and frequencies, while a difference-in-difference model estimated the impact of telehealth adoption on rural hospital financial performance.

Findings

Telehealth adoption varied among rural hospitals. Before the PHE, 75% (751) of rural hospitals had adopted telehealth, while 25% (247) were nonadopters. Despite efforts to promote remote care delivery during the PHE, 58% (144) of pre-PHE nonadopters did not adopt telehealth. Among the 42% (103) that did adopt telehealth during the PHE, no statistically significant effect was observed on operating or total margins.

Conclusion

Rural hospitals in economically disadvantaged and sparsely populated areas, which stand to benefit the most from telehealth adoption, often face substantial barriers that limit their ability to adopt this technology. Financial constraints and limited resources continue to hinder adoption, underscoring the need for targeted policies and investments to expand telehealth access and improve health care outcomes in rural communities.

目的探讨新型冠状病毒肺炎突发公共卫生事件（PHE）期间农村医院采用远程医疗的相关因素，并评估其与PHE之前和期间农村医院财务绩效的关系。方法：本小组研究使用了来自美国医院协会年度调查、医疗保险和医疗服务中心的回顾性数据（2017-2021年）；医疗补助服务医疗成本报告信息系统和区域卫生资源文件。根据远程医疗的采用情况，农村医院被分为持续采用、持续不采用或转换。双变量分析评估了亚组均值和频率的差异，而差异中差异模型估计了采用远程医疗对农村医院财务绩效的影响。结果农村医院采用远程医疗的情况存在差异。在PHE之前，75%（751家）的农村医院采用了远程医疗，而25%（247家）没有采用。尽管在PHE期间努力促进远程医疗服务，但58%（144）未采用PHE的人没有采用远程医疗。在PHE期间采用远程医疗的42%（103）中，没有观察到对营业利润或总利润的统计显着影响。结论：经济条件不利和人口稀少地区的农村医院从采用远程保健中获益最多，但往往面临重大障碍，限制了它们采用这一技术的能力。财政限制和有限的资源继续阻碍采用，突出表明需要有针对性的政策和投资，以扩大远程保健的可及性并改善农村社区的保健成果。

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引用次数: 0

Obstetric care in rural critical access hospitals: A domestic application of the World Health Organization Emergency Obstetric Care framework in rural communities 农村关键医院的产科护理：世界卫生组织紧急产科护理框架在农村社区的国内应用

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-05-24 DOI: 10.1111/jrh.70037

Annie L. Glover PhD, MPH, MPA, Diane Brown MPH, Carly Holman MS, Megan Nelson MSW

Purpose

Pregnancy-related mortality has increased steadily over the last 30 years in the United States; during the same period, rural communities have lost access to care as rural hospitals and obstetric units have shut their doors. Rural critical access hospitals (CAHs) are often the only option for a pregnant person in a rural community needing emergency care. This study aimed to apply a uniform assessment of the capacity of hospitals that do not have obstetric units to meet the emergency obstetric care needs of the rural communities they serve, with the goal of facilitating ongoing obstetric emergency readiness assessments that can be used in the rural context.

Methods

The study team conducted facility assessments across Montana's statewide system of hospital care. The Centers for Disease Control and Prevention (CDC) Levels of Care Assessment Tool (LOCATe) was used in hospitals with an obstetrics unit (N = 25). The team adapted the World Health Organization (WHO) Emergency Obstetric Care (EmOC) framework to assess readiness in hospitals without an obstetrics unit (N = 34) but with Emergency Medical Treatment and Labor Act (EMTALA)-based obligations to patients presenting to emergency departments with obstetric emergencies.

Findings

None of the responding hospitals without obstetric units met criteria indicating readiness to provide comprehensive emergency obstetric care (CEmOC), and only one hospital met criteria indicating readiness to provide basic emergency obstetric care (BEmOC).

Conclusion

Significant work must be done to bring CAHs up to a level of readiness where they can safely and effectively screen, stabilize, and transfer or accept an obstetric emergency. The WHO EmOC framework can provide a starting point for assessing the capacity of hospitals without obstetric units, but a standardized assessment, such as LOCATe, should be developed to improve readiness for obstetric emergencies.

在过去的30年里，美国与妊娠相关的死亡率稳步上升；在同一时期，由于农村医院和产科关闭，农村社区失去了获得护理的机会。农村危重医院（CAHs）往往是农村社区孕妇需要紧急护理的唯一选择。这项研究的目的是对没有产科部门的医院满足其所服务的农村社区紧急产科护理需求的能力进行统一评估，目的是促进可用于农村情况的持续产科应急准备评估。研究小组对蒙大拿州的全州医院护理系统进行了设施评估。在有产科的医院（N = 25）使用疾病控制和预防中心（CDC）护理水平评估工具（LOCATe）。该小组采用了世界卫生组织（WHO）紧急产科护理（EmOC）框架，以评估没有产科部门（N = 34）但根据《紧急医疗和劳动法》（EMTALA）对产科急诊患者的义务的医院的准备情况。调查结果：没有产科科室的受访医院中，没有一家达到提供全面产科急诊（CEmOC）的准备标准，只有一家达到提供基本产科急诊（BEmOC）的准备标准。结论：必须开展大量工作，使CAHs达到能够安全有效地筛查、稳定和转移或接受产科急诊的准备水平。世卫组织紧急产科服务框架可为评估没有产科的医院的能力提供一个起点，但应制定标准化评估，如LOCATe，以改善产科急诊的准备情况。

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引用次数: 0

Development of chronic pain and high-impact chronic pain across the US rural–urban continuum, 2019–2020 2019-2020年美国城乡连续体慢性疼痛和高影响慢性疼痛的发展

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-05-22 DOI: 10.1111/jrh.70036

Feinuo Sun PhD, Yulin Yang PhD, Richard L. Nahin MPH, PhD

Purpose

Rural health disadvantages are well documented in previous literature; however, research on rural–urban disparities in chronic pain outcomes is scarce. This paper fills this gap by examining pain prevalences and longitudinal transitions across the rural–urban continuum (i.e., large central metro, large fringe metro, medium and small metro, and nonmetropolitan).

Methods

Based on the 2019–2020 National Health Interview Survey Longitudinal Cohort (NHIS-LC) data, we examined the disparities in pain prevalences and transitions among different pain statuses, including no pain, nonchronic pain, chronic pain, and high-impact chronic pain (HICP), across the rural–urban continuum and by age, sex, race/ethnicity, and region. A test for linear trend was conducted to examine the significance of linear changes across the rural–urban continuum.

Findings

The findings reveal significant linear increases in the prevalence of chronic pain and HICP, as well as transitions from no pain to nonchronic pain and from nonchronic pain to more severe pain conditions, along the continuum from metropolitan to nonmetropolitan areas. Subgroup analyses indicate that rural–urban gaps are most pronounced among middle-aged (45–64) groups and non-Hispanic Whites.

Conclusions

This longitudinal analysis provides new evidence on rural–urban health disparities by focusing on pain, highlighting the urgent need to enhance health care services in remote and rural areas for effective pain prevention and management.

目的：以前的文献充分记录了农村卫生劣势；然而，关于城乡慢性疼痛结果差异的研究很少。本文通过研究城乡连续体（即大型中心地铁、大型边缘地铁、中小地铁和非大都市）的疼痛患病率和纵向转变来填补这一空白。方法基于2019-2020年全国健康访谈调查纵向队列（NHIS-LC）数据，我们研究了不同疼痛状态（包括无疼痛、非慢性疼痛、慢性疼痛和高影响慢性疼痛（HICP））在城乡连续体中的疼痛患病率和转变差异，并按年龄、性别、种族/民族和地区进行了分类。通过线性趋势检验来检验城乡连续体线性变化的意义。研究结果显示，慢性疼痛和HICP的患病率呈显著的线性增长，以及从无疼痛到非慢性疼痛和从非慢性疼痛到更严重疼痛状况的转变，沿着从大都市到非大都市地区的连续体。亚组分析表明，城乡差距在中年（45-64岁）群体和非西班牙裔白人中最为明显。结论本纵向分析通过关注疼痛为城乡健康差异提供了新的证据，强调了在偏远和农村地区加强医疗保健服务以有效预防和管理疼痛的迫切需要。

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引用次数: 0

Care packages to promote universal suicide prevention for remote Alaska Native communities: What worked? 护理包促进阿拉斯加偏远原住民社区普遍预防自杀：什么有效？

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-05-15 DOI: 10.1111/jrh.70032

Joshua Kennedy MPH, Lisa Wexler PhD, Tara Schmidt MPH, Suzanne Rataj MPH, Josie Garnie AAS, Roberta Moto BSW, Zinan Tao MSW, Lauren White MPH, MSW, Diane McEachern PhD

Purpose

Alaska Native (AN) youth living in remote Alaska suffer disproportionately from suicide when compared to all other American youth. Promoting Community Conversations About Research to End Suicide (PC CARES) is an intervention led by trained community facilitators, which shares scientific best practices to prevent youth suicide with community adults to spark feasible, culturally tailored personal and collective action. After training 34 AN facilitators to implement PC CARES in their home communities in late 2019, COVID-19 precluded in-person PC CARES activities, but the need to help adults support youth mental health during this period of quarantine and social distancing remained.

Method

The resulting adapted “PC CARES at Home” intervention delivered mail-based mental wellness and suicide prevention information and resources to adult community members from June 2020 to July 2022. The project sent 1527 care packages to 492 participants.

Finding

According to short surveys (n = 199) and interviews done with randomly selected recipients (n = 24), adults who received the PC CARES care packages were very satisfied with the contents and found them useful.

Conclusion

Both acceptance and utility of mental health and safety promotion care packages has implications for offering information and resources to adults in remote communities to support them in promoting youth mental wellness.

目的阿拉斯加原住民（AN）青年生活在偏远的阿拉斯加遭受不成比例的自杀与所有其他美国青年相比。促进社区关于结束自杀研究的对话（PC CARES）是一项由训练有素的社区促进者领导的干预活动，它与社区成年人分享预防青少年自杀的科学最佳实践，以激发可行的、符合文化的个人和集体行动。2019年底，在培训了34名AN协调员在其家庭社区实施PC关怀之后，COVID-19排除了面对面的PC关怀活动，但在这段隔离和社交距离期间，帮助成年人支持青少年心理健康的必要性仍然存在。方法自2020年6月至2022年7月，采用“居家PC关怀”干预措施，向社区成年成员提供基于邮件的心理健康和自杀预防信息和资源。该项目向492名参与者发送了1527个护理包。根据简短调查（n = 199）和随机选择接受者的访谈（n = 24），收到PC CARES护理包的成年人对内容非常满意，并认为它们很有用。结论心理健康与安全促进护理包的接受和使用对偏远社区成人提供信息和资源，支持他们促进青少年心理健康具有重要意义。

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引用次数: 0

Identifying risk factors for adverse lung health outcomes among rural Appalachian women

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-05-13 DOI: 10.1111/jrh.70035

Jessica R. Thompson PhD, Courtney J. Walker PhD, John C. Flunker PhD, W. Jay Christian PhD, Wayne T. Sanderson PhD, Nancy E. Schoenberg PhD, Steven R. Browning PhD

Purpose

Despite high rates of lung disease and lung cancer among women, few studies have focused on adverse lung health risk factors among rural Appalachian women. We aim to describe the prevalence of demographic, behavioral, and economic characteristics among a cohort of rural Appalachian women and ascertain the association between these risk factors and lung function.

Methods

Through a cross-sectional study in two rural Appalachian Kentucky counties (2015–2017), we collected demographics, health history/behaviors, and lung function via pulmonary function tests. Restricting to female participants with interpretable pulmonary function tests (N = 456), we estimated prevalence ratios of the association between individual-level characteristics and lung function using log binomial regression.

Findings

Reduced lung function was high among this sample, including 20.8% with restrictive function and 18.4% with obstructive function. After adjustment, those age 65+ had 7× the prevalence of obstructive function compared to those <45 years, and current smokers had 6× the prevalence of never-smokers. Conversely, those age 45–64 had over 5× the prevalence of restrictive function compared to those <45 years, and participants with an obese-classified BMI or 2+ co-morbidities had nearly 4× the prevalence of restrictive function compared to those with normal BMI or without a comorbid condition, respectively.

Conclusions

This study highlights the high levels of reduced lung function among rural Appalachian women, including varying risk factors between those with restrictive and obstructive function. The high prevalence of restrictive function among middle-aged women with high BMI, poor cardiovascular health, and multiple comorbidities suggests the need for culturally tailored health behavior interventions.

尽管妇女中肺病和肺癌的发病率很高，但很少有研究关注阿巴拉契亚农村妇女中不利的肺部健康风险因素。我们的目的是描述阿巴拉契亚农村妇女队列中人口统计学、行为和经济特征的患病率，并确定这些危险因素与肺功能之间的关系。方法通过对肯塔基州阿巴拉契亚两个农村县（2015-2017）的横断面研究，通过肺功能测试收集人口统计学、健康史/行为和肺功能。研究对象为具有可解释肺功能测试的女性受试者（N = 456），我们使用对数二项回归估计了个体水平特征与肺功能之间关联的患病率。本组患者肺功能降低率较高，其中限制性肺功能20.8%，阻塞性肺功能18.4%。调整后，65岁以上人群的阻塞性功能患病率是45岁人群的7倍，目前吸烟者的患病率是不吸烟者的6倍。相反，45 - 64岁的参与者的限制性功能患病率是45岁人群的5倍以上，BMI为肥胖或2+合并症的参与者的限制性功能患病率是BMI正常或无合并症的参与者的近4倍。结论：该研究强调了阿巴拉契亚农村妇女肺功能降低的高水平，包括限制性和阻塞性肺功能的不同危险因素。在具有高BMI、心血管健康状况差和多种合并症的中年妇女中，限制性功能的高流行率表明，需要针对不同文化进行健康行为干预。

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引用次数: 0

Continuity of pain clinic care among rural and urban veterans 城乡退伍军人疼痛门诊护理的连续性

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-05-09 DOI: 10.1111/jrh.70031

Katherine Hadlandsmyth PhD, Rena E. Courtney PhD, Jenna L. Adamowicz PhD, Mary A. Driscoll PhD, Jennifer L. Murphy PhD, Brian C. Lund PharmD

Purpose

In the context of increased access to multidisciplinary pain team care in the veterans health administration (VHA) in recent years, the current study sought to determine whether continuity of pain clinic care varied for rural compared to urban veterans, following an initial pain clinic visit. Specifically, the frequency of general pain clinic visits and pain clinic psychology visits were contrasted between rural and urban veterans in 2015 and 2022.

Methods

National VHA administrative data were used to build two cohorts of veterans with an initial pain clinic visit in 2015 or 2022. Number of pain clinic visits and number of pain clinic psychology visits in the following year were calculated. Multivariable regression models examined rural/urban differences in receipt of follow-up pain clinic visits and receipt of follow-up pain psychology visits in both 2015 and 2022, after adjusting for demographic characteristics and psychiatric comorbidity.

Findings

Veterans with an initial pain clinic visit increased by 22.5% from 2015 (n = 95,549) to 2022 (n = 117,044) and included about one-third rural veterans in both years. Rural veterans had lower rates of follow-up pain clinic visits in 2015 (adjusted odds ratio [aOR]: 0.85; 95% confidence interval [CI]: 0.82–0.87) and this gap remained, but narrowed, by 2022 (aOR: 0.92; 95% CI: 0.90–0.95). The gap in pain psychology follow-up visits, however, disappeared between 2015 (adjusted incidence rate ratio [aIRR]: 0.88; 95% CI: 0.81–0.95) and 2022 (aIRR: 1.00; 95% CI: 0.93–1.08).

Conclusions

The rural gap in continuity of specialty pain clinic services for veterans has improved across time, particularly in relation to pain clinic psychology visits.

在近年来退伍军人健康管理局（VHA）多学科疼痛小组护理的背景下，本研究旨在确定在首次疼痛门诊就诊后，农村退伍军人与城市退伍军人的疼痛门诊护理的连续性是否有所不同。具体而言，对比2015年和2022年农村和城市退伍军人的疼痛门诊和疼痛门诊心理就诊频率。方法采用国家VHA管理数据，建立2015年和2022年首次就诊的退伍军人疼痛门诊两组队列。计算第二年疼痛门诊就诊次数和疼痛门诊心理就诊次数。在调整了人口统计学特征和精神疾病合并症后，多变量回归模型检验了2015年和2022年农村/城市接受随访疼痛门诊就诊和接受随访疼痛心理就诊的差异。从2015年（n = 95,549）到2022年（n = 117,044），首次就诊的退伍军人增加了22.5%，其中包括约三分之一的农村退伍军人。2015年农村退伍军人的疼痛门诊随访率较低(调整优势比[aOR]: 0.85；95%置信区间[CI]: 0.82-0.87)，到2022年，这一差距仍然存在，但缩小了(aOR: 0.92；95% ci: 0.90-0.95)。2015年至2015年，两组患者疼痛心理随访差异消失(调整后发病率比[aIRR]: 0.88；95% CI: 0.81-0.95)和2022 (aIRR: 1.00；95% ci: 0.93-1.08)。结论农村退伍军人专科疼痛门诊服务的连续性差距随着时间的推移而改善，特别是在疼痛门诊心理就诊方面。

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引用次数: 0

Risks of adverse health outcomes among older rural prostate cancer survivors in the SEER-Medicare data SEER-Medicare数据中老年农村前列腺癌幸存者的不良健康结局风险

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-05-08 DOI: 10.1111/jrh.70029

Chun-Pin Chang (Esther) PhD, Daren Huang MPH, Shane Lloyd MD, N. Lynn Henry MD, PhD, Brock O'Neil MD, Mia Hashibe PhD

Background

Rural prostate cancer patients face challenges such as greater distance for cancer treatment and care fragmentation. There have been very few studies investigating adverse health outcomes among prostate cancer survivors residing in rural areas. A comprehensive evaluation of adverse health outcomes among rural prostate cancer patients is needed to understand potential health disparities and provide scientific evidence for interventions. The aims of this study were to investigate prevalent and incident adverse health outcomes among older rural prostate cancer survivors compared to urban prostate cancer survivors in the United States.

Methods

The SEER-Medicare linked database was used to identify first primary prostate cancer survivors. Fine-Gray subdistribution hazard models were utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI), comparing rural prostate cancer patients to urban prostate cancer patients.

Results

A total of 37,126 rural prostate cancer survivors and 109,176 urban prostate cancer survivors were identified. We observed that rural prostate cancer survivors had a higher prevalence of rheumatoid arthritis/osteoarthritis (22.1% vs 20.9%; P-value <.001) and chronic obstructive pulmonary disease (COPD)/bronchiectasis (14.2% vs 10.5%; P-value <.001). A higher incident risk of acute myocardial infarction, COPD/bronchiectasis, hip pelvic fracture, and rheumatoid arthritis/osteoarthritis among rural prostate cancer was observed compared to their urban counterparts >5 years after cancer diagnosis.

Conclusions

This study provides important results on the prevalence and incident adverse health outcomes among older rural prostate cancer survivors. Further investigation into how other factors influence these disparities is warranted.

背景农村前列腺癌患者面临着癌症治疗距离远、护理碎片化等挑战。很少有研究调查居住在农村地区的前列腺癌幸存者的不良健康后果。需要对农村前列腺癌患者的不良健康结果进行全面评估，以了解潜在的健康差异，并为干预措施提供科学证据。本研究的目的是调查美国农村老年前列腺癌幸存者与城市前列腺癌幸存者之间普遍和偶然的不良健康结果。方法使用SEER-Medicare关联数据库识别原发性前列腺癌幸存者。采用细灰色亚分布风险模型估计农村前列腺癌患者与城市前列腺癌患者的风险比（HR）和95%置信区间（CI）。结果共发现农村前列腺癌幸存者37126人，城市前列腺癌幸存者109176人。我们观察到，农村前列腺癌幸存者的类风湿关节炎/骨关节炎患病率较高(22.1% vs 20.9%；p值<；.001)和慢性阻塞性肺疾病(COPD)/支气管扩张(14.2% vs 10.5%；假定值& lt;措施)。与城市前列腺癌患者相比，农村前列腺癌患者在癌症诊断5年后发生急性心肌梗死、慢性阻塞性肺病/支气管扩张、髋部骨盆骨折和类风湿关节炎/骨关节炎的风险更高。结论本研究提供了农村老年前列腺癌幸存者患病率和不良健康结局发生率的重要结果。有必要进一步调查其他因素如何影响这些差异。

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引用次数: 0

The relationship between low social/emotional support and health care affordability among rural and urban residents 城乡居民低社会/情感支持与卫生保健负担能力的关系

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-05-07 DOI: 10.1111/jrh.70034

Ingrid Jacobson MPH, Katie Rydberg MPH, Alexis Swendener PhD, Hannah MacDougall PhD, MSW, Carrie Henning-Smith PhD, MPH, MSW

Purpose

Social/emotional support can help to buffer the health and financial impacts of health care costs. However, little research examines differences in social/emotional support as it relates to health care affordability, and even less examines these issues by rurality despite rural/urban differences in health and health care access. This study addresses these gaps by examining differences in social/emotional support and health care affordability issues among rural and urban adults.

Methods

Using weighted data from the 2020 and 2021 National Health Interview Survey (n = 44,987), we examined differences in three health care affordability issues: worry about medical bills, problems paying medical bills, and inability to pay medical bills. We conducted bivariate and multivariate logistic regression analyses comparing these issues by rurality, social/emotional support, and other sociodemographic and health characteristics, generating adjusted odds ratios and predicted probabilities of these issues.

Findings

Rural residents were more likely to report problems paying and inability to pay medical bills (13.0% vs. 10.2%, p < 0.001; 8.2% vs 6.2%, p < 0.001). Sociodemographic and health covariates were differentially associated with adjusted odds of health care affordability issues, while low social/emotional support was associated with higher adjusted odds and adjusted predicted probabilities of all three health care affordability issues in both rural and urban areas.

Conclusions

Low social/emotional support is associated with higher odds and predicted probabilities of all health care affordability issues regardless of rurality. Future policy aimed at reducing medical debt in rural areas should consider the beneficial impacts of social/emotional support.

社会/情感支持有助于缓冲医疗保健费用对健康和财务的影响。然而，很少有研究审查与医疗保健负担能力有关的社会/情感支持方面的差异，尽管农村/城市在健康和医疗保健获取方面存在差异，但按农村情况审查这些问题的研究就更少了。本研究通过考察农村和城市成年人在社会/情感支持和医疗保健负担能力问题上的差异来解决这些差距。方法利用2020年和2021年全国健康访谈调查（n = 44,987）的加权数据，研究了三个医疗负担能力问题的差异：担心医疗费用、支付医疗费用的问题和无力支付医疗费用。我们进行了双变量和多变量逻辑回归分析，通过农村性、社会/情感支持以及其他社会人口统计学和健康特征来比较这些问题，得出调整后的优势比并预测这些问题的概率。调查结果：农村居民更有可能报告支付问题和无力支付医疗费用(13.0%比10.2%,p <；0.001;8.2% vs 6.2%, p <；0.001)。社会人口统计学和健康协变量与医疗保健可负担性问题的调整几率存在差异，而低社会/情感支持与农村和城市地区所有三个医疗保健可负担性问题的调整几率和调整预测概率较高相关。结论低社会/情感支持与所有医疗负担能力问题的高几率和预测概率相关，与农村无关。未来旨在减少农村地区医疗债务的政策应考虑到社会/情感支持的有益影响。

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引用次数: 0

Addressing the growing rural–urban divide in opioid prescribing for veterans 解决退伍军人在阿片类药物处方方面日益扩大的城乡差距

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-05-05 DOI: 10.1111/jrh.70030

Suhanee Mitragotri , Kevan Shah MSM, MSc

引用次数: 0

Living with chronic myelogenous leukemia in rural communities: Exploring factors related to tyrosine kinase inhibitors adherence with a mixed methods approach 农村社区慢性髓性白血病患者：用混合方法探索酪氨酸激酶抑制剂依从性相关因素

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-04-26 DOI: 10.1111/jrh.70028

Jingxi Sheng PhD, Sue P. Heiney PhD, Karen E. Wickersham PhD, Lan A. Nguyen PhD, Kartina W. Harrison MSN, Swann Arp Adams PhD

Purpose

Tyrosine kinase inhibitors (TKIs) improve chronic myeloid leukemia (CML) outcomes dramatically. However, limited research exists on patient-specific, medical, and psychosocial factors influencing TKI adherence. The purpose of the study was to better understand TKI adherence among rural CML patients, using a convergent parallel mixed-method design guided by the Information Motivation and Behavioral Skills Model.

Methods

Survivors with CML participated in semistructured interviews and completed self-reported questionnaires, including demographics, perceived stress, side effects, emotional support, and self-efficacy for managing chronic conditions. Qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated.

Results

Sixteen participants aged 26 to 76 years completed the study. The duration of TKI therapy ranged from 0 to 12 years (mean ± standard deviation, 5.56 ± 4.08). While all reported adherence to TKI therapy, 31% held misconceptions about treatment duration, and 38% misunderstood reasons for blood tests prior to treatment or TKI refilled. Qualitative data yielded five major themes with descriptions of the shock of diagnosis, educational experiences regarding CML and its treatment, challenges in managing side effects and refills, the importance of social support, and strategies for maintaining remission and motivating adherence to TKI.

Conclusions

This study describes the knowledge, motivations, challenges, and skills related to TKI adherence among rural patients with CML. A patient-centered approach is recommended for health care providers to improve adherence and enhance outcomes for CML patients on TKI therapy.

目的酪氨酸激酶抑制剂（TKIs）可显著改善慢性髓性白血病（CML）的预后。然而，关于患者特异性、医学和社会心理因素影响TKI依从性的研究有限。本研究的目的是为了更好地了解农村CML患者的TKI依从性，采用以信息动机和行为技能模型为指导的趋同并行混合方法设计。方法慢性粒细胞白血病幸存者参与半结构化访谈并完成自我报告问卷，包括人口统计学、感知压力、副作用、情感支持和慢性疾病管理的自我效能。定性和定量数据同时收集，分别分析，然后整合。结果16名年龄在26岁至76岁之间的参与者完成了研究。TKI治疗持续时间为0 ~ 12年（平均值±标准差，5.56±4.08）。虽然所有人都报告了TKI治疗的依从性，但31%的人对治疗时间有误解，38%的人误解了治疗前血液检查或TKI补充的原因。定性数据产生了五个主要主题，描述了诊断的震惊，关于CML及其治疗的教育经验，管理副作用和再填充的挑战，社会支持的重要性，以及维持缓解和激励坚持TKI的策略。结论本研究描述了农村CML患者TKI依从性相关的知识、动机、挑战和技能。建议卫生保健提供者采用以患者为中心的方法，以提高CML患者对TKI治疗的依从性和增强结果。

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