Journal of Rural Health最新文献_第9页

Rural and urban differences in family physician burnout before and during the COVID-19 pandemic 在COVID-19大流行之前和期间，城乡家庭医生职业倦怠的差异

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-07-11 DOI: 10.1111/jrh.70051

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}

引用次数: 0

Increasing access to orthotic and prosthetic care in rural communities: Satisfaction with the Department of Veterans Affairs Mobile Prosthetic and Orthotic Care Program 在农村社区增加矫形器和矫形器护理：对退伍军人事务部移动矫形器和矫形器护理计划的满意度

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-07-11 DOI: 10.1111/jrh.70050

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.

在退伍军人健康管理局（VHA）中，需要矫形和假肢（O&；P）护理的农村退伍军人通常前往城市VHA医疗中心（VAMCs）。这对接受o&p护理构成障碍，因为由于医疗或社会心理问题，旅行可能会带来负担。VHA移动假肢和矫形护理项目（MoPOC）通过在农村VHA诊所或退伍军人家中提供护理，消除了VHA o&p护理的准入障碍。本评估的目的是了解退伍军人是否对获得MoPOC护理、MoPOC临床医生和护理的影响感到满意。方法采用满意度调查和定性访谈相结合的融合混合方法对接受MoPOC护理的退伍军人进行评价。对调查进行描述性分析。访谈采用快速矩阵分析进行分析。结果共收到598份问卷，回复率36%，共进行了35次访谈。研究结果包括退伍军人对MoPOC临床医生的高满意度，对MoPOC护理的高满意度，改善护理的可及性，允许退伍军人留在VHA接受护理，对生活质量的积极影响，以及与设备交付及时性相关的挑战。讨论/意义退伍军人对MoPOC感到满意，MoPOC增加了获得护理的机会。许多退伍军人报告说，如果没有MoPOC，他们就不会得到o&p护理。这一点，再加上对生活质量的影响，表明在农村地区扩大获得VHA o&p护理的机会有利于退伍军人。许多退伍军人更愿意在VHA接受护理，这表明像MoPOC这样的项目比将护理外包给非VHA机构更可取。确保设备交付的及时性是一项关键挑战，目前尚不清楚VHA内的及时性满意度与其他设置中设备提供的及时性满意度相比如何。

{"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}

引用次数: 0

Disparities in rural and urban outcomes in populations with human papillomavirus–associated oropharyngeal cancers 人乳头瘤病毒相关口咽癌农村和城市人群预后的差异

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-07-10 DOI: 10.1111/jrh.70048

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.

有必要了解hpv阳性口咽癌发病率的上升如何影响资源不足的人群。目的探讨农村和城市人群hpv相关口咽癌的生存率和病因特异性死亡率的差异。我们的回顾性队列研究利用了2006年至2018年的HPV状态监测、流行病学和最终结果（SEER）咽癌数据库。采用Cox比例风险模型和Kaplan-Meier曲线来评估总生存率和原因特异性死亡率的差异。本研究中使用的SEER数据来自全国各地的一组区域癌症登记处。在SEER HPV状态数据库中，从2006年到2018年诊断为HPV相关口咽癌的患者。主要结局和测量方法：农村和城市人群hpv相关口咽癌患者的总生存率和病因特异性死亡率的差异。结果共纳入13294例患者，其中大部分生活在城市县（88.5%,n = 11766），平均年龄60.6岁（SD = 9.6），原发肿瘤部位位于扁桃体（47.6%,n = 6328）。与城市社区相比，农村社区有更高的全因死亡率（风险比[HR] 1.14, 95%可信区间[CI]， 1.02-1.29）。此外，与城市居民相比，农村居民因特定原因死亡的概率更高（HR 1.15, 95% CI 1.01-1.32）。结论居住在农村地区的hpv相关口咽癌患者比城市患者更容易死亡。需要更多的研究来确定减轻这种差距的最佳方法。

{"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}

引用次数: 0

Colorectal cancer survival disparities in persistent poverty areas 持续贫困地区结直肠癌生存差异

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-07-08 DOI: 10.1111/jrh.70045

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.

目的：我们研究了生活在持续贫困人口普查区是否与结直肠癌（CRC）生存差异有关，以及城市和农村环境之间的关联是否存在差异。方法利用2013-2019年全国癌症登记数据和2013-2021年死亡记录数据，按地区持续贫困和城乡状况对结直肠癌患者进行分类。采用Kaplan-Meier估计和log-rank检验比较总生存率和crc特异性生存率。采用Cox比例风险模型和Fine-Gray竞争风险模型进行调整分析。在研究期间，1055例CRC患者中有558例（53%）死于持续贫困区，而6938例患者中有3117例（45%）死于非持续贫困区。在3675例死亡中，2269例（61.7%）死于crc特异性原因。在未经调整的分析中，持续贫困地区的结直肠癌患者具有更高的全因死亡率（HR, 95%CI: 1.28, 1.17 - 1.40）和CRC特异性死亡率（HR, 95%CI: 1.17, 1.04-1.31）。协变量调整后，持续贫困与全因死亡率（HR, 95% CI: 1.17, 1.06-1.29）和非crc特异性死亡率（HR, 95% CI: 1.34, 1.15-1.57）之间的关系仍然显著，但crc特异性死亡率不显著。在亚组分析中，持续贫困与城市地区总体死亡率增加有关（HR, 95% CI: 1.22, 1.08-1.38），但与农村地区无关。经协变量调整后，持续贫困地区的结直肠癌患者比非持续贫困地区的结直肠癌患者更可能死于所有原因和非结直肠癌原因，而不是CRC特异性原因，这表明CRC特异性死亡的差异可能部分归因于人口统计学、地理、肿瘤特征和治疗。

{"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}

引用次数: 0

The provision of tele-behavioral health services by critical access hospitals and short-term acute care hospitals during the COVID-19 public health emergency 在COVID-19突发公共卫生事件期间，重症医院和短期急症护理医院提供的远程行为卫生服务

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-07-04 DOI: 10.1111/jrh.70047

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.

本研究考察了COVID-19突发公共卫生事件（PHE）期间引入的远程医疗（TH）灵活性如何影响在关键通道医院（CAHs）和非cah短期急性护理医院接受治疗的医疗保险服务收费受益人的现场行为健康（BH）和远程行为健康（TBH）使用模式。方法使用2019 - 2021年5%医疗保险有限数据集门诊和携带者文件，探讨2019年大流行前和大流行期间（2020-2021年）不同医院类型TBH使用趋势的差异。从2019年到2020-2021年，提供TBH服务的医院比例显著增加(CAHs: 9%至17%-23%；非cahs: 3%至21%-22%)。虽然在大流行前，CAHs的TBH使用率（即通过TH就诊的百分比）高于非CAHs，但在大流行期间，所有人口普查区域，特别是东北部地区，非CAHs的使用率（7%-25%）超过了CAHs（5%-16%）。2021年，在除南方以外的所有人口普查区域，非卫生保健机构的卫生保健使用水平均高于卫生保健机构。结论CAHs和非CAHs都利用了PHE TH的灵活性，显著提高了TBH服务的可能性和水平，但非CAHs的TBH使用率高于CAHs。在大流行期间，使用波黑就诊的增加不足以遏制亲自到波黑就诊的减少。鉴于在农村地区扩大宽带和提高数字素养的努力，卫生保健在缩小城乡卫生保健在获得卫生保健服务方面的差异方面仍然具有巨大潜力。

{"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}

引用次数: 0

Insights into suicidality in rural communities: Lessons from Rawat et al. (2025) and perspectives from Alaska and Colorado 对农村社区自杀行为的洞察：来自Rawat等人（2025）的经验教训以及来自阿拉斯加和科罗拉多州的观点

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-06-30 DOI: 10.1111/jrh.70046

Ezra N. S. Lockhart PhD, LMFT, LAC

引用次数: 0

Impact of rurality and the area deprivation index on outcomes of collaborative care for depression 乡村性和地区剥夺指数对抑郁症协同护理结果的影响

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-06-22 DOI: 10.1111/jrh.70044

Samuel T. Savitz PhD, Alanna M. Chamberlain PhD, Ruoxiang Jiang BSc, Sheharyar Sarwar DO, Mark D. Williams MD

Purpose

The Collaborative care model (CoCM) is the leading model for integrating behavioral health into primary care for patients with major depressive disorder (MDD). However, CoCM requires engagement and ongoing participation. We aimed to assess whether two area-based measures, the area-deprivation index (ADI) and rurality, were associated with enrollment, participation, and outcomes with CoCM.

Methods

This was an observational analysis of Mayo Clinic patients eligible for CoCM: adults aged ≥18 years, empaneled in primary care, and with a PHQ-9 of ≥10. We operationalized ADI as quintiles with Q1 being least deprived and Q5 being most deprived and rurality using RUCA codes with two categories: urban and rural. We evaluated enrollment in CoCM, drop out defined by leaving the program early, the count and type of contacts with the care coordinator, and clinical improvement measured using the PHQ-9.

Findings

We identified 54,030 individuals with 16,532 (30.6%) residing in rural areas and 11,122 (20.6%) residing in the most deprived ADI quintile (Q5). Living in a rural area was associated with lower enrollment in CoCM (–2.3 percentage points [95% confidence interval (CI): –2.5, 2.2]), longer length in CoCM (18.6 days [95% CI: 5.7, 31.5]), more contacts with the care coordinator (1.1 contacts [95% CI: 0.2, 2.0]), and worse response and remission. In contrast, ADI Q5 was only associated with worse response and remission.

Conclusions

Rurality was associated with lower enrollment, greater engagement, and worse clinical outcomes. More work may be needed to address enrollment barriers for individuals living in rural areas to improve clinical outcomes.

目的协作护理模式（CoCM）是将行为健康纳入重度抑郁障碍（MDD）患者初级保健的主要模式。然而，CoCM需要参与和持续的参与。我们的目的是评估两个基于区域的指标，即区域剥夺指数（ADI）和乡村性，是否与CoCM的入组、参与和结果相关。方法：对符合CoCM条件的梅奥诊所患者进行观察性分析：年龄≥18岁，纳入初级保健，PHQ-9≥10的成年人。我们将ADI按五分位数进行操作，其中Q1是最不贫困的，Q5是最贫困的，农村使用RUCA代码分为两类：城市和农村。我们评估了CoCM的入组情况、提前退出定义、与护理协调员接触的数量和类型，以及使用PHQ-9测量的临床改善。我们确定了54,030人，其中16,532人（30.6%）居住在农村地区，11,122人（20.6%）居住在最贫困的ADI五分位数（Q5）。生活在农村地区的患者CoCM入组率较低（-2.3个百分点[95%可信区间（CI）： -2.5, 2.2]）， CoCM持续时间较长（18.6天[95% CI: 5.7, 31.5]），与护理协调员接触较多（1.1次接触[95% CI: 0.2, 2.0]），反应和缓解较差。相比之下，ADI Q5仅与较差的反应和缓解相关。结论：乡村性与较低的入组率、较高的参与度和较差的临床结果相关。可能需要做更多的工作来解决生活在农村地区的个体的入学障碍，以改善临床结果。

{"title":"Impact of rurality and the area deprivation index on outcomes of collaborative care for depression","authors":"Samuel T. Savitz PhD, Alanna M. Chamberlain PhD, Ruoxiang Jiang BSc, Sheharyar Sarwar DO, Mark D. Williams MD","doi":"10.1111/jrh.70044","DOIUrl":"https://doi.org/10.1111/jrh.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The Collaborative care model (CoCM) is the leading model for integrating behavioral health into primary care for patients with major depressive disorder (MDD). However, CoCM requires engagement and ongoing participation. We aimed to assess whether two area-based measures, the area-deprivation index (ADI) and rurality, were associated with enrollment, participation, and outcomes with CoCM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an observational analysis of Mayo Clinic patients eligible for CoCM: adults aged ≥18 years, empaneled in primary care, and with a PHQ-9 of ≥10. We operationalized ADI as quintiles with Q1 being least deprived and Q5 being most deprived and rurality using RUCA codes with two categories: urban and rural. We evaluated enrollment in CoCM, drop out defined by leaving the program early, the count and type of contacts with the care coordinator, and clinical improvement measured using the PHQ-9.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We identified 54,030 individuals with 16,532 (30.6%) residing in rural areas and 11,122 (20.6%) residing in the most deprived ADI quintile (Q5). Living in a rural area was associated with lower enrollment in CoCM (–2.3 percentage points [95% confidence interval (CI): –2.5, 2.2]), longer length in CoCM (18.6 days [95% CI: 5.7, 31.5]), more contacts with the care coordinator (1.1 contacts [95% CI: 0.2, 2.0]), and worse response and remission. In contrast, ADI Q5 was only associated with worse response and remission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rurality was associated with lower enrollment, greater engagement, and worse clinical outcomes. More work may be needed to address enrollment barriers for individuals living in rural areas to improve clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339502","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}

引用次数: 0

The impact of California Proposition 56 on smoking behaviors across geographic residence 加州第56号提案对跨地域居住地吸烟行为的影响

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-06-13 DOI: 10.1111/jrh.70041

Courtney Keeler PhD, Alexa Colgrove Curtis PhD, MPH, APRN

Purpose

To explore the geographic impact of California's Proposition 56 (Prop 56) on smoking behaviors.

Methods

We identified 61,193 respondents aged 21+ from the 2012–2018 California Behavioral Risk Factor Surveillance Survey. We constructed county identifiers indicating whether (1) a respondent lived in an urban, suburban, or rural county and (2) whether a respondent lived in a metropolitan statistical area (MSA) or not. Similarly, we created a binary variable indicating whether Prop 56 was in effect (Yes/No). We used a two-part model to estimate the association of Prop 56 with smoking participation among all adults and smoking intensity (average number of cigarettes smoked per day (CPD)) among current smokers. Models were run separately for each geographic subgroup. Additional covariates included sociodemographic characteristics and a time trend variable.

Findings

Smoking prevalence was significantly different across geographic groups, with rates highest among the rural population group (13.8%) and lowest among the urban subgroup (9.1%). Similarly, rates of smoking intensity were significantly higher among non-urban populations, with average CPD highest among the rural population (10.66) and lowest among the urban subgroup (8.32). Regression models highlighted a negative association between Prop 56 and smoking participation only among the urban and MSA subgroups (p < 0.001). We found no evidence of an association between the enactment of Prop 56 with average CPD for any geographic group.

Conclusion

Public health experts, clinicians, and policymakers might consider additional interventions that can be implemented in tandem with pricing tools to help reduce observed geographic disparities in smoking among rural—and even suburban—communities.

目的探讨加州第56号提案（Prop 56）对吸烟行为的地理影响。方法：我们从2012-2018年加州行为风险因素监测调查中确定了61193名21岁以上的受访者。我们构建了县标识符，表明(1)受访者是否居住在城市、郊区或农村县，以及(2)受访者是否居住在大都市统计区（MSA）。类似地，我们创建了一个二元变量，表明Prop 56是否有效（是/否）。我们使用了一个两部分模型来估计第56号提案与所有成年人的吸烟参与和当前吸烟者的吸烟强度（平均每天吸烟的数量（CPD））的关系。每个地理亚组分别运行模型。其他协变量包括社会人口学特征和时间趋势变量。研究发现，不同地域人群的吸烟率存在显著差异，农村人群吸烟率最高（13.8%），城市人群吸烟率最低（9.1%）。同样，非城市人口的吸烟强度率明显更高，农村人口的平均CPD最高（10.66），城市亚群的平均CPD最低（8.32）。回归模型强调了第56号提案与吸烟参与率之间的负相关关系，仅在城市和MSA亚组中(p <；0.001)。我们没有发现任何证据表明第56号提案的颁布与任何地理群体的平均CPD之间存在关联。结论：公共卫生专家、临床医生和政策制定者可以考虑额外的干预措施，可以与定价工具一起实施，以帮助减少观察到的农村甚至郊区社区吸烟的地理差异。

{"title":"The impact of California Proposition 56 on smoking behaviors across geographic residence","authors":"Courtney Keeler PhD, Alexa Colgrove Curtis PhD, MPH, APRN","doi":"10.1111/jrh.70041","DOIUrl":"https://doi.org/10.1111/jrh.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To explore the geographic impact of California's Proposition 56 (Prop 56) on smoking behaviors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified 61,193 respondents aged 21+ from the 2012–2018 California Behavioral Risk Factor Surveillance Survey. We constructed county identifiers indicating whether (1) a respondent lived in an urban, suburban, or rural county and (2) whether a respondent lived in a metropolitan statistical area (MSA) or not. Similarly, we created a binary variable indicating whether Prop 56 was in effect (Yes/No). We used a two-part model to estimate the association of Prop 56 with smoking participation among all adults and smoking intensity (average number of cigarettes smoked per day (CPD)) among current smokers. Models were run separately for each geographic subgroup. Additional covariates included sociodemographic characteristics and a time trend variable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Smoking prevalence was significantly different across geographic groups, with rates highest among the rural population group (13.8%) and lowest among the urban subgroup (9.1%). Similarly, rates of smoking intensity were significantly higher among non-urban populations, with average CPD highest among the rural population (10.66) and lowest among the urban subgroup (8.32). Regression models highlighted a negative association between Prop 56 and smoking participation only among the urban and MSA subgroups (<i>p</i> < 0.001). We found no evidence of an association between the enactment of Prop 56 with average CPD for any geographic group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Public health experts, clinicians, and policymakers might consider additional interventions that can be implemented in tandem with pricing tools to help reduce observed geographic disparities in smoking among rural—and even suburban—communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281485","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}

引用次数: 0

Geographic disparities in unpaid caregiving 无偿看护的地域差异

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-06-13 DOI: 10.1111/jrh.70039

Emma Kathryn Boswell MPH, Monique J. Brown PhD, Lorie Donelle PhD, Nicholas Yell PhD, Taryn Farrell MPH, Peiyin Hung PhD, Elizabeth Crouch PhD

Purpose

An updated, nationally representative examination of rural–urban differences in the experiences, health, and well-being of caregivers is needed; previous research on this topic uses older data or has limited generalizability. This study examines rural–urban differences in the characteristics, experiences, and health of caregivers.

Methods

The 2021–2022 Behavioral Risk Factor Surveillance System (n = 44,274 unpaid caregivers) was used, with rurality defined according to the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme. Chi-square tests compared rural–urban differences in these caregivers’ characteristics, including demographic factors, caregiving intensity (e.g., weekly hours spent caregiving, reason for caregiving, past-month ADL/IADL assistance), caregiver's health (e.g., general health status and past month physical health, mental health, and limited activity), and caregiver's health behavior (chronic illness, smoking status, binge drinking, and annual checkups).

Findings

Compared to urban caregivers, rural caregivers were more likely to have at least one chronic condition (58.3% vs. 53.2%; p < 0.0001), be obese (42.9% vs. 37.5%; p < 0.0001), be a smoker (24.2% vs. 15.5%; p < 0.0001), and less likely to be a binge drinker (12.7% vs. 15.3%; p = 0.003). Compared to urban caregivers, rural caregivers were more likely to report their general health status as fair/poor (20.3% vs. 17.0%, p = 0.0003) and were more likely to report 14 or more days of poor physical health in the past month (15.6% vs. 12.0%, p < 0.0001).

Conclusions

Understanding geographic disparities in the experiences and context of unpaid caregiving is needed to improve their overall well-being and health. Future research will be necessary to determine factors associated with these outcomes.

需要对农村和城市在护理人员的经历、健康和福祉方面的差异进行最新的、具有全国代表性的调查；以前关于这一主题的研究使用的是较旧的数据，或者泛化能力有限。本研究考察了农村和城市在看护者的特征、经历和健康方面的差异。方法采用2021-2022年行为风险因素监测系统（n = 44,274名无报酬照顾者），农村性根据2013年国家卫生统计中心城乡分类方案定义。卡方检验比较了这些照护者特征的城乡差异，包括人口统计学因素、照护强度（例如，每周照护时间、照护原因、过去一个月的ADL/IADL协助）、照护者健康（例如，一般健康状况和过去一个月的身体健康、心理健康和有限的活动）以及照护者的健康行为（慢性病、吸烟状况、酗酒、残疾和残疾）。以及每年的体检)。与城市护理人员相比，农村护理人员更有可能患有至少一种慢性疾病(58.3%比53.2%；p & lt;0.0001)，肥胖(42.9% vs. 37.5%；p & lt;0.0001)，吸烟(24.2% vs. 15.5%；p & lt;0.0001)，并且不太可能成为酗酒者(12.7% vs. 15.3%；P = 0.003)。与城市护理人员相比，农村护理人员更有可能报告自己的总体健康状况为一般/较差（20.3%比17.0%,p = 0.0003），并且更有可能报告过去一个月有14天或更长时间的身体健康状况不佳(15.6%比12.0%,p <；0.0001)。结论：了解无偿照护经历和背景的地域差异是改善他们整体福祉和健康的必要条件。未来的研究将有必要确定与这些结果相关的因素。

{"title":"Geographic disparities in unpaid caregiving","authors":"Emma Kathryn Boswell MPH, Monique J. Brown PhD, Lorie Donelle PhD, Nicholas Yell PhD, Taryn Farrell MPH, Peiyin Hung PhD, Elizabeth Crouch PhD","doi":"10.1111/jrh.70039","DOIUrl":"https://doi.org/10.1111/jrh.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>An updated, nationally representative examination of rural–urban differences in the experiences, health, and well-being of caregivers is needed; previous research on this topic uses older data or has limited generalizability. This study examines rural–urban differences in the characteristics, experiences, and health of caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 2021–2022 Behavioral Risk Factor Surveillance System (<i>n</i> = 44,274 unpaid caregivers) was used, with rurality defined according to the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme. Chi-square tests compared rural–urban differences in these caregivers’ characteristics, including demographic factors, caregiving intensity (e.g., weekly hours spent caregiving, reason for caregiving, past-month ADL/IADL assistance), caregiver's health (e.g., general health status and past month physical health, mental health, and limited activity), and caregiver's health behavior (chronic illness, smoking status, binge drinking, and annual checkups).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Compared to urban caregivers, rural caregivers were more likely to have at least one chronic condition (58.3% vs. 53.2%; <i>p</i> < 0.0001), be obese (42.9% vs. 37.5%; <i>p</i> < 0.0001), be a smoker (24.2% vs. 15.5%; <i>p</i> < 0.0001), and less likely to be a binge drinker (12.7% vs. 15.3%; <i>p</i> = 0.003). Compared to urban caregivers, rural caregivers were more likely to report their general health status as fair/poor (20.3% vs. 17.0%, <i>p</i> = 0.0003) and were more likely to report 14 or more days of poor physical health in the past month (15.6% vs. 12.0%, <i>p</i> < 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Understanding geographic disparities in the experiences and context of unpaid caregiving is needed to improve their overall well-being and health. Future research will be necessary to determine factors associated with these outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281486","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

Phone-only mental health care within the Department of Veterans Affairs: Associations with rurality, age, sex, and clinical severity 退伍军人事务部的纯电话精神保健：与农村、年龄、性别和临床严重程度的关系

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-06-13 DOI: 10.1111/jrh.70043

Samantha L. Connolly PhD, Amber B. Amspoker PhD, Annette Walder MS, Kathleen M. Grubbs PhD, Liang Chen MD MS, Anthony H. Ecker PhD, Julianna B. Hogan PhD, Jan A. Lindsay PhD

Objective

This study explores factors associated with an increased likelihood of receiving mental health (MH) care exclusively via audio-only phone visits within the Department of Veterans Affairs (VA).

Methods

Included patients had ≥1 VA MH outpatient encounter between October 1, 2021-September 30, 2022 and October 1, 2022-September 30, 2023. Patients were divided into a “phone only” group and an “all other” group, which encompassed all patients who did not exclusively receive phone care, including video and/or in-person care. Logistic regression models evaluated demographic and clinical predictors of receiving MH care via phone only.

Results

The sample included 1,156,146 patients; 49,125 (4.25%) in the phone only group and 1,107,021 (95.75%) in the all other group. The following were associated with greater odds of receiving MH care via phone only in a multivariate model, all Ps<.0001: being highly rural (OR = 1.50), age 65+ (ORs ≥2.17), with fewer than 3 MH diagnoses (OR = 2.03), and >50% of MH visits conducted by a medical MH provider (OR = 1.87).

Conclusions

Patients who were rural and older had greater odds of receiving MH care exclusively by phone. It will be important to assess whether this was by choice or whether they are experiencing barriers to accessing video or in-person care that could be addressed. Patients who were less clinically severe and were seen primarily by a medical MH provider were also more likely to receive phone-only care. Future research should examine the relative effectiveness of audio-only care as compared to video and in-person.

目的：本研究探讨退伍军人事务部（VA）内通过纯音频电话访问接受心理健康（MH）护理的可能性增加的相关因素。方法纳入2021年10月1日至2022年9月30日和2022年10月1日至2023年9月30日期间在VA MH门诊就诊≥1次的患者。患者被分为“仅电话”组和“所有其他”组，其中包括所有不完全接受电话护理的患者，包括视频和/或面对面护理。Logistic回归模型评估仅通过电话接受MH护理的人口学和临床预测因素。结果共纳入1156146例患者；纯电话组49125人（4.25%），其他组1107021人（95.75%）。在多变量模型中，以下因素与仅通过电话接受MH护理的更大几率相关，均为Ps<；0001：高度农村（OR = 1.50），年龄65岁以上（OR≥2.17），MH诊断少于3例（OR = 2.03），并且50%的MH就诊是由医疗MH提供者进行的（OR = 1.87）。结论农村和老年患者仅通过电话接受MH护理的几率较大。重要的是要评估这是出于自愿，还是他们在获得视频或面对面护理方面遇到了可以解决的障碍。临床严重程度较轻且主要由医疗保健提供者就诊的患者也更有可能接受电话护理。未来的研究应该检验纯音频治疗相对于视频治疗和面对面治疗的有效性。

{"title":"Phone-only mental health care within the Department of Veterans Affairs: Associations with rurality, age, sex, and clinical severity","authors":"Samantha L. Connolly PhD, Amber B. Amspoker PhD, Annette Walder MS, Kathleen M. Grubbs PhD, Liang Chen MD MS, Anthony H. Ecker PhD, Julianna B. Hogan PhD, Jan A. Lindsay PhD","doi":"10.1111/jrh.70043","DOIUrl":"https://doi.org/10.1111/jrh.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study explores factors associated with an increased likelihood of receiving mental health (MH) care exclusively via audio-only phone visits within the Department of Veterans Affairs (VA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Included patients had ≥1 VA MH outpatient encounter between October 1, 2021-September 30, 2022 and October 1, 2022-September 30, 2023. Patients were divided into a “phone only” group and an “all other” group, which encompassed all patients who did not exclusively receive phone care, including video and/or in-person care. Logistic regression models evaluated demographic and clinical predictors of receiving MH care via phone only.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sample included 1,156,146 patients; 49,125 (4.25%) in the phone only group and 1,107,021 (95.75%) in the all other group. The following were associated with greater odds of receiving MH care via phone only in a multivariate model, all <i>Ps</i><.0001: being highly rural (OR = 1.50), age 65+ (ORs ≥2.17), with fewer than 3 MH diagnoses (OR = 2.03), and >50% of MH visits conducted by a medical MH provider (OR = 1.87).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients who were rural and older had greater odds of receiving MH care exclusively by phone. It will be important to assess whether this was by choice or whether they are experiencing barriers to accessing video or in-person care that could be addressed. Patients who were less clinically severe and were seen primarily by a medical MH provider were also more likely to receive phone-only care. Future research should examine the relative effectiveness of audio-only care as compared to video and in-person.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281571","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}

引用次数: 0