Journal of Rural Health最新文献

{"title":"Metropolitan/nonmetropolitan differences of the impact of COVID-19 on cancer survivors' care","authors":"Whitney E. Zahnd PhD,&nbsp;Jason T. Semprini PhD, MPP,&nbsp;Robin C. Vanderpool DrPH,&nbsp;Sarah H. Nash PhD, MPH,&nbsp;Erin L. Van Blarigan ScD,&nbsp;Mindy C. DeRouen PhD, MPH,&nbsp;Angela L. W. Meisner MPH,&nbsp;Chuck Wiggins PhD","doi":"10.1111/jrh.70061","DOIUrl":"https://doi.org/10.1111/jrh.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate pandemic-related changes in cancer-related care for cancer survivors residing in nonmetropolitan and metropolitan areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the Health Information National Trends-Surveillance Epidemiology End Results (HINTS-SEER) survey administered to cancer survivors from the Greater San Francisco Bay Area, Iowa, and New Mexico between January and August 2021. Respondents were queried on changes to their cancer-related care, including treatment, follow-up appointments, and routine cancer screening/preventive care. We calculated weighted percentages and Rao-Scott chi-square tests for reported differences between nonmetropolitan and metropolitan areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Compared to survivors residing in metropolitan areas, a higher proportion of those in nonmetropolitan areas reported that their cancer treatment or follow-up appointments were unaffected by the pandemic (38.6% vs 28.1%; <i>P</i> = .008). Survivors in metropolitan areas experienced more of a shift in cancer treatment or follow-up appointments to telehealth (12.5% vs 5.7%, <i>P</i> = .003), but there was no difference in appointment cancellations. More survivors residing in metropolitan versus nonmetropolitan areas reported shifts to telehealth for preventive care (8.2% vs 2.9%, <i>P</i> = .005). There was no difference across nonmetropolitan and metropolitan survivors reporting that cancer-related care was cancelled, that routine cancer screening or preventive care was unaffected by the pandemic, or that providers discussed COVID-19 risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Survivors in nonmetropolitan compared to metropolitan areas had less perceived change in cancer follow-up and treatment schedules. It will be important to assess whether shifts in follow-up and preventive care to telehealth for cancer survivors in need of care during the COVID-19 pandemic affect their long-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urban–rural differences in the age of US physicians","authors":"Ryan J. Crowley MPhil,&nbsp;Jag S. Lally MPhil,&nbsp;David M. Kline PhD,&nbsp;Amanda M. Bunting PhD","doi":"10.1111/jrh.70054","DOIUrl":"https://doi.org/10.1111/jrh.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess county-level and specialty-level age differences between urban and rural physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We linked the 2008–2021 Medicare Data on Provider Practice and Specialty (MD-PPAS) dataset with the 2024 Doctors and Clinicians national downloadable file. We assessed specialty-level differences in the age of rural versus urban physicians using Rural–Urban Continuum Codes (RUCC) with four groups: urban (RUCC 1–3), large rural (RUCC 4–5), small rural (RUCC 6–7), and isolated rural (RUCC 8–9). We analyzed the relationship between rurality and physician age using choropleth graphs, spatial clustering, and univariable regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Our final cohort comprised 571,886 physicians. The mean ages of physicians were higher in rural counties (large rural: 53.1 years; small rural: 53.3 years; isolated rural: 53.5 years) than urban counties (52.5 years; <i>p</i> value &lt;0.001). Some specialties including medical oncology, palliative care, and thoracic surgery showed particularly large age differences with older physicians in more rural areas. There were clusters of older physicians in the South and clusters of younger physicians in the Mountain West and Midwest. Rurality was strongly associated with clusters of older physicians (odds ratio [OR]: 3.8; 95% confidence interval [CI], 2.6–5.5), and the percentage of households with broadband internet subscription was strongly associated with clusters of younger physicians (OR: 2.6; 95% CI, 2.2–3.0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural physicians were older than urban physicians with certain specialties and regions demonstrating large age disparities. The aging of rural physicians could worsen existing urban–rural health care disparities. Initiatives focusing on recruiting and retaining rural physicians should target specific regions and specialties to ameliorate these inequities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144725611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial resilience of rural hospitals: Prepandemic vulnerabilities and Provider Relief Funds’ role during COVID-19","authors":"Saleema A. Karim MHA, MBA, PhD,&nbsp;Nathan W. Carroll PhD,&nbsp;Paula H. Song PhD,&nbsp;Adam Atherly PhD","doi":"10.1111/jrh.70060","DOIUrl":"https://doi.org/10.1111/jrh.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Rural hospitals struggling with prepandemic financial instability faced heightened challenges during COVID-19. While Provider Relief Funds (PRFs) offered essential support, their impact varied, highlighting the need to examine how prepandemic financial health influenced rural hospitals’ financial performance during the pandemic. This study evaluates PRF's role across three hospital categories: financially strained (low operating margin), financially vulnerable (midrange operating margin), and financially strong (high operating margin).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort study with a pre–post research design analyzed 2243 US rural hospitals from 2017 to 2022. The sample included short-term general acute nonfederal hospitals and Critical Access Hospitals in nonmetropolitan counties and rural tracts within metropolitan counties. Financial health was assessed using operating margin measures and total margins with and without PRF across four time periods: pre-COVID-19 (2017–2019), COVID-19 Year 1 (2020), Year 2 (2021), and Year 3 (2022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Financially strained and vulnerable hospitals represented 85% of rural hospitals. Financially strained hospitals had the lowest average operating margins from patient services (−17.36%), trailing financially vulnerable (−3.09%), and financially strong (8.04%). In COVID-19 Year 1, operating margins declined across all categories. PRF increased total margins for financially strained hospitals to 8.39% in 2021 before dropping to 0.76% in 2022. Financially vulnerable hospitals also benefited, while financially strong hospitals remained profitable even without PRF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PRF played a critical role in stabilizing rural hospitals, mitigating financial declines, and preventing closures. Its expiration leaves many hospitals facing renewed financial pressures. Addressing long-term financial challenges through sustainable funding strategies and operational adaptations will be essential to preserving health care access in rural communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial performance of rural and urban nursing homes: A comparative analysis","authors":"Gregory N. Orewa PhD, MBA, MSc,&nbsp;Rohit Pradhan PhD, MPA,&nbsp;Akbar Ghiasi PhD,&nbsp;Shivani Gupta PhD, MBA,&nbsp;Robert Weech-Maldonado PhD, MBA","doi":"10.1111/jrh.70053","DOIUrl":"https://doi.org/10.1111/jrh.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The financial sustainability of nursing homes is increasingly critical as the aging US population continues to grow. Rural facilities often encounter more significant economic challenges than urban counterparts. This study investigates the disparities in financial performance between rural and urban nursing homes in the United States, emphasizing the influence of organizational and environmental factors. A comprehensive understanding of these differences is necessary for the implementation of effective policy and management interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study used a longitudinal dataset (2018–2022) comprising 66,056 nursing home-year observations. Data sources included Centers for Medicare and Medicaid Services (CMS) Cost Reports, Payroll-Based Journal, Care Compare, LTCFocus, and the Area Health Resource File. The dependent variable was the operating margin. The primary independent variable, geographic location, was classified using Rural–Urban Commuting Area (RUCA) codes. We conducted multivariable linear regression with facility-level random effects and two-way fixed effects (state and year) to assess rural–urban financial disparities while controlling for organizational and environmental factors and the impact of COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural nursing homes had lower operating margins than urban facilities in unadjusted models. However, after adjusting for organizational factors such as size, occupancy, and payer mix, the rural–urban difference was no longer significant. Environmental factors, including population demographics and income levels, contributed to financial disparities. COVID-19 exacerbated financial challenges, disproportionately affecting rural facilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Financial disparities between rural and urban nursing homes are not solely due to geographical location, but also stem from structural challenges. These insights have significant policy implications suggesting that addressing reimbursement rates, operational efficiency, and resource allocation is crucial to ensure the financial sustainability and quality care for aging populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of telehealth did not mitigate persistent disparities in prenatal care access among American Indian women in North Dakota","authors":"Tara Stiller PhD, MPH,&nbsp;Anna Charlotta Kihlstrom MPH,&nbsp;Nishat Sultana  ,&nbsp;Grace Njau PhD,&nbsp;Matthew Schmidt MPH,&nbsp;Anastasia Stepanov  ,&nbsp;Andrew D. Williams PhD, MPH","doi":"10.1111/jrh.70056","DOIUrl":"https://doi.org/10.1111/jrh.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In North Dakota (ND), American Indian (AI) women face a persistent disparity in prenatal care (PNC) access compared to other women. During the COVID pandemic, the expansion of telehealth emerged as a potential solution to disparate access to health care. We examined whether telehealth use mitigated disparities in PNC in ND.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were drawn from the 2020 to 2021 ND Pregnancy Risk Assessment Monitoring System (weighted <i>n</i> = 10,189). PNC initiation &gt;13 weeks gestation or not receiving PNC was considered “late/no PNC.” Maternal race/ethnicity was self-reported. Use of telehealth for prenatal visits was self-reported and categorized as “any telehealth use” versus “no telehealth use.” Those not using telehealth self-reported eight barriers to telehealth (e.g., lacking internet, no appointments). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for late/no PNC among AI and other race/ethnicity women compared to White women. Models included maternal sociodemographic and health factors. Chi-square was used to examine prevalence of telehealth barriers by race/ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to White women, AI/AN women were twice as likely to receive late/no PNC (OR: 2.40; 95% CI, 1.08, 5.35). When telehealth was accounted for, the AI–White disparity was lowered by only 2% (OR: 2.35; 95% CI, 1.05, 5.26). Compared to White and other race/ethnicity women, a higher prevalence of AI/AN women reported a lack of telehealth appointments (<i>p</i> &lt; 0.01), no computers (<i>p</i> &lt; 0.01), no phones (<i>p</i> &lt; 0.01), and no physical space (<i>p</i> &lt; 0.01) as barriers to telehealth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The use of telehealth did not mitigate PNC disparities in ND. Infrastructure investments and culturally safe initiatives are needed to improve PNC access for AI/AN women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of rural-urban residence and deprivation on care pathways for depression disorders among adults in the UK","authors":"Maxime Inghels PhD,&nbsp;David Nelson PhD,&nbsp;Ros Kane PhD,&nbsp;Mark Gussy PhD,&nbsp;Carl Deaney MD","doi":"10.1111/jrh.70055","DOIUrl":"https://doi.org/10.1111/jrh.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate how rurality shapes individual care pathways and health outcomes for depression and to investigate the sociodemographic and economic relationships with urban-rural variations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study using routinely collected data from adult patients diagnosed for depression and registered at a general practice in Lincolnshire in the UK. Access and time to access from the onset of depression symptoms to the following care pathway states were described (ie, access to a depression screening tool, confirmed diagnosis, access to treatment and outcomes). Multistate survival analyses were conducted to investigate the effect of the patient's living environment (rural/urban, index of multiple deprivation) on progression through their care pathway for depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Overall, 1,111 patients with depression were included. While access to depression services were lower for patients living in rural areas, they were more likely to experience positive depression outcomes, and more quickly, compared to their urban counterparts. Controlled depression and relapse rates were, respectively, 29% lower and 31% higher among urban residents. The level of deprivation was found to have a limited effect on care access, as well as on depression outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While accessing care services remains a challenge in rural areas, our study highlights the potential benefits of the rural context in improving depression outcomes and lowering relapse risk. Area-based deprivation had minimal impact on both care access and depression outcomes. Future mental health programs must tailor their strategies to the unique challenges of urban and rural environments to facilitate more effective interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An assessment of area-level vulnerability and resilience indices by geography: A rural-urban comparison","authors":"Casey P Balio PhD,&nbsp;Olivia A Sullivan DrPH, MPH, EMT,&nbsp;E Grace Petty BBA,&nbsp;Benjamin Pelton MPH, RT(R),&nbsp;Nathan Dockery MPH,&nbsp;Kate E Beatty PhD, MPH","doi":"10.1111/jrh.70059","DOIUrl":"https://doi.org/10.1111/jrh.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Area-level vulnerability and resilience indices combine multiple dimensions of demographic, economic, and environmental factors into a single measure of area-level risk. These indices are widely used to allocate resources in health care and public health. We investigated how commonly used, existing area-level indices correlate with each other, and how they differ by geography, comparing rural and urban areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven publicly available indices were selected for inclusion. Rurality was defined by Rural-Urban Continuum Codes and/or Rural-Urban Commuting Areas, depending on the geographic level of each index. Percentiles were obtained or calculated for each index and compared by rurality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We find that these area-level indices are not substitutes for each other, and they differ significantly across the rural-urban continuum in conflicting ways. Three different patterns generally emerged from analysis: indices that increase as geography becomes more rural; indices that decrease as geography becomes more rural; and indices with the greatest values among middle levels of geography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings from this work underscore the importance of better understanding how area-level indices may differ across the United States and by specific populations. When using area-level indices in policy and resource allocation, strategic selection and implementation considering differences by rurality may be warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health information technology in rural health care: A systematic review of its impact on critical access hospitals","authors":"Dinesh R. Pai PhD","doi":"10.1111/jrh.70052","DOIUrl":"https://doi.org/10.1111/jrh.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review examines the profound impact of health information technology (HIT) on critical access hospitals (CAHs), focusing on the persistent challenges hindering effective implementation and utilization, and their consequences for rural health care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following Primary Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically searched ProQuest, Web of Science, Scopus, and MEDLINE (2000–2024) for peer-reviewed articles, screening titles, abstracts, and full texts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-five studies were included, with a majority (<i>n</i> = 31) published post-Health Information Technology for Economic and Clinical Health (HITECH) Act. Analysis revealed recurring challenges: crippling financial constraints, persistent staffing shortages, and frustrating interoperability failures. Diverse methodologies, including statistical analyses, surveys, case studies, and interviews, underscored the pervasive nature of these issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Beyond financial, human, and interoperability barriers, our review identified key themes related to organizational dynamics and network effects. We discuss critical policy implications, offer actionable recommendations, acknowledge study limitations, and highlight crucial directions for future research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review provides compelling evidence of the urgent need to address the unique HIT adoption challenges facing CAHs. By understanding these barriers and leveraging HIT's potential, we can significantly improve patient care and health equity in vulnerable rural communities. These findings are critical for policymakers, health care leaders, and researchers striving to strengthen rural health care delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural-urban disparities in the prevalence of chronic pain in adults: Associations with demographic and socioeconomic characteristics","authors":"Jean A. Talbot PhD, MPH,&nbsp;Celia Jewell BSN, MPH,&nbsp;Brianna Holston BSPH,&nbsp;Joshua Plavin MD, MPH, FAAP,&nbsp;Gail L. Rose PhD,&nbsp;Erika C. Ziller PhD","doi":"10.1111/jrh.70058","DOIUrl":"https://doi.org/10.1111/jrh.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To explore rural-urban differences in chronic pain prevalence among adults in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study analyzed pooled data from the 2019-2021 and 2023 National Health Interview Survey. We used chi-square tests and logistic regression to determine how rurality of residence was associated with chronic pain prevalence among adults aged 18 and older before and after adjustment for demographic and socioeconomic variables. STROBE reporting guidelines were applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Unadjusted prevalence of chronic pain was 29% for rural adults and 21% for their urban counterparts (<i>P</i> &lt;.0001). After control for covariates, rural-urban differences decreased but remained statistically significant. Adjusted odds of chronic pain were 9% higher in rural than in urban populations (<i>P</i> &lt;.01). Adjusted chronic pain prevalence was 23% for rural and 22% for urban adults (<i>P</i> &lt;.01). Multivariable analyses suggested that rural-urban prevalence differences were related to risk factors that were more common in rural populations, including older age, current or past married status, lower income, lower education levels, and non-Hispanic White race and ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The substantial rural-urban disparity in chronic pain prevalence is partly associated with demographic and socioeconomic risk factors correlated with rurality. Persisting rural-urban differences in adjusted chronic pain prevalence may also be correlated with barriers limiting rural residents’ access to guideline-concordant pain management. Innovations in delivery systems and payment policies may help to reduce these barriers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enduring lessons from the COVID-19 pandemic: Advancing virtual care for substance use disorders in rural America","authors":"Thomas M. LaPorte PhD,&nbsp;Sandra McGinnis PhD,&nbsp;Griffin Lacy MA","doi":"10.1111/jrh.70049","DOIUrl":"https://doi.org/10.1111/jrh.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study explores how rural substance use disorder (SUD) treatment providers in New York State adapted to pandemic-era policy changes by rapidly adopting virtual care, identifying both challenges and opportunities to inform future practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thematic analysis of qualitative data from individual interviews with 12 SUD treatment providers and a focus group with an additional 6 providers in rural New York State was conducted between February and May 2021, capturing experiences with virtual care during the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The pandemic drove swift virtual care adoption, overcoming some rural barriers to SUD treatment access, like limited transportation and provider shortages. Providers noted enhanced flexibility, allowing more person-centered care adapting to clients’ logistical challenges. However, limitations emerged, including digital access disparities, reduced client accountability, and challenges establishing therapeutic relationships—especially for new clients or group sessions. Virtual care effectiveness varied by treatment stage, client demographics, and access to reliable technology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although virtual care presents opportunities to expand rural SUD treatment access, a hybrid model combining in-person and virtual care may better meet diverse client needs. Addressing technological inequities and tailoring approaches to individual circumstances are essential for future interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}