Maxime Inghels PhD, David Nelson PhD, Ros Kane PhD, Mark Gussy PhD, Carl Deaney MD
Purpose
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.
Methods
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.
Findings
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.
Conclusion
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.
{"title":"Impact of rural-urban residence and deprivation on care pathways for depression disorders among adults in the UK","authors":"Maxime Inghels PhD, David Nelson PhD, Ros Kane PhD, Mark Gussy PhD, 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}
Casey P Balio PhD, Olivia A Sullivan DrPH, MPH, EMT, E Grace Petty BBA, Benjamin Pelton MPH, RT(R), Nathan Dockery MPH, Kate E Beatty PhD, MPH
Purpose
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.
Methods
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.
Findings
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.
Conclusions
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.
{"title":"An assessment of area-level vulnerability and resilience indices by geography: A rural-urban comparison","authors":"Casey P Balio PhD, Olivia A Sullivan DrPH, MPH, EMT, E Grace Petty BBA, Benjamin Pelton MPH, RT(R), Nathan Dockery MPH, 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}
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.
Methods
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.
Results
Forty-five studies were included, with a majority (n = 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.
Discussion
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.
Conclusion
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.
目的本系统综述探讨了卫生信息技术（HIT）对关键通道医院（CAHs）的深远影响，重点关注阻碍有效实施和利用的持续挑战及其对农村卫生保健的影响。方法按照PRISMA （Primary Reporting Items for Systematic Reviews and Meta-Analysis）指南，系统检索ProQuest、Web of Science、Scopus和MEDLINE(2000-2024)，检索同行评议文章、筛选标题、摘要和全文。结果纳入45项研究，其中大多数（n = 31）发表了《卫生信息技术促进经济和临床健康（HITECH）法案》。分析揭示了反复出现的挑战：严重的财务限制、持续的人员短缺和令人沮丧的互操作性失败。各种方法，包括统计分析、调查、案例研究和访谈，都强调了这些问题的普遍性。除了财务、人力和互操作性障碍之外，我们的综述确定了与组织动力学和网络效应相关的关键主题。我们讨论关键的政策影响，提供可行的建议，承认研究的局限性，并强调未来研究的关键方向。本综述提供了令人信服的证据，表明迫切需要解决卫生保健机构面临的独特的采用卫生保健技术的挑战。通过了解这些障碍并利用HIT的潜力，我们可以显著改善脆弱农村社区的患者护理和卫生公平。这些发现对决策者、卫生保健领导者和努力加强农村卫生保健服务的研究人员至关重要。
{"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}
Jean A. Talbot PhD, MPH, Celia Jewell BSN, MPH, Brianna Holston BSPH, Joshua Plavin MD, MPH, FAAP, Gail L. Rose PhD, Erika C. Ziller PhD
Purpose
To explore rural-urban differences in chronic pain prevalence among adults in the United States.
Methods
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.
Findings
Unadjusted prevalence of chronic pain was 29% for rural adults and 21% for their urban counterparts (P <.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 (P <.01). Adjusted chronic pain prevalence was 23% for rural and 22% for urban adults (P <.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.
Conclusions
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.
{"title":"Rural-urban disparities in the prevalence of chronic pain in adults: Associations with demographic and socioeconomic characteristics","authors":"Jean A. Talbot PhD, MPH, Celia Jewell BSN, MPH, Brianna Holston BSPH, Joshua Plavin MD, MPH, FAAP, Gail L. Rose PhD, 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> <.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> <.01). Adjusted chronic pain prevalence was 23% for rural and 22% for urban adults (<i>P</i> <.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}
Thomas M. LaPorte PhD, Sandra McGinnis PhD, Griffin Lacy MA
Purpose
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.
Methods
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.
Findings
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.
Conclusions
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.
{"title":"Enduring lessons from the COVID-19 pandemic: Advancing virtual care for substance use disorders in rural America","authors":"Thomas M. LaPorte PhD, Sandra McGinnis PhD, 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}
Sara C. Woolcock MPH, RDN, Davis G. Patterson PhD, Julia A. Dunn MSc, Lars E. Peterson MD, PhD, C. Holly A. Andrilla MS
Purpose
Understanding the different challenges rural and urban family physicians faced during the COVID-19 pandemic is essential for developing strategies to combat burnout. This study described the prevalence of burnout among rural and urban family physicians before and during the pandemic, examining physician and practice characteristics associated with burnout.
Methods
We conducted a repeated cross-sectional analysis of survey responses of 25,018 family physicians from the American Board of Family Medicine National Graduate Survey and Practice Demographic Survey from 3 time periods: pre-pandemic (January 2019-March 2020), early pandemic (April 2020-April 2021), and later pandemic (May 2021-June 2022). We used bivariate analyses and logistic regression to compare self-reported burnout in rural and urban family physicians over these time periods, controlling for physician and practice characteristics.
Results
Overall, 43.5% of family physicians included in this study met the criteria for burnout. The burnout rate was slightly higher for rural physicians (45.2%) compared to urban physicians (43.2%), but not statistically significant. In the adjusted analyses, there was no association of rurality and burnout (adjusted risk ratio [aRR] 1.04, 95% CI 1.00-1.09). Family physicians in the later stage of the pandemic were more likely to report burnout than in the pre-pandemic stage (aRR 1.06, 95% CI 1.02-1.10).
Conclusions
We found burnout was a pervasive concern among family physicians over the stages of the pandemic, although we found no differences in burnout between rural and urban family physicians. Addressing family physician burnout is crucial to maintaining a resilient rural primary care workforce.
了解农村和城市家庭医生在2019冠状病毒病大流行期间面临的不同挑战，对于制定应对职业倦怠的战略至关重要。本研究描述了大流行之前和期间农村和城市家庭医生中职业倦怠的流行情况，检查了与职业倦怠相关的医生和执业特征。方法：我们对来自美国家庭医学委员会全国毕业生调查和实践人口调查的25,018名家庭医生的调查反馈进行了重复横断面分析，这些调查来自3个时间段：大流行前（2019年1月- 2020年3月）、大流行早期（2020年4月- 2021年4月）和大流行后期（2021年5月- 2022年6月）。我们使用双变量分析和逻辑回归来比较这些时期农村和城市家庭医生自我报告的职业倦怠，控制医生和执业特征。结果总体而言，43.5%的家庭医生符合职业倦怠标准。农村医生的职业倦怠率（45.2%）略高于城市医生（43.2%），但无统计学意义。在校正分析中，乡村性与职业倦怠没有关联（校正风险比[aRR] 1.04, 95% CI 1.00-1.09）。大流行后期的家庭医生比大流行前阶段更有可能报告倦怠（aRR 1.06, 95% CI 1.02-1.10）。结论：我们发现，在流感大流行的各个阶段，职业倦怠是家庭医生普遍关注的问题，尽管我们发现农村和城市家庭医生在职业倦怠方面没有差异。解决家庭医生职业倦怠问题对于保持农村初级保健队伍的弹性至关重要。
{"title":"Rural and urban differences in family physician burnout before and during the COVID-19 pandemic","authors":"Sara C. Woolcock MPH, RDN, Davis G. Patterson PhD, Julia A. Dunn MSc, Lars E. Peterson MD, PhD, C. Holly A. Andrilla MS","doi":"10.1111/jrh.70051","DOIUrl":"https://doi.org/10.1111/jrh.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Understanding the different challenges rural and urban family physicians faced during the COVID-19 pandemic is essential for developing strategies to combat burnout. This study described the prevalence of burnout among rural and urban family physicians before and during the pandemic, examining physician and practice characteristics associated with burnout.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a repeated cross-sectional analysis of survey responses of 25,018 family physicians from the American Board of Family Medicine National Graduate Survey and Practice Demographic Survey from 3 time periods: pre-pandemic (January 2019-March 2020), early pandemic (April 2020-April 2021), and later pandemic (May 2021-June 2022). We used bivariate analyses and logistic regression to compare self-reported burnout in rural and urban family physicians over these time periods, controlling for physician and practice characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 43.5% of family physicians included in this study met the criteria for burnout. The burnout rate was slightly higher for rural physicians (45.2%) compared to urban physicians (43.2%), but not statistically significant. In the adjusted analyses, there was no association of rurality and burnout (adjusted risk ratio [aRR] 1.04, 95% CI 1.00-1.09). Family physicians in the later stage of the pandemic were more likely to report burnout than in the pre-pandemic stage (aRR 1.06, 95% CI 1.02-1.10).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found burnout was a pervasive concern among family physicians over the stages of the pandemic, although we found no differences in burnout between rural and urban family physicians. Addressing family physician burnout is crucial to maintaining a resilient rural primary care workforce.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598757","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}
Chelsea Leonard , William Feser , Lauren McKown , Emily Whitfield , George E. Kaufman , Daniel Abrahamson , Jessica Young
Background
In the Veteran's Health Administration (VHA), rural Veterans who need orthotic and prosthetic (O&P) care typically travel to urban VHA medical centers (VAMCs). This presents a barrier to receiving O&P care, as travel may be burdensome due to medical or psychosocial issues. The VHA Mobile Prosthetic and Orthotic Care Program (MoPOC) removes access barriers to VHA O&P care by providing care in rural VHA clinics or in Veterans’ homes. The goal of this evaluation was to understand if Veterans are satisfied with access to MoPOC care, MoPOC clinicians, and impacts of care.
Methods
We conducted a convergent mixed methods evaluation with a satisfaction survey and qualitative interviews among Veterans who received MoPOC care. Surveys were analyzed descriptively. Interviews were analyzed using rapid matrix analysis.
Results
We received 598 survey responses (36% response rate) from six MoPOC sites and conducted 35 interviews. Findings included high Veteran satisfaction with MoPOC clinicians, high satisfaction with MoPOC care, improved access to care, allowing Veterans to stay in the VHA for care, positive impacts on quality of life, and challenges related to timeliness of device delivery.
Discussion/significance
Veterans were satisfied with MoPOC and MoPOC increased access to care. Many Veterans reported that they would not have received O&P care without MoPOC. This, along with the perceived quality of life impacts, indicates that expanding access to VHA O&P care in rural areas benefits Veterans. Many Veterans preferred to receive care in the VHA, suggesting programs like MoPOC are preferable to outsourcing care to non-VHA settings. Ensuring timeliness of device delivery is a key challenge, and it is unknown how satisfaction of timeliness within the VHA compares to satisfaction with timeliness of device provision in other settings.
{"title":"Increasing access to orthotic and prosthetic care in rural communities: Satisfaction with the Department of Veterans Affairs Mobile Prosthetic and Orthotic Care Program","authors":"Chelsea Leonard , William Feser , Lauren McKown , Emily Whitfield , George E. Kaufman , Daniel Abrahamson , Jessica Young","doi":"10.1111/jrh.70050","DOIUrl":"https://doi.org/10.1111/jrh.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the Veteran's Health Administration (VHA), rural Veterans who need orthotic and prosthetic (O&P) care typically travel to urban VHA medical centers (VAMCs). This presents a barrier to receiving O&P care, as travel may be burdensome due to medical or psychosocial issues. The VHA Mobile Prosthetic and Orthotic Care Program (MoPOC) removes access barriers to VHA O&P care by providing care in rural VHA clinics or in Veterans’ homes. The goal of this evaluation was to understand if Veterans are satisfied with access to MoPOC care, MoPOC clinicians, and impacts of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a convergent mixed methods evaluation with a satisfaction survey and qualitative interviews among Veterans who received MoPOC care. Surveys were analyzed descriptively. Interviews were analyzed using rapid matrix analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We received 598 survey responses (36% response rate) from six MoPOC sites and conducted 35 interviews. Findings included high Veteran satisfaction with MoPOC clinicians, high satisfaction with MoPOC care, improved access to care, allowing Veterans to stay in the VHA for care, positive impacts on quality of life, and challenges related to timeliness of device delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion/significance</h3>\u0000 \u0000 <p>Veterans were satisfied with MoPOC and MoPOC increased access to care. Many Veterans reported that they would not have received O&P care without MoPOC. This, along with the perceived quality of life impacts, indicates that expanding access to VHA O&P care in rural areas benefits Veterans. Many Veterans preferred to receive care in the VHA, suggesting programs like MoPOC are preferable to outsourcing care to non-VHA settings. Ensuring timeliness of device delivery is a key challenge, and it is unknown how satisfaction of timeliness within the VHA compares to satisfaction with timeliness of device provision in other settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598756","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}
Kale G. Mills BS, Nathan Farrokhian MD, Elizabeth Ablah PhD, MPH, Kevin J. Sykes PhD, MPH
Importance
There is a need to understand how the increasing rate of HPV-positive oropharyngeal cancers may affect underresourced populations.
Purpose
To investigate possible disparities in survival and cause-specific mortality between rural and urban populations with HPV-associated oropharyngeal cancer.
Design
Our retrospective cohort study utilized the Surveillance, Epidemiology, and End Results (SEER) Pharyngeal Cancer with HPV Status Database from 2006 to 2018. Cox proportional hazard models and Kaplan–Meier curves were employed to evaluate the differences in overall survival and cause-specific mortality.
Setting
SEER data used in this study originate from a set of regional cancer registries located across the country.
Participants
Patients diagnosed with HPV-associated oropharyngeal cancer from 2006 through 2018 in the SEER HPV status database.
Main Outcome(s) and Measure(s)
The difference in overall survival and cause-specific mortality between rural and urban populations with HPV-associated oropharyngeal cancer.
Results
A total of 13,294 patients were included in our study, most of whom lived in urban counties (88.5%, n = 11,766), had a mean age of 60.6 years (SD = 9.6), and had a primary tumor site located in the tonsil (47.6%, n = 6328). Rural communities had a higher likelihood of all-cause mortality (hazard ratio [HR] 1.14, 95% confidence interval [CI], 1.02–1.29) compared to their urban counterparts. Additionally, rural residents had a higher probability of cause-specific mortality (HR 1.15, 95% CI, 1.01–1.32) compared to their urban counterparts.
Conclusions
Patients with HPV-associated oropharyngeal cancer who reside in rural areas were more likely to die when compared to their urban counterparts. More research is needed to determine the best way to mitigate this disparity.
{"title":"Disparities in rural and urban outcomes in populations with human papillomavirus–associated oropharyngeal cancers","authors":"Kale G. Mills BS, Nathan Farrokhian MD, Elizabeth Ablah PhD, MPH, Kevin J. Sykes PhD, MPH","doi":"10.1111/jrh.70048","DOIUrl":"https://doi.org/10.1111/jrh.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Importance</h3>\u0000 \u0000 <p>There is a need to understand how the increasing rate of HPV-positive oropharyngeal cancers may affect underresourced populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate possible disparities in survival and cause-specific mortality between rural and urban populations with HPV-associated oropharyngeal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Our retrospective cohort study utilized the Surveillance, Epidemiology, and End Results (SEER) Pharyngeal Cancer with HPV Status Database from 2006 to 2018. Cox proportional hazard models and Kaplan–Meier curves were employed to evaluate the differences in overall survival and cause-specific mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>SEER data used in this study originate from a set of regional cancer registries located across the country.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Patients diagnosed with HPV-associated oropharyngeal cancer from 2006 through 2018 in the SEER HPV status database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome(s) and Measure(s)</h3>\u0000 \u0000 <p>The difference in overall survival and cause-specific mortality between rural and urban populations with HPV-associated oropharyngeal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 13,294 patients were included in our study, most of whom lived in urban counties (88.5%, <i>n</i> = 11,766), had a mean age of 60.6 years (SD = 9.6), and had a primary tumor site located in the tonsil (47.6%, <i>n</i> = 6328). Rural communities had a higher likelihood of all-cause mortality (hazard ratio [HR] 1.14, 95% confidence interval [CI], 1.02–1.29) compared to their urban counterparts. Additionally, rural residents had a higher probability of cause-specific mortality (HR 1.15, 95% CI, 1.01–1.32) compared to their urban counterparts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with HPV-associated oropharyngeal cancer who reside in rural areas were more likely to die when compared to their urban counterparts. More research is needed to determine the best way to mitigate this disparity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589746","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}
Peter DelNero PhD, Mario Schootman PhD, Cheng Peng PhD, Mahima Saini B. Pharm, Emily Hallgren PhD, Jonathan Laryea MD, Chenghui Li PhD
Purpose
We examined whether living in persistent poverty census tracts was associated with disparities in colorectal cancer (CRC) survival and whether the association varied between urban and rural settings.
Methods
Using 2013–2019 state-wide cancer registry and 2013–2021 death records data, CRC patients were classified by tract-level persistent poverty and rural/urban status. Overall and CRC-specific survival were compared using Kaplan–Meier estimation and log-rank tests. Adjusted analyses were conducted using Cox proportional hazard and Fine-Gray competing risk models.
Findings
During the study period, 558 (53%) of 1055 CRC patients died in persistent poverty tracts versus 3117 (45%) of 6938 patients in nonpersistent poverty tracts. Of the 3675 deaths, 2269 (61.7%) were from CRC-specific causes. In unadjusted analysis, CRC patients in persistent poverty areas had a higher risk of all-cause (HR, 95%CI: 1.28, 1.17–1.40) and CRC-specific (HR, 95% CI: 1.17, 1.04–1.31) mortality. After covariates adjustment, the relationship between persistent poverty and all-cause mortality (HR, 95% CI: 1.17, 1.06–1.29) and non-CRC-specific mortality (HR, 95% CI: 1.34, 1.15–1.57) remained significant, but CRC-specific mortality did not. In subgroup analyses, persistent poverty was associated with increased overall mortality among urban tracts (HR, 95% CI: 1.22, 1.08–1.38), but not rural tracts.
Conclusions
After covariates adjustment, CRC patients in persistent poverty tracts are more likely to die of all causes and non-CRC causes but not CRC-specific causes than those in nonpersistent poverty areas, suggesting that differences in CRC-specific deaths may be partly attributed to demographics, geography, tumor characteristics, and treatment.
{"title":"Colorectal cancer survival disparities in persistent poverty areas","authors":"Peter DelNero PhD, Mario Schootman PhD, Cheng Peng PhD, Mahima Saini B. Pharm, Emily Hallgren PhD, Jonathan Laryea MD, Chenghui Li PhD","doi":"10.1111/jrh.70045","DOIUrl":"https://doi.org/10.1111/jrh.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>We examined whether living in persistent poverty census tracts was associated with disparities in colorectal cancer (CRC) survival and whether the association varied between urban and rural settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using 2013–2019 state-wide cancer registry and 2013–2021 death records data, CRC patients were classified by tract-level persistent poverty and rural/urban status. Overall and CRC-specific survival were compared using Kaplan–Meier estimation and log-rank tests. Adjusted analyses were conducted using Cox proportional hazard and Fine-Gray competing risk models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>During the study period, 558 (53%) of 1055 CRC patients died in persistent poverty tracts versus 3117 (45%) of 6938 patients in nonpersistent poverty tracts. Of the 3675 deaths, 2269 (61.7%) were from CRC-specific causes. In unadjusted analysis, CRC patients in persistent poverty areas had a higher risk of all-cause (HR, 95%CI: 1.28, 1.17–1.40) and CRC-specific (HR, 95% CI: 1.17, 1.04–1.31) mortality. After covariates adjustment, the relationship between persistent poverty and all-cause mortality (HR, 95% CI: 1.17, 1.06–1.29) and non-CRC-specific mortality (HR, 95% CI: 1.34, 1.15–1.57) remained significant, but CRC-specific mortality did not. In subgroup analyses, persistent poverty was associated with increased overall mortality among urban tracts (HR, 95% CI: 1.22, 1.08–1.38), but not rural tracts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>After covariates adjustment, CRC patients in persistent poverty tracts are more likely to die of all causes and non-CRC causes but not CRC-specific causes than those in nonpersistent poverty areas, suggesting that differences in CRC-specific deaths may be partly attributed to demographics, geography, tumor characteristics, and treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582355","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}
Yvonne Jonk PhD, Heidi O'Connor MS, Sharita Thomas MPP, Chrisopher M. Shea PhD
Purpose
This study examined how the telehealth (TH) flexibilities introduced during the COVID-19 public health emergency (PHE) affected in-person behavioral health (BH) and tele-behavioral health (TBH) patterns of use among Medicare Fee-for-Service beneficiaries receiving care at critical access hospitals (CAHs) and non-CAH short-term acute care hospitals.
Methods
We used the 2019–2021 5% Medicare Limited Data Set Outpatient and Carrier files to explore differences in TBH usage trends by hospital type in the pre-pandemic year of 2019 and during the pandemic (2020–2021).
Findings
The percentage of hospitals providing TBH services significantly increased from 2019 to 2020–2021 (CAHs: 9% to 17%–23%; non-CAHs: 3% to 21%–22%). Although CAHs had higher TBH usage rates (i.e., the percentage of BH visits conducted through TH) than non-CAHs in the pre-pandemic period, usage rates among non-CAHs (7%–25%) outpaced CAHs (5%–16%) across all census regions—particularly in the Northeast—during the pandemic. In 2021, non-CAHs were able to sustain the use of TBH at higher levels than CAHs across all census regions except for the South.
Conclusions
While both CAHs and non-CAHs took advantage of the PHE TH flexibilities and significantly increased the likelihood and levels of TBH services, non-CAHs realized higher TBH usage rates than CAHs. The increase in the use of TBH visits was not enough to curb the decline in in-person BH visits during the pandemic. Given efforts to expand broadband and improve digital literacy in rural areas, TH continues to have great potential to reduce rural–urban BH differences in access to BH services.
{"title":"The provision of tele-behavioral health services by critical access hospitals and short-term acute care hospitals during the COVID-19 public health emergency","authors":"Yvonne Jonk PhD, Heidi O'Connor MS, Sharita Thomas MPP, Chrisopher M. Shea PhD","doi":"10.1111/jrh.70047","DOIUrl":"https://doi.org/10.1111/jrh.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study examined how the telehealth (TH) flexibilities introduced during the COVID-19 public health emergency (PHE) affected in-person behavioral health (BH) and tele-behavioral health (TBH) patterns of use among Medicare Fee-for-Service beneficiaries receiving care at critical access hospitals (CAHs) and non-CAH short-term acute care hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the 2019–2021 5% Medicare Limited Data Set Outpatient and Carrier files to explore differences in TBH usage trends by hospital type in the pre-pandemic year of 2019 and during the pandemic (2020–2021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The percentage of hospitals providing TBH services significantly increased from 2019 to 2020–2021 (CAHs: 9% to 17%–23%; non-CAHs: 3% to 21%–22%). Although CAHs had higher TBH usage rates (i.e., the percentage of BH visits conducted through TH) than non-CAHs in the pre-pandemic period, usage rates among non-CAHs (7%–25%) outpaced CAHs (5%–16%) across all census regions—particularly in the Northeast—during the pandemic. In 2021, non-CAHs were able to sustain the use of TBH at higher levels than CAHs across all census regions except for the South.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While both CAHs and non-CAHs took advantage of the PHE TH flexibilities and significantly increased the likelihood and levels of TBH services, non-CAHs realized higher TBH usage rates than CAHs. The increase in the use of TBH visits was not enough to curb the decline in in-person BH visits during the pandemic. Given efforts to expand broadband and improve digital literacy in rural areas, TH continues to have great potential to reduce rural–urban BH differences in access to BH services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144550853","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}
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