{"title":"Addressing the growing rural–urban divide in opioid prescribing for veterans","authors":"Suhanee Mitragotri , Kevan Shah MSM, MSc","doi":"10.1111/jrh.70030","DOIUrl":"https://doi.org/10.1111/jrh.70030","url":null,"abstract":"","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905282","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}
Jingxi Sheng PhD, Sue P. Heiney PhD, Karen E. Wickersham PhD, Lan A. Nguyen PhD, Kartina W. Harrison MSN, Swann Arp Adams PhD
Purpose
Tyrosine kinase inhibitors (TKIs) improve chronic myeloid leukemia (CML) outcomes dramatically. However, limited research exists on patient-specific, medical, and psychosocial factors influencing TKI adherence. The purpose of the study was to better understand TKI adherence among rural CML patients, using a convergent parallel mixed-method design guided by the Information Motivation and Behavioral Skills Model.
Methods
Survivors with CML participated in semistructured interviews and completed self-reported questionnaires, including demographics, perceived stress, side effects, emotional support, and self-efficacy for managing chronic conditions. Qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated.
Results
Sixteen participants aged 26 to 76 years completed the study. The duration of TKI therapy ranged from 0 to 12 years (mean ± standard deviation, 5.56 ± 4.08). While all reported adherence to TKI therapy, 31% held misconceptions about treatment duration, and 38% misunderstood reasons for blood tests prior to treatment or TKI refilled. Qualitative data yielded five major themes with descriptions of the shock of diagnosis, educational experiences regarding CML and its treatment, challenges in managing side effects and refills, the importance of social support, and strategies for maintaining remission and motivating adherence to TKI.
Conclusions
This study describes the knowledge, motivations, challenges, and skills related to TKI adherence among rural patients with CML. A patient-centered approach is recommended for health care providers to improve adherence and enhance outcomes for CML patients on TKI therapy.
{"title":"Living with chronic myelogenous leukemia in rural communities: Exploring factors related to tyrosine kinase inhibitors adherence with a mixed methods approach","authors":"Jingxi Sheng PhD, Sue P. Heiney PhD, Karen E. Wickersham PhD, Lan A. Nguyen PhD, Kartina W. Harrison MSN, Swann Arp Adams PhD","doi":"10.1111/jrh.70028","DOIUrl":"https://doi.org/10.1111/jrh.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Tyrosine kinase inhibitors (TKIs) improve chronic myeloid leukemia (CML) outcomes dramatically. However, limited research exists on patient-specific, medical, and psychosocial factors influencing TKI adherence. The purpose of the study was to better understand TKI adherence among rural CML patients, using a convergent parallel mixed-method design guided by the Information Motivation and Behavioral Skills Model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Survivors with CML participated in semistructured interviews and completed self-reported questionnaires, including demographics, perceived stress, side effects, emotional support, and self-efficacy for managing chronic conditions. Qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen participants aged 26 to 76 years completed the study. The duration of TKI therapy ranged from 0 to 12 years (mean ± standard deviation, 5.56 ± 4.08). While all reported adherence to TKI therapy, 31% held misconceptions about treatment duration, and 38% misunderstood reasons for blood tests prior to treatment or TKI refilled. Qualitative data yielded five major themes with descriptions of the shock of diagnosis, educational experiences regarding CML and its treatment, challenges in managing side effects and refills, the importance of social support, and strategies for maintaining remission and motivating adherence to TKI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study describes the knowledge, motivations, challenges, and skills related to TKI adherence among rural patients with CML. A patient-centered approach is recommended for health care providers to improve adherence and enhance outcomes for CML patients on TKI therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875485","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}
Rebecca L. Boyd-Bais M.IntTdeComLaw, B.Com, B.PsychSc (Hons), Fiona Ann Papps PhD, Jessica Sipes PhD
Introduction
Anxiety is the most prevalent mental health condition in the perinatal period and may be experienced more by rural and remote pregnant women, who, compared with urban counterparts, have fewer available and less access to maternity health care services. Research has yet to examine the relationship between pregnancy-related anxiety and access to and availability of health care services and social support for pregnant women, how relationships are affected by telehealth usefulness, satisfaction, and online social support, and whether relationships are different for rural and remote women compared with those in urban areas.
Method
We used a quantitative cross-sectional design and online survey to collect data from 174 pregnant women living in urban and rural and remote regions of Australia. Data were collected from January to May 2023.
Results
Compared with urban pregnant women, rural and remote pregnant women reported greater pregnancy-related anxiety, lower accessibility and availability of health services, and lower levels of social and online social support. Controlling for all variables, lower reported social support (b = −0.34, 95% BCaCI [−0.56, −0.14]) and online social support (b = −0.17, 95% BCaCI [−0.30, −0.04]) were significantly associated with higher pregnancy-related anxiety for rural and remote pregnant women, but only no previously reported pregnancies was associated with higher pregnancy-related anxiety for urban women (b = −5.04, 95% BCaCI [−7.88, −2.02]).
Conclusion
Future research could further investigate individual, social–cultural, and location-specific factors to determine the specific needs of women during pregnancy with the view to shaping targeted pregnancy-related interventions.
{"title":"Health care, social support, and pregnancy-related anxiety in urban and rural and remote Australian women","authors":"Rebecca L. Boyd-Bais M.IntTdeComLaw, B.Com, B.PsychSc (Hons), Fiona Ann Papps PhD, Jessica Sipes PhD","doi":"10.1111/jrh.70025","DOIUrl":"https://doi.org/10.1111/jrh.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Anxiety is the most prevalent mental health condition in the perinatal period and may be experienced more by rural and remote pregnant women, who, compared with urban counterparts, have fewer available and less access to maternity health care services. Research has yet to examine the relationship between pregnancy-related anxiety and access to and availability of health care services and social support for pregnant women, how relationships are affected by telehealth usefulness, satisfaction, and online social support, and whether relationships are different for rural and remote women compared with those in urban areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We used a quantitative cross-sectional design and online survey to collect data from 174 pregnant women living in urban and rural and remote regions of Australia. Data were collected from January to May 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with urban pregnant women, rural and remote pregnant women reported greater pregnancy-related anxiety, lower accessibility and availability of health services, and lower levels of social and online social support. Controlling for all variables, lower reported social support (<i>b</i> = −0.34, 95% BCaCI [−0.56, −0.14]) and online social support (<i>b</i> = −0.17, 95% BCaCI [−0.30, −0.04]) were significantly associated with higher pregnancy-related anxiety for rural and remote pregnant women, but only no previously reported pregnancies was associated with higher pregnancy-related anxiety for urban women (<i>b</i> = −5.04, 95% BCaCI [−7.88, −2.02]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Future research could further investigate individual, social–cultural, and location-specific factors to determine the specific needs of women during pregnancy with the view to shaping targeted pregnancy-related interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875486","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 PhD, Rachael R. Kenney MA, Adnan Syed BA, Edward Hess MS, Chris Wilson MS, Ashlyn Smith MMS, PA-C, Cynthia Schihl MSN, RN, Janee Lai MS-RN, MPH, MA, CDCES, CPT, Peter Reaven MD, Gauri Behari MD
Purpose
The prevalence of diabetes mellitus in the Department of Veteran's Affairs (VA) is higher than in the general public, with nearly 25% of Veterans enrolled in VA care diagnosed with diabetes. VA cares for over 2.7 million Veterans in rural areas who may face barriers to accessing specialty care for diabetes management. The goal of this study was to understand Veteran patient experiences with a novel telehealth diabetes program designed to improve diabetes care for Veterans in rural areas.
Methods
We conducted a qualitative evaluation of Veteran's experiences as part of a larger mixed methods evaluation of the VA Telediabetes program. We conducted semistructured interviews with rural Veterans enrolled in the program to understand their experiences and perceptions. We conducted an inductive-deductive content analysis to identify salient themes related to diabetes control, perceptions of telehealth for diabetes care, and previous experiences with diabetes management. Methods are described according to the SRQR checklist for qualitative research.
Findings
We conducted interviews with 26 rural Veterans enrolled in the Telediabetes program between April 2022 and March 2023 and identified three themes related to their experience in the program: (1) Telediabetes care is more frequent and comprehensive than previous diabetes care; (2) Telediabetes care is convenient and thorough, but there are some barriers; and (3) Patients describe that their diabetes control as better in Telediabetes program compared to diabetes management in primary care.
Conclusions
Veterans perceived that Telediabetes had a positive impact on their diabetes control and described the quality of care as excellent. Programs like Telediabetes bring together a group of interdisciplinary specialists to provide care for rural patients have the potential to alleviate barriers to specialty care in rural areas.
{"title":"Patient perceptions of rural telehealth diabetes control program in Department of Veteran's Affairs","authors":"Chelsea Leonard PhD, Rachael R. Kenney MA, Adnan Syed BA, Edward Hess MS, Chris Wilson MS, Ashlyn Smith MMS, PA-C, Cynthia Schihl MSN, RN, Janee Lai MS-RN, MPH, MA, CDCES, CPT, Peter Reaven MD, Gauri Behari MD","doi":"10.1111/jrh.70027","DOIUrl":"https://doi.org/10.1111/jrh.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The prevalence of diabetes mellitus in the Department of Veteran's Affairs (VA) is higher than in the general public, with nearly 25% of Veterans enrolled in VA care diagnosed with diabetes. VA cares for over 2.7 million Veterans in rural areas who may face barriers to accessing specialty care for diabetes management. The goal of this study was to understand Veteran patient experiences with a novel telehealth diabetes program designed to improve diabetes care for Veterans in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative evaluation of Veteran's experiences as part of a larger mixed methods evaluation of the VA Telediabetes program. We conducted semistructured interviews with rural Veterans enrolled in the program to understand their experiences and perceptions. We conducted an inductive-deductive content analysis to identify salient themes related to diabetes control, perceptions of telehealth for diabetes care, and previous experiences with diabetes management. Methods are described according to the SRQR checklist for qualitative research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We conducted interviews with 26 rural Veterans enrolled in the Telediabetes program between April 2022 and March 2023 and identified three themes related to their experience in the program: (1) Telediabetes care is more frequent and comprehensive than previous diabetes care; (2) Telediabetes care is convenient and thorough, but there are some barriers; and (3) Patients describe that their diabetes control as better in Telediabetes program compared to diabetes management in primary care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Veterans perceived that Telediabetes had a positive impact on their diabetes control and described the quality of care as excellent. Programs like Telediabetes bring together a group of interdisciplinary specialists to provide care for rural patients have the potential to alleviate barriers to specialty care in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875670","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}
Britta L. Anderson PhD, Jared Sawyer MPH, Ashley Palmer PhD, C Holly A Andrilla MS, Alexa Beeson MPP
Purpose
Examine retention factors and challenges among CRNAs who provide obstetric services and assess whether these factors differ between rural or urban areas.
Methods
Cross-sectional analysis of weighted data from a survey of CRNAs that are members of the American Association of Nurse Anesthesiology and provide obstetric anesthesia services. CRNAs selected reasons why they chose to work in their geographic area, factors that make them want to stay in their job, and challenges that make them want to leave their job.
Findings
Among all respondents (1213), 39% reported practicing in rural areas. Overall, 64% of respondents reported practicing in staffing models without medical direction, with 88% of those in rural areas working without medical direction. The following factors were “very important” for choosing to provide obstetric anesthesia services in a rural area: scope of practice (74%), job autonomy (72%), respect (64%), and work–life balance (62%). Controlling for staffing model, gender, and age, CRNAs practicing in rural areas were more likely to select “concern about care availability” as a reason factor and “the need to be on call” as a retention challenge.
Conclusions
Findings indicate that CRNAs choose to work in rural areas because of concern for care availability and the sense of autonomy, scope of practice, and control they experience in these areas, among other factors.
{"title":"Retaining CRNAs who provide obstetrics services in rural communities: Results from a national survey","authors":"Britta L. Anderson PhD, Jared Sawyer MPH, Ashley Palmer PhD, C Holly A Andrilla MS, Alexa Beeson MPP","doi":"10.1111/jrh.70021","DOIUrl":"https://doi.org/10.1111/jrh.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Examine retention factors and challenges among CRNAs who provide obstetric services and assess whether these factors differ between rural or urban areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cross-sectional analysis of weighted data from a survey of CRNAs that are members of the American Association of Nurse Anesthesiology and provide obstetric anesthesia services. CRNAs selected reasons why they chose to work in their geographic area, factors that make them want to stay in their job, and challenges that make them want to leave their job.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Among all respondents (1213), 39% reported practicing in rural areas. Overall, 64% of respondents reported practicing in staffing models without medical direction, with 88% of those in rural areas working without medical direction. The following factors were “very important” for choosing to provide obstetric anesthesia services in a rural area: scope of practice (74%), job autonomy (72%), respect (64%), and work–life balance (62%). Controlling for staffing model, gender, and age, CRNAs practicing in rural areas were more likely to select “concern about care availability” as a reason factor and “the need to be on call” as a retention challenge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings indicate that CRNAs choose to work in rural areas because of concern for care availability and the sense of autonomy, scope of practice, and control they experience in these areas, among other factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875425","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}
Rural hospital closures since 2005 reached 194 this year, raising concerns for rural health care access. Little is known about the effects of facility closures on the local long-term care sector. This analysis models the relationship between rural hospital closure and nursing homes in the same county. We explore nursing home-level outcomes related to utilization and resident health.
Methods
Centers for Medicare & Medicaid Services Healthcare Cost Report Information System, LTCFocus, and NC Rural Health Research Program hospital closure datasets are used to conduct a difference-in-differences study of closures from 2012 to 2019.
Findings
We do not find evidence that hospital closure impacted non-hospital-based nursing home occupancy rate, proportion of Medicare paying residents, or average resident ADL score. However, hospitalizations per resident year declined by 0.13 following closure (95% CI: –0.24, –0.02), representing a change of 0.33 standard deviations from the grand mean. It is unclear if reduced nursing home hospitalizations reflect a reduction in emergent, urgent, or elective admissions.
Conclusions
Our results build on the existing body of hospital closure literature by highlighting the understudied role of hospitals in rural postacute and long-term care. To our knowledge, this was the first study examining the impacts of hospital closure on nursing homes. These findings are particularly relevant in the wake of COVID-19 as rural long-term care facilities and hospitals alike navigate exacerbated workforce and funding challenges.
{"title":"Rural hospital closures and nursing home outcomes","authors":"Emmaline Keesee MSPH, Tyler Malone PhD, Susie Gurzenda MS, George Pink PhD","doi":"10.1111/jrh.70026","DOIUrl":"https://doi.org/10.1111/jrh.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Rural hospital closures since 2005 reached 194 this year, raising concerns for rural health care access. Little is known about the effects of facility closures on the local long-term care sector. This analysis models the relationship between rural hospital closure and nursing homes in the same county. We explore nursing home-level outcomes related to utilization and resident health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Centers for Medicare & Medicaid Services Healthcare Cost Report Information System, LTCFocus, and NC Rural Health Research Program hospital closure datasets are used to conduct a difference-in-differences study of closures from 2012 to 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We do not find evidence that hospital closure impacted non-hospital-based nursing home occupancy rate, proportion of Medicare paying residents, or average resident ADL score. However, hospitalizations per resident year declined by 0.13 following closure (95% CI: –0.24, –0.02), representing a change of 0.33 standard deviations from the grand mean. It is unclear if reduced nursing home hospitalizations reflect a reduction in emergent, urgent, or elective admissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results build on the existing body of hospital closure literature by highlighting the understudied role of hospitals in rural postacute and long-term care. To our knowledge, this was the first study examining the impacts of hospital closure on nursing homes. These findings are particularly relevant in the wake of COVID-19 as rural long-term care facilities and hospitals alike navigate exacerbated workforce and funding challenges.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875426","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}
Melissa A. Romaire PhD, Alison Banger MS, Regina Rutledge PhD, Saira Haque PhD
Purpose
In 2016, the Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) to test the impact of a Medicare payment change for telehealth and ambulance services and a policy change for skilled nursing facility (SNF) beds for critical access hospitals (CAHs) treating Medicare fee-for-service patients in frontier regions. We evaluated the impact of FCHIP on ambulance, SNF, and telehealth service delivery.
Methods
We conducted a primarily qualitative evaluation, with some descriptive analyses, of 10 CAHs in Montana, Nevada, and North Dakota that participated in FCHIP. Key informant interviews and program documents were thematically analyzed to understand how CAHs implemented their interventions. Analyses of Medicare fee-for-service ambulance, SNF, and telehealth claims from August 2013 through July 2019 described service use over time at participating CAHs.
Findings
CAHs used the demonstration to develop their workforce, even when staff turnover was a primary concern, and the demonstration gave CAHs a reason to change care delivery and improve partnerships with other hospitals or specialists treating their patients. Technical assistance supported CAHs in transforming care. CAH staff reported that FCHIP payment and policy changes had little impact on hospital finances. Changes in service use over time varied by FCHIP service.
Conclusion
Despite notable challenges like staffing shortages, CAHs remain committed to meeting community need by making improvements in care delivery. With low population volume and thus minimal demand for certain services, expectations that volume-based payment policies can financially bolster CAHs may need to be tempered.
{"title":"Critical access hospitals: Lessons from the Frontier Community Health Integration Project","authors":"Melissa A. Romaire PhD, Alison Banger MS, Regina Rutledge PhD, Saira Haque PhD","doi":"10.1111/jrh.70024","DOIUrl":"https://doi.org/10.1111/jrh.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>In 2016, the Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) to test the impact of a Medicare payment change for telehealth and ambulance services and a policy change for skilled nursing facility (SNF) beds for critical access hospitals (CAHs) treating Medicare fee-for-service patients in frontier regions. We evaluated the impact of FCHIP on ambulance, SNF, and telehealth service delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a primarily qualitative evaluation, with some descriptive analyses, of 10 CAHs in Montana, Nevada, and North Dakota that participated in FCHIP. Key informant interviews and program documents were thematically analyzed to understand how CAHs implemented their interventions. Analyses of Medicare fee-for-service ambulance, SNF, and telehealth claims from August 2013 through July 2019 described service use over time at participating CAHs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>CAHs used the demonstration to develop their workforce, even when staff turnover was a primary concern, and the demonstration gave CAHs a reason to change care delivery and improve partnerships with other hospitals or specialists treating their patients. Technical assistance supported CAHs in transforming care. CAH staff reported that FCHIP payment and policy changes had little impact on hospital finances. Changes in service use over time varied by FCHIP service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite notable challenges like staffing shortages, CAHs remain committed to meeting community need by making improvements in care delivery. With low population volume and thus minimal demand for certain services, expectations that volume-based payment policies can financially bolster CAHs may need to be tempered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856749","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}
Lavanya Vasudevan PhD, MPH, CPH, Yunfei Wang DrPH, Jan Ostermann PhD, Valerie Yelverton PhD, MSc, Jingyi Yang MA, Laura J. Fish PhD, Sayward E. Harrison PhD, MA, CAS, Charnetta Williams MD, Emmanuel B. Walter MD, MPH
<div> <section> <h3> Background</h3> <p>Rural adolescents in the United States lag behind their urban counterparts in the uptake of the human papillomavirus (HPV) vaccine. However, a systematic assessment of factors associated with rural-urban disparities in HPV vaccination coverage to inform potential vaccination promotion interventions is lacking in the literature. Prioritizing HPV vaccination for rural adolescents is necessary for increasing overall HPV vaccination coverage for adolescents and for reducing the incidence of HPV infections and future HPV-related cancers.</p> </section> <section> <h3> Methods</h3> <p>We conducted a cross-sectional survey of caregivers of adolescents aged 9-17 years from 13 states located in the southern United States. Participants were recruited from a nationally representative online survey panel and self-administered the survey from December 2019 to January 2020. The survey assessed HPV vaccination initiation and series completion for rural and urban adolescents, and sought to systematically identify modifiable factors (eg, caregiver knowledge and attitudes about HPV/HPV vaccine, health care access) and nonmodifiable factors (eg, sociodemographic characteristics) that may be associated with rural-urban disparities in adolescent HPV vaccination. Rural versus urban residence status of respondents was determined using the US Census definition and Federal Information Processing System (FIPS) codes.</p> </section> <section> <h3> Results</h3> <p>Among 2,262 sampled caregivers, data from 987 respondents (43.6%) were included in the analysis; 193 respondents (19.6%) were from rural areas and 794 (80.4%) were from urban areas. Overall, 333 (33.7%) adolescents had received at least 1 dose of HPV vaccination and 259 (26.3%) adolescents had completed HPV vaccination. In comparison to urban adolescents, fewer rural adolescents had initiated (−7.7 percentage points) or completed (−14.9 percentage points) HPV vaccination. Uptake of tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal (MenACWY), and influenza vaccines was similar between urban and rural adolescents. Caregiver attitudes, but not their knowledge about HPV infection or the HPV vaccine, were associated with disparities in HPV vaccination initiation. Rural caregivers were more likely to report concerns with the HPV vaccine, lower access to a pediatric primary care provider, longer travel times to reach health care providers, and HPV vaccination at age 11 years or older compared with age 9 or 10 years. When compared with urban caregivers, fewer rural caregivers reported discussing HPV vaccination with their adolescent's provider although difference in the receipt of a provider recommendation was not statistically si
{"title":"Rural-urban disparities in human papillomavirus vaccination: Findings from a cross-sectional survey of 13 southern US states, December 2019-January 2020","authors":"Lavanya Vasudevan PhD, MPH, CPH, Yunfei Wang DrPH, Jan Ostermann PhD, Valerie Yelverton PhD, MSc, Jingyi Yang MA, Laura J. Fish PhD, Sayward E. Harrison PhD, MA, CAS, Charnetta Williams MD, Emmanuel B. Walter MD, MPH","doi":"10.1111/jrh.12913","DOIUrl":"https://doi.org/10.1111/jrh.12913","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Rural adolescents in the United States lag behind their urban counterparts in the uptake of the human papillomavirus (HPV) vaccine. However, a systematic assessment of factors associated with rural-urban disparities in HPV vaccination coverage to inform potential vaccination promotion interventions is lacking in the literature. Prioritizing HPV vaccination for rural adolescents is necessary for increasing overall HPV vaccination coverage for adolescents and for reducing the incidence of HPV infections and future HPV-related cancers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional survey of caregivers of adolescents aged 9-17 years from 13 states located in the southern United States. Participants were recruited from a nationally representative online survey panel and self-administered the survey from December 2019 to January 2020. The survey assessed HPV vaccination initiation and series completion for rural and urban adolescents, and sought to systematically identify modifiable factors (eg, caregiver knowledge and attitudes about HPV/HPV vaccine, health care access) and nonmodifiable factors (eg, sociodemographic characteristics) that may be associated with rural-urban disparities in adolescent HPV vaccination. Rural versus urban residence status of respondents was determined using the US Census definition and Federal Information Processing System (FIPS) codes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2,262 sampled caregivers, data from 987 respondents (43.6%) were included in the analysis; 193 respondents (19.6%) were from rural areas and 794 (80.4%) were from urban areas. Overall, 333 (33.7%) adolescents had received at least 1 dose of HPV vaccination and 259 (26.3%) adolescents had completed HPV vaccination. In comparison to urban adolescents, fewer rural adolescents had initiated (−7.7 percentage points) or completed (−14.9 percentage points) HPV vaccination. Uptake of tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal (MenACWY), and influenza vaccines was similar between urban and rural adolescents. Caregiver attitudes, but not their knowledge about HPV infection or the HPV vaccine, were associated with disparities in HPV vaccination initiation. Rural caregivers were more likely to report concerns with the HPV vaccine, lower access to a pediatric primary care provider, longer travel times to reach health care providers, and HPV vaccination at age 11 years or older compared with age 9 or 10 years. When compared with urban caregivers, fewer rural caregivers reported discussing HPV vaccination with their adolescent's provider although difference in the receipt of a provider recommendation was not statistically si","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801695","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}
Margaret Sugg MA, PhD, Shishir Shakya PhD, Sarah Ulrich MA, Jennifer Schroeder Tyson MPH, CPDM, Jennifer Runkle MPH, PhD
Objective
This study evaluated the association between maternal care deserts (MCDs)—defined by accessibility measures such as travel time and distance to obstetric and gynecological care—and maternal and infant health outcomes in North Carolina from 2016 to 2021.
Methods
This was a retrospective secondary data analysis examining residents of North Carolina from 2016 to 2021, using travel metrics from residential zip codes to the nearest clinical providers. Maternal and infant health outcomes were assessed using data from the National Plan and Provider Enumeration System (NPPES) from the Centers for Medicare & Medicaid Services (CMS) and inpatient hospitalization records for North Carolina. Outcomes of interest included cesarean delivery rates, severe maternal morbidity (SMM20 and SMM21), and hypertension, which were examined across rural-urban disparities based on RUCA codes. Statistical analyses were conducted to link travel metrics with health outcomes, adjusting for age, race, and insurance status to control for potential confounding factors.
Results
The study found that rural and low-income areas in North Carolina had fewer health care providers. Increased travel times and distances to clinical care were associated with higher cesarean delivery rates, increased severe maternal morbidity, preterm birth, and higher rates of gestational diabetes. These associations remained significant even after adjusting for age, race, and insurance status.
Conclusion
Women living in maternal care deserts in North Carolina, often in rural locations, are more likely to experience adverse health outcomes, including severe maternal morbidity and hypertension, likely due to limited access to essential obstetric and gynecological care. These findings highlight the negative impact of health care inaccessibility on maternal and infant health in underserved regions.
{"title":"Mapping maternity care deserts: Driving distance and health outcomes in North Carolina","authors":"Margaret Sugg MA, PhD, Shishir Shakya PhD, Sarah Ulrich MA, Jennifer Schroeder Tyson MPH, CPDM, Jennifer Runkle MPH, PhD","doi":"10.1111/jrh.70020","DOIUrl":"https://doi.org/10.1111/jrh.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study evaluated the association between maternal care deserts (MCDs)—defined by accessibility measures such as travel time and distance to obstetric and gynecological care—and maternal and infant health outcomes in North Carolina from 2016 to 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective secondary data analysis examining residents of North Carolina from 2016 to 2021, using travel metrics from residential zip codes to the nearest clinical providers. Maternal and infant health outcomes were assessed using data from the National Plan and Provider Enumeration System (NPPES) from the Centers for Medicare & Medicaid Services (CMS) and inpatient hospitalization records for North Carolina. Outcomes of interest included cesarean delivery rates, severe maternal morbidity (SMM20 and SMM21), and hypertension, which were examined across rural-urban disparities based on RUCA codes. Statistical analyses were conducted to link travel metrics with health outcomes, adjusting for age, race, and insurance status to control for potential confounding factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study found that rural and low-income areas in North Carolina had fewer health care providers. Increased travel times and distances to clinical care were associated with higher cesarean delivery rates, increased severe maternal morbidity, preterm birth, and higher rates of gestational diabetes. These associations remained significant even after adjusting for age, race, and insurance status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Women living in maternal care deserts in North Carolina, often in rural locations, are more likely to experience adverse health outcomes, including severe maternal morbidity and hypertension, likely due to limited access to essential obstetric and gynecological care. These findings highlight the negative impact of health care inaccessibility on maternal and infant health in underserved regions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793786","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}
Affan Ghaffari PhD, Katelyn Y. Graves PhD, Russell F. Bradbury MS, Jeffrey S. Harman PhD
Purpose
To determine the extent to which there were disparities in access to recommended preventive oral services between US-based children living in rural versus urban areas.
Methods
The study used cross-sectional, parent-reported National Survey of Children's Health data from 2022, which is the most current year of publicly available data when analyses were performed. Inclusion criteria included all children from the ages of 2 through 17. The US Census Bureau definition of rural was used to guide the analyses. Survey procedures within Stata were used to build the multiple regression models. To test the association between the main predictor variable (i.e., rural–urban designation) and outcome variable (i.e., percentage of those receiving five recommended preventive dental services), five sets of multiple logistic regressions were used, which controlled for the effects of all the other covariates. The STROBE checklist for cross-sectional studies was used for reporting purposes in this manuscript.
Findings
Controlling for the effects of covariates, there was no association of living in an urban area (as opposed to a rural area) and children receiving any of the five recommended services, including comprehensive oral examination, prophylaxis, sealants, radiographs, and fluoride treatments (p > 0.01).
Conclusions
Our study demonstrated the lack of disparities in utilization of preventive dental procedures among US-based children, which may be attributable to factors such as innovative service delivery models integrating telehealth and community-based management in rural communities, COVID-19, and public insurance expansion. Future studies should be conducted to track whether the trend of eroding disparities remains consistent.
{"title":"Examination of rural–urban disparities in utilization of preventive dental procedures in the US pediatric population: A cross-sectional study","authors":"Affan Ghaffari PhD, Katelyn Y. Graves PhD, Russell F. Bradbury MS, Jeffrey S. Harman PhD","doi":"10.1111/jrh.70022","DOIUrl":"https://doi.org/10.1111/jrh.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To determine the extent to which there were disparities in access to recommended preventive oral services between US-based children living in rural versus urban areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study used cross-sectional, parent-reported National Survey of Children's Health data from 2022, which is the most current year of publicly available data when analyses were performed. Inclusion criteria included all children from the ages of 2 through 17. The US Census Bureau definition of rural was used to guide the analyses. Survey procedures within Stata were used to build the multiple regression models. To test the association between the main predictor variable (i.e., rural–urban designation) and outcome variable (i.e., percentage of those receiving five recommended preventive dental services), five sets of multiple logistic regressions were used, which controlled for the effects of all the other covariates. The STROBE checklist for cross-sectional studies was used for reporting purposes in this manuscript.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Controlling for the effects of covariates, there was no association of living in an urban area (as opposed to a rural area) and children receiving any of the five recommended services, including comprehensive oral examination, prophylaxis, sealants, radiographs, and fluoride treatments (<i>p</i> > 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study demonstrated the lack of disparities in utilization of preventive dental procedures among US-based children, which may be attributable to factors such as innovative service delivery models integrating telehealth and community-based management in rural communities, COVID-19, and public insurance expansion. Future studies should be conducted to track whether the trend of eroding disparities remains consistent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749319","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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