The effectiveness of a rural nursing center in improving health care access in a three-county area

Interventions to improve primary healthcare in rural settings: A scoping review

BACKGROUND

Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations.

OBJECTIVE

Synthesize and categorize studies that examine interventions to improve rural primary care.

ELIGIBILITY CRITERIA

Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison.

SOURCES OF EVIDENCE

Pubmed, CINAHL, Cochrane Library, Embase.

CHARTING METHODS

We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant.

RESULTS

372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017.

CONCLUSIONS

Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.

Structural Interventions in HIV Prevention: A Taxonomy and Descriptive Systematic Review

One of the four national HIV prevention goals is to incorporate combinations of effective, evidence-based approaches to prevent HIV infection. In fields of public health, techniques that alter environment and affect choice options are effective. Structural approaches may be effective in preventing HIV infection. Existing frameworks for structural interventions were lacking in breadth and/or depth. We conducted a systematic review and searched CDC's HIV/AIDS Prevention Research Synthesis Project's database for relevant interventions during 1988-2013. We used an iterative process to develop the taxonomy. We identified 213 structural interventions: Access (65%), Policy/Procedure (32%), Mass Media (29%), Physical Structure (27%), Capacity Building (24%), Community Mobilization (9%), and Social Determinants of Health (8%). Forty percent targeted high-risk populations (e.g., people who inject drugs [12%]). This paper describes a comprehensive, well-defined taxonomy of structural interventions with 7 categories and 20 subcategories. The taxonomy accommodated all interventions identified.

Bloodroot: Life Stories of Nurse Practitioners in Rural Appalachia

This nursing research study was designed to reveal the life stories of nurse practitioners in rural Appalachia using storytelling and ballad elements of the culture. The researcher was born in a rural Appalachian community in Virginia and was summoned to return to the place of her birth, feeling an invisible kinship to land, blood ties to family, and a longing to honor rural nursing. Seven nurse practitioners from the same community shared their life stories. Using the heuristic phenomenological research method of Moustakas, the researcher became storyteller. The metaphor of bloodroot emerged as the unity of meaning for the life stories. The theme essences were revealed as interconnection: intricate patterns of rural Appalachian culture, intertwining relationships, interrelationships, and inner journey. “Brand New Home,” an Appalachian bluegrass ballad, along with pictures of Appalachia, underpins and culminates this study as a creative synthesis. Implications for nursing practice, education, and research are included.

Understanding disparities in health care access--and reducing them--through a focus on public health

Attempts to explain disparities in access to health care faced by racial and ethnic minorities and other underserved populations often focus on individual-level factors such as demographics, personal health beliefs, and health insurance status. This article proposes an examination of these disparities-and an effort to redress them-through the lens of public health. Public health agencies can link people to needed services such as immunizations, testing, and treatment; ensure the availability of health care; ensure the competency of the public health and personal health care workforce; and evaluate the effectiveness, accessibility, and quality of personal and population-based services. Approaching disparities through a public health framework can provide the foundation for developing more robust evidence to inform additional policies for improving access and reducing disparities.

Use of healthcare access models to inform the patient protection and affordable care act

Health policy findings on access to care provide more substantive information if linked to a theory that provides meaningful structure and standard definitions. Three theories of access are reviewed here because they have been used to inform health policy: Penchansky's Model, The Institute of Medicine (IOM) Model of Access Monitoring, and The Behavioral Model of Health Services Use. Penchansky's model is useful when subjective experiences with health care access are needed to inform policy makers. The IOM model is used for monitoring quality of health care services provided. The Behavioral Model identifies explanatory/predictive factors associated with utilization of services. Each model uniquely evaluates different health policies. Given the passage of the Patient Protection and Affordable Care Act (PPACA) of 2010, researchers and policy makers must agree on the model that best monitors and evaluates these new policy initiatives.

Practice-based research networks: nursing centers and communities working collaboratively to reduce health disparities

Practice-based research networks (PBRNs) can provide a range of opportunities for nurses working in primary care settings. This article reports on the early experiences of the Midwest Nursing Centers Consortium Research Network (MNCCRN), one of only two nursing PBRNs in the nation. Findings from the MNCCRN's first research study, Wellness for a Lifetime, indicate success with implementing research across geographically distant sites, and positive client outcomes related to improving nutrition and physical activity. Lessons learned in establishing a PBRN and implementing research studies in the real world are described as well as challenges for the future.

A Unique Set of Interactions: The MSU Sustained Partnership Model of Nurse Practitioner Primary Care

PURPOSE

To present a unified conceptual model that identifies the integral processes of nurse practitioner (NP) care delivery and that integrates major structural influences and potential outcomes. The model is further characterized to delineate the unique and "value-added" nature of NP primary care and to describe how this nature may be correlated with specific clinical outcomes.

DATA SOURCES

Extensive review of the literature, relevant conceptual models, clinical experiences of th authors, and two sets of qualitative dat exploring differences between NP practice an other practices.

CONCLUSIONS

The basis of NP primary care is the unique provider-client relationship that develops within the primary care setting. This relationship is oriented toward (a) helping client become empowered to more appropriately manage their own care in a way that will best meet their needs, (b) encouraging mutual deci sion making, (c) ensuring clients' continuity o care, and (d) providing a holistic approach to primary care. The major structural influences are NP role components, interdisciplinary practice relationships, budget resources and payer mix, and environmental characteristics. The potential outcomes are increased health promoting behaviors, improved utilization of care, higher client satisfaction levels, and improved health status.

IMPLICATIONS FOR PRACTICE

NPs can use this model to articulate the unique contribution of NP practice and its interrelationships within the broader primary care setting. Practicing NPs can use this framework to better understand the complexities of their current and future primary care practices. Faculty can utilize the concepts to help guide students' understanding of their prospective roles as advanced practice nurses. Finally, this conceptual framework can inform research about specific NP processes and related outcomes. A clearly delineated model that accurately depicts structures, processes, and outcomes relevant to NP primary care can strengthen NP education, distinguish NP practice, and advance evidenced-based research linking NP practice and outcomes.