Journal of Rural Health最新文献_第7页

Rural–urban disparities in health care delivery for children with medical complexity and moderating effects of payer, disability, and community poverty 为病情复杂的儿童提供医疗服务方面的城乡差异以及支付方、残疾和社区贫困的调节作用。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2024-02-20 DOI: 10.1111/jrh.12827

Mary Arakelyan MPH, Seneca D. Freyleue MS, Andrew P. Schaefer PhD, Andrea M. Austin PhD, Erika L. Moen PhD, A. James O'Malley PhD, David C. Goodman MD, MS, JoAnna K. Leyenaar MD, PhD, MPH

Purpose

Children with medical complexity (CMC) may be at increased risk of rural–urban disparities in health care delivery given their multifaceted health care needs, but these disparities are poorly understood. This study evaluated rural–urban disparities in health care delivery to CMC and determined whether Medicaid coverage, co-occurring disability, and community poverty modified the effects of rurality on care delivery.

Methods

This retrospective cohort study of 2012–2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire included CMC <18 years. Health care delivery measures (ambulatory clinic visits, emergency department visits, acute care hospitalizations, total hospital days, and receipt of post-acute care) were compared for rural- versus urban-residing CMC in multivariable regression models, following established methods to evaluate effect modification.

Findings

Of 112,475 CMC, 7307 (6.5%) were rural residing and 105,168 (93.5%) were urban residing. A total of 68.9% had Medicaid coverage, 33.9% had a disability, and 39.7% lived in communities with >20% child poverty. In adjusted analyses, rural-residing CMC received significantly fewer ambulatory visits (risk ratio [RR] = 0.95, 95% confidence interval [CI]: 0.94–0.96), more emergency visits (RR = 1.12, 95% CI: 1.08–1.16), and fewer hospitalization days (RR = 0.90, 95% CI = 0.85–0.96). The estimated modification effects of rural residence by Medicaid coverage, disability, and community poverty were each statistically significant. Differences in the odds of having a hospitalization and receiving post-acute care did not persist after incorporating sociodemographic and clinical characteristics and interaction effects.

Conclusions

Rural- and urban-residing CMC differed in their receipt of health care, and Medicaid coverage, co-occurring disabilities, and community poverty modified several of these effects. These modifying effects should be considered in clinical and policy initiatives to ensure that such initiatives do not widen rural–urban disparities.

目的：医疗复杂性儿童（CMC）有多方面的医疗保健需求，因此他们在医疗保健服务方面面临城乡差异的风险可能会增加，但人们对这些差异知之甚少。本研究评估了城乡之间在为 CMC 提供医疗服务方面的差异，并确定医疗补助覆盖范围、并发残疾和社区贫困是否会改变农村地区对医疗服务的影响：这项回顾性队列研究收集了来自科罗拉多州、马萨诸塞州和新罕布什尔州的 2012-2017 年所有支付方的索赔数据，其中包括 CMC 的调查结果：在 112,475 名 CMC 中，7307 人（6.5%）居住在农村，105,168 人（93.5%）居住在城市。共有 68.9% 的人享受医疗补助，33.9% 的人有残疾，39.7% 的人生活在儿童贫困率大于 20% 的社区。在调整分析中，居住在农村的 CMC 接受的门诊次数明显较少（风险比 [RR] = 0.95，95% 置信区间 [CI]：0.94-0.96），急诊次数较多（RR = 1.12，95% CI：1.08-1.16），住院天数较少（RR = 0.90，95% CI = 0.85-0.96）。农村居住地对医疗补助覆盖率、残疾和社区贫困的估计修正效应均具有显著的统计学意义。在纳入社会人口学和临床特征及交互效应后，住院和接受急性期后护理的几率差异并未持续存在：结论：居住在农村和城市的社区医疗中心在接受医疗护理方面存在差异，医疗补助覆盖范围、并发残疾和社区贫困改变了其中的一些影响。在临床和政策措施中应考虑这些影响因素，以确保这些措施不会扩大城乡差别。

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引用次数: 0

Rural–urban disparities and trends in utilization of palliative care services among US patients with metastatic breast cancer 美国转移性乳腺癌患者使用姑息治疗服务的城乡差异和趋势。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2024-02-20 DOI: 10.1111/jrh.12826

Jincong Q. Freeman MPH, MS, Adam W. Scott BS, Ted O. Akhiwu MBBS, MPH

Purpose

To assess trends and rural–urban disparities in palliative care utilization among patients with metastatic breast cancer.

Methods

We analyzed data from the 2004–2019 National Cancer Database. Palliative care services, including surgery, radiotherapy, systemic therapy, and/or other pain management, were provided to control pain or alleviate symptoms; utilization was dichotomized as “yes/no.” Rural–urban residence, defined by the US Department of Agriculture Economic Research Service's Rural–Urban Continuum Codes, was categorized as “rural/urban/metropolitan.” Multivariable logistic regression was used to examine rural–urban differences in palliative care use. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated.

Findings

Of 133,500 patients (mean age 62.4 [SD = 14.2] years), 86.7%, 11.7%, and 1.6% resided in metropolitan, urban, and rural areas, respectively; 72.5% were White, 17.0% Black, 5.8% Hispanic, and 2.7% Asian. Overall, 20.3% used palliative care, with a significant increase from 15.6% in 2004–2005 to 24.5% in 2008–2019 (7.0% increase per year; p-value for trend <0.001). In urban areas, 23.3% received palliative care, compared to 21.0% in rural and 19.9% in metropolitan areas (p < 0.001). After covariate adjustment, patients residing in rural (AOR = 0.84; 95% CI: 0.73–0.98) or metropolitan (AOR = 0.85, 95% CI: 0.80–0.89) areas had lower odds of having used palliative care than those in urban areas.

Conclusions

In this national, racially diverse sample of patients with metastatic breast cancer, the utilization of palliative care services increased over time, though remained suboptimal. Further, our findings highlight rural–urban disparities in palliative care use and suggest the potential need to promote these services while addressing geographic access inequities for this patient population.

目的：评估转移性乳腺癌患者使用姑息治疗的趋势和城乡差异：我们分析了 2004-2019 年国家癌症数据库中的数据。姑息治疗服务包括手术、放疗、全身治疗和/或其他疼痛治疗，以控制疼痛或减轻症状；使用情况被二分为 "是/否"。根据美国农业部经济研究局的农村-城市连续代码定义的农村-城市居住地分为 "农村/城市/大都市"。多变量逻辑回归用于检验姑息关怀使用的城乡差异。计算了调整后的几率比（AOR）和 95% 的置信区间（CI）：在 13.35 万名患者（平均年龄 62.4 [SD = 14.2] 岁）中，86.7%、11.7% 和 1.6% 分别居住在大都市、城市和农村地区；72.5% 为白人，17.0% 为黑人，5.8% 为西班牙裔，2.7% 为亚裔。总体而言，20.3%的人使用姑息治疗，从2004-2005年的15.6%大幅增至2008-2019年的24.5%（每年增长7.0%；趋势结论的P值）：在这一全国性、种族多样化的转移性乳腺癌患者样本中，姑息治疗服务的利用率随着时间的推移而增加，但仍未达到最佳水平。此外，我们的研究结果还突显了姑息治疗使用率方面的城乡差异，并表明可能需要推广这些服务，同时解决这一患者群体在获得服务方面的地域不平等问题。

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引用次数: 0

Geographic disparities in late HIV diagnoses in Tennessee: Opportunities for interventions in the rural Southeast 田纳西州艾滋病毒晚期诊断的地域差异：东南部农村地区的干预机会。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2024-02-15 DOI: 10.1111/jrh.12829

Kevin M. Gibas MD, Peter F. Rebeiro PhD, Meredith Brantley PhD, Samantha Mathieson MPH, Laurie Maurer PhD, April C. Pettit MD

Purpose

Incident HIV remains an important public health issue in the US South, the region leading the nation in HIV incidence, rural HIV cases, and HIV-related deaths. Late diagnoses drive incident HIV and understanding factors driving late diagnoses is critical for developing locally relevant HIV testing and prevention interventions, decreasing HIV transmission, and ending the HIV epidemic.

Methods

Retrospective cohort study utilizing Tennessee Department of Health (TDH) surveillance data and US Census Bureau data. Adults of ≥18-year old with a new HIV diagnosis between January 1, 2015 and December 31, 2019 identified in the TDH electronic HIV/AIDS Reporting System were included. Individuals were followed from initial HIV diagnosis until death, 90 days of follow-up for outcome assessment, or administrative censoring 90 days after study enrollment closed.

Findings

We included 3652 newly HIV-diagnosed individuals; median age was 31 years (IQR: 25, 42), 2909 (79.7%) were male, 2057 (56.3%) were Black, 246 (6.7%) were Hispanic, 408 (11.2%) were residing in majority-rural areas at diagnosis, and 642 (17.6%) individuals received a late HIV diagnosis. Residents of majority-rural counties (adjusted risk ratios [aRR] = 1.39, 95% confidence intervals [CI]: 1.16–1.67) and Hispanic individuals (aRR = 1.87, 95% CI: 1.50–2.33) had an increased likelihood of receiving a late diagnosis after controlling for race/ethnicity, age, and year of HIV diagnosis.

Conclusions

Rural residence and Hispanic ethnicity were associated with an increased risk of receiving a late HIV diagnosis in Tennessee. Future HIV testing and prevention efforts should be adapted to the needs of these vulnerable populations.

目的：在美国南部地区，HIV 事件仍然是一个重要的公共卫生问题，该地区的 HIV 发病率、农村 HIV 病例和 HIV 相关死亡人数均居全国之首。晚期诊断是艾滋病发病的驱动因素，而了解导致晚期诊断的因素对于制定与当地相关的艾滋病检测和预防干预措施、减少艾滋病传播以及结束艾滋病流行至关重要：方法：利用田纳西州卫生部（TDH）的监测数据和美国人口普查局的数据进行回顾性队列研究。研究对象包括 2015 年 1 月 1 日至 2019 年 12 月 31 日期间在田纳西州卫生部艾滋病电子报告系统中新确诊为艾滋病病毒感染者的≥18 岁成年人。研究人员从最初确诊艾滋病毒开始进行随访，直至死亡、90 天的随访结果评估或研究注册结束后 90 天的行政剔除：我们纳入了 3652 名新确诊的 HIV 感染者；其中年龄中位数为 31 岁（IQR：25，42），2909 人（79.7%）为男性，2057 人（56.3%）为黑人，246 人（6.7%）为西班牙裔，408 人（11.2%）在确诊时居住在大多数农村地区，642 人（17.6%）在确诊后很晚才感染 HIV。在控制了种族/人种、年龄和 HIV 诊断年份之后，居住在多数农村地区的居民（调整风险比 [aRR] = 1.39，95% 置信区间 [CI]：1.16-1.67）和西班牙裔个人（调整风险比 [aRR] = 1.87，95% 置信区间 [CI]：1.50-2.33）接受晚期诊断的可能性增加：结论：在田纳西州，居住在农村和西班牙裔与艾滋病晚期诊断风险增加有关。未来的 HIV 检测和预防工作应适应这些弱势群体的需求。

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引用次数: 0

Firearm exposure and safety training of rural Iowa youth 爱荷华州农村青年的枪支接触和安全培训。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2024-02-06 DOI: 10.1111/jrh.12823

Jamie L. Koopman MD, Cole C. Wymore BS, Nicholas R. Stange BS, Kristel M. Wetjen RN, MSN, Pamela J. Hoogerwerf BA, Junlin Liao PhD, Kelly E. Wood MD, Gerene M. Denning PhD, Charles A. Jennissen MD

Purpose

Our objective was to investigate rural adolescents’ use of firearms and whether they had received firearm training.

Methods

2019 Iowa FFA Leadership Conference attendees were surveyed. Descriptive and comparative analyses were performed.

Results

One thousand three hundred and eighty-two FFA members aged 13-18 years participated. The vast majority (85%) had fired a rifle/shotgun; 58% reported firing them >20 times. Of those who had fired rifles/shotguns, 32% had done so before 9 years old; 79% before 13 years. Most had also fired a handgun (62%), with 30% having fired handguns >20 times. Of those who had fired handguns, 34% had done so before 11 years old. The average age for first firing rifles/shotguns was 10.1 (SD 2.9) years, and 11.9 (SD 2.8) years for handguns. Males, older teenagers, and those living on farms or in the country had significantly greater percentages that had fired a rifle/shotgun or a handgun. Greater proportions of males had used firearms >20 times and started firing them at younger ages. Over half (55%) reported having gone hunting. Of those, 24% first hunted before 9 years old; 48% before 11 years. Of those who had used a firearm, 61% had completed a firearm safety training course. For hunters, 80% had taken a course.

Conclusions

Most participants had used firearms, and many did so at very young ages. Substantial numbers had not received formal training. The authors believe that families should be counseled when it is developmentally appropriate to introduce youth to firearms, and all should take firearm safety training before using them.

目的：我们的目标是调查农村青少年使用枪支的情况，以及他们是否接受过枪支培训。方法：我们对 2019 年爱荷华州 FFA 领导会议的与会者进行了调查。方法：对 2019 年爱荷华州 FFA 领导会议的与会者进行了调查，并进行了描述性分析和比较分析：13-18岁的1382名FFA成员参加了调查。绝大多数人（85%）都开过步枪/霰弹枪；58%的人表示开过 20 次以上。在开过步枪/霰弹枪的人中，32%的人在 9 岁之前开过枪；79%的人在 13 岁之前开过枪。大多数人还开过手枪（62%），其中 30% 的人开手枪超过 20 次。在开过手枪的人中，34%的人在 11 岁之前开过枪。首次使用步枪/霰弹枪的平均年龄为 10.1 岁（标准差为 2.9 岁），首次使用手枪的平均年龄为 11.9 岁（标准差为 2.8 岁）。男性、年龄较大的青少年以及居住在农场或乡村的人使用过步枪/霰弹枪或手枪的比例明显更高。使用过 20 次以上枪支的男性比例更高，开始使用枪支的年龄也更小。超过半数（55%）的人表示曾经打过猎。其中 24% 的人在 9 岁前第一次打猎，48% 的人在 11 岁前第一次打猎。在使用过枪支的人中，61%的人完成了枪支安全培训课程。在狩猎者中，80%的人参加过课程：结论：大多数参与者都使用过枪支，而且很多人在很小的时候就使用过。相当多的人没有接受过正规培训。作者认为，在青少年的成长过程中，应该向他们的家庭提供建议，让他们接触枪支，而且在使用枪支之前，所有人都应该接受枪支安全培训。

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引用次数: 0

Preparing behavioral health clinicians for success and retention in rural safety net practices 为行为健康临床医生在农村安全网实践中取得成功并留住他们做好准备。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2024-02-05 DOI: 10.1111/jrh.12824

Donald E. Pathman MD MPH, Lisa de Saxe Zerden PhD MSW, Mandi Gingras , Jessica Seel MPH, Jackie Fannell , Brianna M. Lombardi PhD MSW

Purpose

This study assesses how, among behavioral health clinicians working in rural safety net practices, the amount of exposure to care in rural underserved communities received during training relates to confidence in skills important in their work settings, successes in jobs and communities, and anticipated retention.

Methods

This study uses survey data from Licensed Clinical Social Workers, Licensed Professional Counselors, and Psychologists working in rural safety net practices in 21 states while receiving educational loan repayment support from the National Health Service Corps, from 2015 to April 2022.

Findings

Of the 778 survey respondents working in rural counties, 486 (62.5%) reported they had formal education experiences with medically underserved populations during their professional training, for a median of 47 weeks. In analyses adjusting for potential confounders, the estimated amount of rural training exposure was positively associated with a variety of indicators of clinicians’ integration and fit with their communities as well as with longer anticipated retention within their rural safety net practices. The amount of training in care for rural underserved populations was not associated with clinicians’ confidence levels in various professional skills or successes in their work, including connection with patients and work satisfaction.

Conclusions

Formal training in care for underserved populations is a large part of the education of behavioral health clinicians who later work in rural safety net practices. More training in rural underserved care for these clinicians is associated with greater integration and fit in their communities and longer anticipated retention in their practices, but not with skills confidence or practice outcomes.

目的：本研究评估了在农村安全网实践中工作的行为健康临床医生在接受培训期间所接触的农村服务不足社区的医疗服务数量与其对工作环境中重要技能的信心、在工作和社区中取得的成功以及预期的留用率之间的关系：本研究使用了从 2015 年到 2022 年 4 月期间在 21 个州的农村安全网实践中工作的持证临床社会工作者、持证专业顾问和心理学家的调查数据，他们当时正在接受国家卫生服务队的教育贷款偿还支持：在农村地区工作的 778 名调查对象中，有 486 人（62.5%）称他们在接受专业培训期间曾在医疗服务不足人群中接受过正规教育，时间中位数为 47 周。在对潜在混杂因素进行调整的分析中，农村培训的估计接触量与临床医生融入和适应其社区的各种指标以及在农村安全网实践中的预期保留时间呈正相关。为农村未得到充分服务的人群提供护理方面的培训次数与临床医生对各种专业技能的自信程度或在工作中取得的成功（包括与病人的联系和工作满意度）无关：为服务不足人群提供护理方面的正规培训是行为健康临床医生教育的重要组成部分，这些医生以后将在农村安全网实践中工作。为这些临床医生提供更多有关农村服务不足人群护理方面的培训有助于他们更好地融入和适应社区，并延长他们在实践中的预期留任时间，但与技能自信心或实践成果无关。

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引用次数: 0

Variations in antibiotic prescribing among children enrolled in North Carolina Medicaid, 2013-2019 2013-2019 年北卡罗来纳州医疗补助计划参保儿童抗生素处方的变化情况。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2024-01-29 DOI: 10.1111/jrh.12825

Ganga S. Moorthy MD, Rebecca R. Young MS, Sudha R. Raman PhD, Michael J. Smith MD

Purpose

The majority of pediatric antibiotic prescribing occurs in the outpatient setting and inappropriate use contributes to antimicrobial resistance. There are regional variations in outpatient antibiotic use with the highest rates occurring in the Southern states, including in Appalachia. The purpose of this study was to describe the rates and risk factors for inappropriate antibiotic prescription among pediatric patients enrolled in North Carolina (NC) Medicaid.

Methods

We used Medicaid prescription claims data from 2013 to 2019 to describe patterns of pediatric antibiotic prescription in NC. We assessed patient and provider factors to identify variations in prescribing.

Findings

Children who were less than 2 years of age, non-Hispanic White, and living in a rural area had the highest overall rates of antibiotic prescription. Compared to pediatricians, the risk of inappropriate antibiotic prescription was highest among other specialists and general practioners and lowest among nurse practitioners. Rural areas of NC had the highest rates of inappropriate antibiotic prescribing, and the risk for non-Hispanic Black children compared to children of other races/ethnicities was compounded by rurality.

Conclusions

Prescribing practices in NC differ compared to neighboring states with a lower overall risk of inappropriate prescription in Appalachian regions; however, disparities by race and rurality exist. Outpatient stewardship efforts in NC should focus on ensuring health equity by appreciating racial and geographic variations in prescribing patterns and providing education to all health care providers.

目的：大多数儿科抗生素处方都是在门诊开具的，使用不当会导致抗菌药耐药性。门诊抗生素的使用存在地区差异，南部各州（包括阿巴拉契亚）的使用率最高。本研究旨在描述北卡罗来纳州（NC）医疗补助计划（Medicaid）登记的儿科患者中抗生素处方不当的比例和风险因素：我们使用 2013 年至 2019 年的医疗补助处方索赔数据来描述北卡罗来纳州儿科抗生素处方的模式。我们评估了患者和医疗服务提供者的因素，以确定处方的变化：2岁以下、非西班牙裔白人和居住在农村地区的儿童开具抗生素处方的总体比例最高。与儿科医生相比，其他专科医生和全科医生开抗生素处方不当的风险最高，执业护士最低。北卡罗来纳州农村地区的抗生素处方不当率最高，与其他种族/族裔的儿童相比，非西班牙裔黑人儿童的风险因农村地区而加剧：结论：与邻近各州相比，北卡罗来纳州的处方做法有所不同，阿巴拉契亚地区不当处方的总体风险较低；但是，不同种族和地区之间也存在差异。北卡罗来纳州的门诊病人监管工作应重点关注处方模式的种族和地域差异，并向所有医疗服务提供者提供教育，从而确保医疗公平。

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引用次数: 0

Patient reports of cancer care coordination in rural Hawaii 夏威夷农村地区癌症护理协调的患者报告。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2024-01-15 DOI: 10.1111/jrh.12821

Izumi Okado PhD, Michelle Liu BA, Carry Elhajj BA, Lynne Wilkens DrPH, Randall F. Holcombe MD, MBA

Purpose

Rural residents experience disproportionate burdens of cancer, and poorer cancer health outcomes in rural populations are partly attributed to care delivery challenges. Cancer patients in rural areas often experience unique challenges with care coordination. In this study, we explored patient reports of care coordination among rural Hawaii patients with cancer and compared rural and urban patients’ perceptions of cancer care coordination.

Methods

80 patients receiving active treatment for cancer from rural Hawaii participated in a care coordination study in 2020–2021. Participants completed the Care Coordination Instrument, a validated oncology patient questionnaire.

Findings

Mean age of rural cancer patients was 63.0 (SD = 12.1), and 57.7% were female. The most common cancer types were breast and GI. Overall, rural and urban patients’ perceptions of care coordination were comparable (p > 0.05). There were statistically significant differences between rural and urban patients’ perceptions in communication and navigation aspects of care coordination (p = 0.02 and 0.04, respectively). Specific differences included a second opinion consultation, clinical trial considerations, and after-hours care. 43% of rural patients reported traveling by air for part or all of their cancer treatment.

Conclusions

Findings suggest that while overall perceptions of care coordination were similar between rural and urban patients, differential perceptions of specific care coordination areas between rural and urban patients may reflect limited access to care for rural patients. Improving access to cancer care may be a potential strategy to enhance care coordination for rural patients and ultimately address rural-urban cancer health disparities.

目的：农村居民的癌症负担过重，而农村人口较差的癌症健康结果部分归因于护理服务方面的挑战。农村地区的癌症患者往往在护理协调方面遇到独特的挑战。在这项研究中，我们探讨了夏威夷农村地区癌症患者对护理协调的报告，并比较了农村和城市患者对癌症护理协调的看法。方法：夏威夷农村地区 80 名接受积极治疗的癌症患者参加了 2020-2021 年的护理协调研究。参与者填写了护理协调问卷（Care Coordination Instrument），这是一份经过验证的肿瘤患者问卷：农村癌症患者的平均年龄为 63.0 岁（SD = 12.1），57.7% 为女性。最常见的癌症类型是乳腺癌和消化道癌症。总体而言，农村和城市患者对护理协调的看法相当（P > 0.05）。农村和城市患者对护理协调的沟通和导航方面的看法存在统计学差异（p = 0.02 和 0.04）。具体差异包括第二意见咨询、临床试验考虑和下班后护理。43%的农村患者表示部分或全部癌症治疗需要乘坐飞机：研究结果表明，虽然农村和城市患者对护理协调的总体看法相似，但农村和城市患者对特定护理协调领域的看法不同，这可能反映出农村患者获得护理的机会有限。改善癌症护理的可及性可能是加强农村患者护理协调并最终解决城乡癌症健康差异的潜在策略。

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引用次数: 0

Nursing home closures and access to post-acute care and long-term care services in rural areas 农村地区养老院的关闭以及获得急性期后护理和长期护理服务的机会。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2024-01-15 DOI: 10.1111/jrh.12822

Hari Sharma PhD, Redwan Bin Abdul Baten PhD, Fred Ullrich BA, A. Clint MacKinney MD, Keith J. Mueller PhD

Purpose

Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. We estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures.

Methods

We identify nursing home closures and the availability of PAC and LTC services in nursing homes, home health agencies, and hospitals with swing beds using the Medicare Provider of Services file (2008–2018). Using distances between ZIP codes, we summarize distances to the closest provider of PAC and LTC services for rural and urban ZIP codes with nursing home closures from 2008 to 2018 and no nursing homes in 2018.

Findings

Compared to urban ZIP codes, rural ZIP codes experiencing nursing home closure had higher distances to the closest nursing home providing PAC (6.4 vs. 0.94 miles; p < 0.05) and LTC services (7.2 vs. 1.1 miles; p < 0.05), and these differences remain even after accounting for the availability of home health agencies and hospitals with swing beds. Distances to the closest providers with PAC and LTC services were even higher for rural ZIP codes with no nursing homes in 2018. About 6.1%–15.7% of rural ZIP codes with a nursing home closure or with no nursing homes had no PAC or LTC providers within 25 miles.

Conclusions

Nursing home closures increased distances to nursing homes, home health agencies, and hospitals with swing beds for rural residents. Access to PAC and LTC services is a concern, especially for rural areas with no nursing homes.

目的：养老院的关闭引发了人们对获得急性期后护理（PAC）和长期护理（LTC）服务的担忧。我们估算了因养老院关闭而导致农村居民获得 PAC 和 LTC 服务所需的额外路程：我们利用医疗保险服务提供者档案（2008-2018 年）确定了养老院的关闭情况以及养老院、家庭医疗机构和拥有周转床位的医院提供的 PAC 和 LTC 服务。利用邮政编码之间的距离，我们总结了 2008 年至 2018 年期间有养老院关闭且 2018 年没有养老院的农村和城市邮政编码到最近的 PAC 和 LTC 服务提供者的距离：与城市邮政编码相比，经历过养老院关闭的农村邮政编码与提供 PAC（6.4 英里 vs. 0.94 英里；p < 0.05）和 LTC 服务（7.2 英里 vs. 1.1 英里；p < 0.05）的最近养老院的距离较远，即使考虑到家庭医疗机构和拥有周转床位的医院的可用性，这些差异仍然存在。在 2018 年没有养老院的农村邮政编码中，距离最近的 PAC 和 LTC 服务提供者的距离甚至更高。约有 6.1%-15.7% 的农村邮政编码关闭了养老院或没有养老院，在 25 英里范围内没有 PAC 或 LTC 提供者：养老院的关闭增加了农村居民前往养老院、家庭医疗机构和拥有周转床位的医院的距离。获得 PAC 和 LTC 服务是一个令人担忧的问题，尤其是在没有养老院的农村地区。

{"title":"Nursing home closures and access to post-acute care and long-term care services in rural areas","authors":"Hari Sharma PhD, Redwan Bin Abdul Baten PhD, Fred Ullrich BA, A. Clint MacKinney MD, Keith J. Mueller PhD","doi":"10.1111/jrh.12822","DOIUrl":"10.1111/jrh.12822","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. We estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identify nursing home closures and the availability of PAC and LTC services in nursing homes, home health agencies, and hospitals with swing beds using the Medicare Provider of Services file (2008–2018). Using distances between ZIP codes, we summarize distances to the closest provider of PAC and LTC services for rural and urban ZIP codes with nursing home closures from 2008 to 2018 and no nursing homes in 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Compared to urban ZIP codes, rural ZIP codes experiencing nursing home closure had higher distances to the closest nursing home providing PAC (6.4 vs. 0.94 miles; <i>p</i> < 0.05) and LTC services (7.2 vs. 1.1 miles; <i>p</i> < 0.05), and these differences remain even after accounting for the availability of home health agencies and hospitals with swing beds. Distances to the closest providers with PAC and LTC services were even higher for rural ZIP codes with no nursing homes in 2018. About 6.1%–15.7% of rural ZIP codes with a nursing home closure or with no nursing homes had no PAC or LTC providers within 25 miles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nursing home closures increased distances to nursing homes, home health agencies, and hospitals with swing beds for rural residents. Access to PAC and LTC services is a concern, especially for rural areas with no nursing homes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"40 3","pages":"557-564"},"PeriodicalIF":4.9,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12822","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472695","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}

引用次数: 0

Effects of rurality and distance to care on perinatal outcomes over a 1-year period during the COVID-19 pandemic 在 COVID-19 大流行期间，农村地区和就医距离对围产期结果的影响。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-12-27 DOI: 10.1111/jrh.12820

Pratyusha V. Bujimalla MS, Kimberly A. Kenne MD, MCR, Haley A. Steffen BA, Samantha R. Swartz MD, Linder H. Wendt MS, Adam M. Skibbe MLA, J. Brooks Jackson MD, MBA, Mary B. Rysavy MD

Purpose

Our aim was to investigate the roles of rurality and distance to care on adverse perinatal outcomes and COVID-19 seroprevalence at the time of delivery over a 1-year period.

Methods

Data were collected from the electronic medical record on all pregnant patients who delivered at a single, large, Midwest academic medical center over 1 year. Rurality was classified using standard Rural-Urban Commuting Area codes. Geographic Information System tools were used to map outcomes. Data were analyzed with univariate and multivariate models, controlling for Body Mass Index (BMI), insurance status, and parity.

Findings

A total of 2,497 patients delivered during the study period; 20% of patients were rural (n = 499), 18.6% were micropolitan (n = 466), and 61.4% were metropolitan (n = 1,532). 10.4% of patients (n = 259) were COVID-19 seropositive. Rural patients did not experience higher rates of any measured adverse outcomes than metropolitan patients; micropolitan patients had increased odds of preterm labor (OR = 1.41, P = .022) and pre-eclampsia (OR = 1.78, P<.001). Patients living 30+ miles away from the medical center had increased odds of preterm labor (OR = 1.94, P<.001), pre-eclampsia (OR = 1.73, P = .002), and infant admission to the neonatal intensive care unit (OR = 2.12, P<.001), as well as lower gestational age at delivery (β = −9.2 days, P<.001) and birth weight (β = −206 grams, P<.001).

Conclusion

Distance to care, rather than rurality, was the key predictor of multiple adverse perinatal outcomes in this cohort of deliveries over a 1-year period. Our study suggests that rurality should not be used as a standalone indicator of access to care without further knowledge of the specific barriers affecting a given population.

目的：我们的目的是研究农村地区和就医距离对围产期不良结局和分娩时 COVID-19 血清流行率的影响：方法：我们从电子病历中收集了一年来在中西部一家大型学术医疗中心分娩的所有孕妇的数据。使用标准的农村-城市通勤区代码对农村地区进行分类。使用地理信息系统工具绘制结果图。数据通过单变量和多变量模型进行分析，并对体重指数（BMI）、保险状况和奇偶性进行了控制：在研究期间，共有 2497 名患者进行了分娩；20% 的患者在农村（n = 499），18.6% 的患者在小城市（n = 466），61.4% 的患者在大都市（n = 1532）。10.4%的患者（n = 259）COVID-19血清反应呈阳性。与大都市患者相比，农村患者的任何不良后果发生率都不高；大都市患者发生早产（OR = 1.41，P = .022）和子痫前期（OR = 1.78，PC结论）的几率增加：在这个为期一年的分娩队列中，预测多种不良围产期结局的关键因素是就医距离，而非居住地。我们的研究表明，在没有进一步了解影响特定人群的具体障碍的情况下，不应将乡镇作为获得医疗服务的独立指标。

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引用次数: 0

The rapid shift to virtual mental health care: Examining psychotherapy disruption by rurality status 向虚拟心理保健的快速转变：考察乡村地区的心理治疗干扰。

IF 4.9 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2023-12-26 DOI: 10.1111/jrh.12818

Lisa R. Miller-Matero PhD, Gregory Knowlton MS, Kaitlyn M. Vagnini PhD, Hsueh-Han Yeh PhD, Rebecca C. Rossom MD, MS, Robert B. Penfold PhD, Gregory E. Simon MD, MPH, Esther Akinyemi MD, Lana Abdole MD, Stephanie A. Hooker PhD, MPH, Ashli A. Owen-Smith PhD, SM, Brian K. Ahmedani PhD

Background

Given the low usage of virtual health care prior to the COVID-19 pandemic, it was unclear whether those living in rural locations would benefit from increased availability of virtual mental health care. The rapid transition to virtual services during the COVID-19 pandemic allowed for a unique opportunity to examine how the transition to virtual mental health care impacted psychotherapy disruption (i.e., 45+ days between appointments) among individuals living in rural locations compared with those living in nonrural locations.

Methods

Electronic health record and insurance claims data were collected from three health care systems in the United States including rurality status and psychotherapy disruption. Psychotherapy disruption was measured before and after the COVID-19 pandemic onset.

Results

Both the nonrural and rural cohorts had significant decreases in the rates of psychotherapy disruption from pre- to post-COVID-19 onset (32.5–16.0% and 44.7–24.8%, respectively, p < 0.001). The nonrural cohort had a greater reduction of in-person visits compared with the rural cohort (96.6–45.0 vs. 98.0–66.2%, respectively, p < 0.001). Among the rural cohort, those who were younger and those with lower education had greater reductions in psychotherapy disruption rates from pre- to post-COVID-19 onset. Several mental health disorders were associated with experiencing psychotherapy disruption.

Conclusions

Though the rapid transition to virtual mental health care decreased the rate of psychotherapy disruption for those living in rural locations, the reduction was less compared with nonrural locations. Other strategies are needed to improve psychotherapy disruption, especially among rural locations (i.e., telephone visits).

背景：鉴于 COVID-19 大流行之前虚拟医疗服务的使用率较低，因此尚不清楚居住在农村地区的人们是否会从虚拟心理保健服务的增加中受益。COVID-19 大流行期间向虚拟服务的快速过渡为我们提供了一个独特的机会，来研究与生活在非农村地区的人相比，向虚拟心理保健的过渡如何影响农村地区人的心理治疗中断（即预约间隔超过 45 天）：方法：从美国的三个医疗保健系统收集了电子健康记录和保险理赔数据，包括农村状况和心理治疗中断情况。在 COVID-19 大流行之前和之后，对心理治疗中断情况进行了测量：结果：从 COVID-19 流行前到流行后，非农村和农村组群的心理治疗中断率都有显著下降（分别为 32.5%-16.0% 和 44.7-24.8%, p 结论：虽然虚拟心理治疗的快速过渡使得心理治疗的中断率大幅下降，但这并不意味着心理治疗的中断率也会下降：虽然向虚拟心理保健的快速过渡降低了农村居民的心理治疗中断率，但与非农村居民相比，降低幅度较小。还需要其他策略来改善心理治疗中断的情况，尤其是在农村地区（如电话就诊）。

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引用次数: 0