1
|
Buhler M, Shah T, Perry M, Tennant M, Kruger E, Milosavljevic S. Geographic accessibility to physiotherapy care in Aotearoa New Zealand. Spat Spatiotemporal Epidemiol 2024; 49:100656. [PMID: 38876567 DOI: 10.1016/j.sste.2024.100656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 06/16/2024]
Abstract
Disparities in care access for health conditions where physiotherapy can play a major role are abetting health inequities. Spatial analyses can contribute to illuminating inequities in health yet the geographic accessibility to physiotherapy care across New Zealand has not been examined. This population-based study evaluated the accessibility of the New Zealand physiotherapy workforce relative to the population at a local scale. The locations of 5,582 physiotherapists were geocoded and integrated with 2018 Census data to generate 'accessibility scores' for each Statistical Area 2 using the newer 3-step floating catchment area method. For examining the spatial distribution and mapping, accessibility scores were categorized into seven levels, centered around 0.5 SD above and below the mean. New Zealand has an above-average physiotherapy-to-population ratio compared with other OECD countries; however, this workforce is maldistributed. This study identified areas (and locations) where geographic accessibility to physiotherapy care is relatively low.
Collapse
Affiliation(s)
- Miranda Buhler
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin North, Dunedin 9016, New Zealand.
| | - Tayyab Shah
- Canadian Hub for Applied and Social Research, University of Saskatchewan, 9 Campus Dr Room 260, Saskatoon, SK S7N 5A5, Canada
| | - Meredith Perry
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin North, Dunedin 9016, New Zealand
| | - Marc Tennant
- The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Estie Kruger
- School of Allied Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Stephan Milosavljevic
- School of Rehabilitation Science, University of Saskatchewan, 104 Clinic Pl, Saskatoon, SK S7N 2Z4, Canada
| |
Collapse
|
2
|
Fraher EP, Lombardi B, Brandt B, Hawes E. Improving the Health of Rural Communities Through Academic-Community Partnerships and Interprofessional Health Care and Training Models. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1272-1276. [PMID: 35731585 DOI: 10.1097/acm.0000000000004794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Health disparities between rural and urban areas are widening at a time when urban health care systems are increasingly buying rural hospitals to gain market share. New payment models, shifting from fee-for-service to value-based care, are gaining traction, creating incentives for health care systems to manage the social risk factors that increase health care utilization and costs. Health system consolidation and value-based care are increasingly linking the success of urban health care systems to rural communities. Yet, despite the natural ecosystem rural communities provide for interprofessional learning and collaborative practice, many academic health centers (AHCs) have not invested in building team-based models of practice in rural areas. With responsibility for training the future health workforce and major investments in research infrastructure and educational capacity, AHCs are uniquely positioned to develop interprofessional practice and training opportunities in rural areas and evaluate the cost savings and quality outcomes associated with team-based care models. To accomplish this work, AHCs will need to develop academic-community partnerships that include networks of providers and practices, non-AHC educational organizations, and community-based agencies. In this commentary, the authors highlight 3 examples of academic-community partnerships that developed and implemented interprofessional practice and education models and were designed around specific patient populations with measurable outcomes: North Carolina's Asheville Project, the Boise Interprofessional Academic Patient Aligned Care model, and the Interprofessional Care Access Network framework. These innovative models demonstrate the importance of academic-community partnerships to build teams that address social needs, improve health outcomes, and lower costs. They also highlight the need for more rigorous reporting on the components of the academic-community partnerships involved, the different types of health workers deployed, and the design of the interprofessional training and practice models implemented.
Collapse
Affiliation(s)
- Erin P Fraher
- E.P. Fraher is associate professor, Department of Family Medicine, and director, Carolina Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brianna Lombardi
- B. Lombardi is assistant professor, Department of Family Medicine, and deputy director, Carolina Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barbara Brandt
- B. Brandt is founding director, National Center for Interprofessional Practice and Education, and professor of pharmaceutical care and health systems, University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | - Emily Hawes
- E. Hawes is associate professor, Department of Family Medicine, University of North Carolina at Chapel Hill, and associate professor of clinical education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-7717-4066
| |
Collapse
|
3
|
Ganta N, Aknouk M, Alnabwani D, Nikiforov I, Bommu VJL, Patel V, Cheriyath P, Hollenbeak CS, Hamza A. Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States. World J Gastrointest Endosc 2022; 14:474-486. [PMID: 36158630 PMCID: PMC9453311 DOI: 10.4253/wjge.v14.i8.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/14/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lower gastrointestinal bleeds (LGIB) is a very common inpatient condition in the United States. Gastrointestinal bleeds have a variety of presentations, from minor bleeding to severe hemorrhage and shock. Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB, there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings.
AIM To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals.
METHODS This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality. It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016. This study does not differentiate between acute and chronic LGIB and both are included in this study. The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds; the secondary outcome measures were in-hospital mortality, length of stay, and costs involved in those receiving colonoscopy for LGIB. Statistical analyses were all performed using STATA software. Logistic regression was used to analyze the utilization of colonoscopy and mortality, and a generalized linear model was used to analyze the length of stay and cost.
RESULTS Our study found that 37.9% of LGIB patients at rural hospitals compared to approximately 45.1% at urban hospitals received colonoscopy, (OR = 0.730, 95%CI: 0.705-0.7, P > 0.0001). After controlling for covariates, colonoscopies were found to have a protective association with lower in-hospital mortality (OR = 0.498, 95%CI: 0.446-0.557, P < 0.0001), but a longer length of stay by 0.72 d (95%CI: 0.677-0.759 d, P < 0.0001) and approximately $2199 in increased costs.
CONCLUSION Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals, patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality. In both settings, benefit came at a cost of extended stay, and higher total costs.
Collapse
Affiliation(s)
- Nagapratap Ganta
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Mina Aknouk
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Dina Alnabwani
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Ivan Nikiforov
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Veera Jayasree Latha Bommu
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Vraj Patel
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Pramil Cheriyath
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Christopher S Hollenbeak
- Penn State Milton S. Hershey Medical Center, 500 University Drive, University Park, PA 16802, United States
| | - Alan Hamza
- Department of Internal Medicine, Ocala Health, Ocala, FL 34471, United States
| |
Collapse
|
4
|
Griffith KN, Schwartzman DA, Pizer SD, Bor J, Kolachalama VB, Jack B, Garrido MM. Local Supply Of Postdischarge Care Options Tied To Hospital Readmission Rates. HEALTH AFFAIRS (PROJECT HOPE) 2022; 41:1036-1044. [PMID: 35787076 DOI: 10.1377/hlthaff.2021.01991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The extent to which patients' risk for readmission after a hospitalization is influenced by local availability of postdischarge care options is not currently known. We used national, hospital-level data to assess whether the supply of postdischarge care options in hospitals' catchment areas was associated with readmission rates for Medicare patients after hospitalizations for acute myocardial infarction, heart failure, or pneumonia. Overall, readmission rates were negatively associated with per capita supply of primary care physicians (-0.16 percentage points per standard deviation) and licensed nursing home beds (-0.09 percentage points per standard deviation). In contrast, readmission rates were positively associated with per capita supply of nurse practitioners (0.09 percentage points per standard deviation). Our results suggest potential modifications to the Hospital Readmissions Reduction Program to account for local health system characteristics when assigning penalties to hospitals.
Collapse
Affiliation(s)
- Kevin N Griffith
- Kevin N. Griffith , Vanderbilt University Medical Center, Nashville, Tennessee, and Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - David A Schwartzman
- David A. Schwartzman, Washington University in St. Louis, St. Louis, Missouri
| | - Steven D Pizer
- Steven D. Pizer, Veterans Affairs Boston Healthcare System and Boston University, Boston, Massachusetts
| | | | | | | | - Melissa M Garrido
- Melissa M. Garrido, Veterans Affairs Boston Healthcare System and Boston University
| |
Collapse
|
5
|
Gurupur VP. Key observations in terms of management of electronic health records from a mHealth perspective. Mhealth 2022; 8:18. [PMID: 35449505 PMCID: PMC9014234 DOI: 10.21037/mhealth-21-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/11/2022] [Indexed: 11/06/2022] Open
Abstract
The article is a narrative review that briefly describes some of the recent advances in healthcare data management that will have positive effect on mHealth. The advances described in this article are in fact innovation introduced by the author to the field of data management with respect to electronic health records. The research delineated is transdisciplinary in nature and will potentially have positive impact on healthcare outcomes. Also, the article illustrates the necessity for an out of the box thinking approach to improve mHealth while discussing the current impending issues related to data incompleteness of electronic health records and the much-needed decision support systems for mHealth. It is to be noted that most of the electronic health records are now accessed by patients through mobile devices. These mobile devices will run as clients while much of the heavy computing is performed using servers. Here it is important to discuss some of the important technologies and methods used for decision making. The article attempts to present a discussion on how this myriad of intertwining technologies support this decision making with respect to electronic health records. More importantly it is these processes that assist in decision making and efficiency for both mHealth users and providers. In this respect, the article first provides insights on the complexities of decision making involved with electronic health records. This is followed by a discussion on the problem of data incompleteness of electronic health records. Finally, the author provides some insights into the gravity of the problem of data incompleteness in terms of revenue loss/gain for healthcare providers.
Collapse
Affiliation(s)
- Varadraj P Gurupur
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
6
|
Phenicie R, Acosta Wright R, Holzberg J. Patient Satisfaction with Telehealth During COVID-19: Experience in a Rural County on the United States-Mexico Border. Telemed J E Health 2021; 27:859-865. [PMID: 34096790 DOI: 10.1089/tmj.2021.0111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of this study was to analyze patient satisfaction with telehealth in a rural county on the United States-Mexico border after rapid expansion of telehealth services during the COVID-19 pandemic. Materials and Methods: Chiricahua Community Health Centers, Inc., a federally qualified health center in southeastern Arizona, conducted phone surveys with 562 patients to measure various outcomes related to patient satisfaction and experience with telehealth between June and August 2020. Data from patient surveys were analyzed within the following age categories: <18 years (37%), 18-34 years (19%), 35-54 years (15%), and 55+ years (29%). Results and Discussion: Patients were overall satisfied with telehealth (87%) and believed the quality of care was just as good as or better than in-person appointments (88%). Many would be willing to try telehealth in the future (54%). Distance/convenience (odds ratio [OR] = 5.01, 95% confidence interval [CI] 2.80-8.97), ease of scheduling (OR = 3.82, 95% CI 1.30-11.21), and protection from potential exposure to coronavirus (OR = 3.01, 95% CI 1.57-5.75) were all strongly predictive of overall satisfaction scores. Adults within the 35-54 (OR = 0.29, 95% CI 0.10-0.81) and 55+ (OR = 0.37, 95% CI 0.14-0.95) age groups were overall less satisfied with telehealth compared with younger adults 18-34 years. Underlying health conditions and primary language were not correlated with satisfaction in using telehealth. Conclusions: Telehealth may be an effective tool for overcoming barriers and providing rural patients with access to health care without compromising patient satisfaction.
Collapse
Affiliation(s)
- Rachael Phenicie
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Rosemary Acosta Wright
- Clinical Research Department, Chiricahua Community Health Centers, Inc., Douglas, Arizona, USA
| | - Jeffrey Holzberg
- Clinical Research Department, Chiricahua Community Health Centers, Inc., Douglas, Arizona, USA
| |
Collapse
|
7
|
Sutton AL, Preston MA, Thomson M, Litzenberg C, Taylor TF, Cole EP, Sheppard VB. Reaching Rural Residents to Identify Colorectal Cancer Education and Intervention Targets. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:338-344. [PMID: 31654321 PMCID: PMC7182473 DOI: 10.1007/s13187-019-01635-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Disparities in cancer screening and care in rural communities warrant the need to determine effective ways to reach, engage, and educate the community residents. The purpose of this cross-sectional study was to pilot methods to engage rural residents in colorectal cancer (CRC) research and education activities and assess knowledge of CRC guidelines, symptoms, and screening behaviors in this sample. The community-engaged research approach was employed to develop and distribute a CRC knowledge and screening behavior assessment using various methods such as email and community drop boxes placed throughout the community. Bivariate analysis assessed the relationship between age and CRC knowledge items. Three hundred ninety-one surveys were returned with most received from community drop boxes (60%) followed by educational events (23%). The most ineffective method to distribute surveys was through community events. Most individuals were knowledgeable of CRC symptoms (70%) and screening facts (67%). Bivariate analysis showed that individuals 50 years or older had significantly more knowledge of CRC risks and screening than those under the age of 50. This study highlights the potential of community drop boxes as an effective method for engaging rural communities. Further, findings from the survey highlight the need to focus CRC education on younger individuals in which CRC incidence has increased.
Collapse
Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA.
| | - Michael A Preston
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Maria Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Charlotte Litzenberg
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Trina F Taylor
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Eva Polly Cole
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
8
|
Wheatley A, Floss M, Bakola M, Kampouraki M, Silveira B, Scott-Jones J. The Rural Family Medicine Café Project: A Social Media Strategy to Reduce Occupational Isolation and Improve Support for Rural Healthcare Professionals. Front Public Health 2020; 8:595255. [PMID: 33330339 PMCID: PMC7710660 DOI: 10.3389/fpubh.2020.595255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Globally rural medicine is currently suffering from staff shortages. Social and professional isolation are identified as significant pressures on health professionals working in rural areas. Social media (SOME) has created new methods of social engagement where conventional forms have failed. The Rural Family Medicine Café (RFMC) is a SOME project created to engage and support those interested in rural family medicine thus decreasing occupational isolation. Methods: A quantitative analysis of SOME activity associated with the RFMC was done by measuring the frequency of #ruralcafe, #ruralwomenGP, #ruralGP, #ruralstories, and #ruralmedicine from October 2015 to October 2016 along with the number of Facebook page likes and YouTube views. A time series and regression analysis were done to assess the correlation between the frequencies of hashtag use and the number of new likes or views. A qualitative analysis of the content of tweets using the associated hashtags and comments on the RFMC YouTube videos was then done to assess participants' response to the RFMC. To add context to the data collected, regularly attending participants were invited for a semi-structured interview. Results: There was a positive trend in the number of Facebook page likes (+273%) and Twitter hashtag use (+2,458%) but a negative trend (−92%) in the number of RFMC YouTube views. There was no statistically significant relationship between the number of views on the RFMC YouTube and RFMC associated SOME activity (p = 0.141). A significant relationship was shown between the number of Facebook page likes and the number of views on the RFMC YouTube (p = 0.037). Participants felt positively about the RFMC with recurring themes of; promotion, advocacy, public health, engagement, inspire, sharing, spreading information, feeling connected and general positive comments such as “enjoying tweets,” “great discussion.” Participants shared anecdotes, useful links, and book recommendations. Conclusion: The RFMC has seen an increase in the amount of associated SOME activity despite having less viewers. This is most likely due to the few participants of the RFMC continuing the café discussions on SOME, particularly Twitter, and engaging outside of the RFMC. The RFMC has developed into a virtual community which is reducing occupational isolation for its participants.
Collapse
Affiliation(s)
- Amber Wheatley
- Ysbyty Glan Clwyd, Betsi Cadwaladr University Health Board, Bodelwyddan, United Kingdom
- *Correspondence: Amber Wheatley
| | - Mayara Floss
- Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Maria Bakola
- Postgraduate Program of Public Health, University of Patras, Patras, Greece
| | - Maria Kampouraki
- 16th Local Unit of Health, Kordelio-Evosmos, Thessaloniki, Greece
| | | | | |
Collapse
|
9
|
Bates JE, Parekh AD, Chowdhary M, Amdur RJ. Geographic Distribution of Radiation Oncologists in the United States. Pract Radiat Oncol 2020; 10:e436-e443. [DOI: 10.1016/j.prro.2020.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
|
10
|
Ruiz Y, Riciputi S, Alexander SC, DeMaria AL, Guilamo-Ramos V. Examining dual method contraceptive use among midwestern parenting Latinx teens: Perspectives from adolescent parents, caretakers, and nurses. Public Health Nurs 2020; 37:647-654. [PMID: 32656790 DOI: 10.1111/phn.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite dual method (DM) contraception being effective in reducing repeat-births and sexually transmitted infections (STIs), Latinx adolescent parents who live in non-traditional migration areas remain vulnerable for both outcomes. OBJECTIVE This study applied the Unified Theory of Behavior (UTB) and drew upon Bronfenbrenner's social ecological model to explore multiple stakeholders' (adolescent parents, caregivers, and nurses) perceptions of factors that influence DM intentions and use among Latinx adolescent parents. METHODS Semi-structured interviews with Latinx adolescent parent-caregiver dyads and nurses were analyzed using thematic analysis. RESULTS Study findings revealed that while all participant groups considered medical providers as DM influencers, contradicting views related to caregivers' as DM influencers emerged among adolescent parents and caregivers. Findings suggest that DM is deemed both acceptable and effective; and adolescent parents' reported DM self-efficacy. DM obstacles included negative emotions, environmental constraints, and poor knowledge and skills. CONCLUSIONS Study results suggest that constructs from the UTB framework are useful in identifying individual and social factors that can potentially influence DM intentions and use among Latinx adolescent parents. IMPLICATIONS FOR PUBLIC HEALTH NURSING This study's findings have potential implications for public health nurses interested in designing community-based interventions to reduce repeat-births and STIs among Latinx adolescent parents.
Collapse
Affiliation(s)
- Yumary Ruiz
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Shaina Riciputi
- Colorado Department of Human Services, Office of Behavioral Health, Denver, CO, USA
| | - Stewart C Alexander
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | | |
Collapse
|
11
|
Feyereisen S, Goodrick E. Examining variable nurse practitioner independence across jurisdictions: A case study of the United States. Int J Nurs Stud 2020; 118:103633. [PMID: 32739108 DOI: 10.1016/j.ijnurstu.2020.103633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nurse Practitioners have the potential to reduce primary care shortages for underserved populations. Yet, scopes of practice in some political jurisdictions (e.g. states, provinces) are more restrictive than others, and prevent Nurse Practitioners from working to the full extent of their training. The research is limited as to which intrastate or interstate characteristics contribute to understanding why scope of practice differences exist. OBJECTIVES To estimate associations between intrastate/interstate characteristics and US state-level Nurse Practitioner Scope of Practice policy. RESEARCH DESIGN Retrospective study of state-level factors influencing Nurse Practitioner Scopes of Practice. SUBJECTS U.S. states from 2001 to 2015. MEASURES Our dependent variable is state-level Scope of Practice policy, indicating the extent to which Nurse Practitioners are autonomous in a state (Independent, Collaboration or Supervision). The intrastate characteristics that we include are numbers of Nurse Practitioners, Primary Care Physicians and rural hospitals per capita, state Board of Medicine governance and Nursing License Compact membership. We also measure the number of border-states that adopt specific policies in order to indicate the extent to which interstate characteristics influence focal states to adopt similar policies. RESULTS Among intrastate characteristics, we found that rural hospital concentrations (Odds Ratio=0.78; 95% Confidence Interval: 0.71-0.85) and Nursing License Compact membership (Odds Ratio=0.23; 95% Confidence Interval: 0.0-0.60) were associated with lower levels of restrictions, while Board of Medicine governance (Odds Ratio=27.36; 95% Confidence Interval: 5.75-130.20) was associated with increased levels of restrictions. Among interstate characteristics, higher numbers of border-states adopting Nursing License Compact membership (Odds Ratio=0.51; 95% Confidence Interval: 0.32-0.80) was associated with lower levels of restrictions. CONCLUSIONS Barriers to Nurse Practitioner independence are largely attributable to unfavorable governance arrangements and non-participation in reciprocal licensing networks. Achieving Nurse Practitioner independence will require cooperation between nursing, medicine and policy makers. We offer some suggestions as to where parties interested in seeing increased Nurse Practitioner independence should focus their efforts when attempting to remove restrictions on Nurse Practitioner practice.
Collapse
Affiliation(s)
- Scott Feyereisen
- Department of Management Programs, College of Business, Florida Atlantic University, Health Administration, 777 Glades Road, Boca Raton, FL 33431, United States.
| | - Elizabeth Goodrick
- Department of Management Programs, College of Business, Florida Atlantic University, Health Administration, 777 Glades Road, Boca Raton, FL 33431, United States.
| |
Collapse
|
12
|
Abstract
The use of telemedicine (TM) to deliver health care has been growing throughout the United States and internationally through asynchronous and synchronous technology. It has proven to be an effective way of delivering health care at a distance. There are multiple ways that a practice can offer these services, from direct-to-consumer to consultations in ambulatory or inpatient services. TM can be used to deliver care in homes, schools, and virtually anywhere that a patient and provider can access technology. For rural communities, emergency departments and inpatient specialty consults that were not available previously are now routine. TM also has been proven to be effective in decreasing costs to patients and increasing access in pediatrics while providing high degrees of satisfaction among patients and providers. [Pediatr Ann. 2019;48(12):e479-e484.].
Collapse
|
13
|
He Y, Qian W, Shi L, Zhang K, Huang J. Standardized residency training: An equalizer for residents at different hospitals in Shanghai, China? Int J Health Plann Manage 2019; 35:592-605. [PMID: 31742772 DOI: 10.1002/hpm.2970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The residency training programme in Shanghai is the first in China to become standardized; however, there has been no evidence that the programme equalizes training quality. This cross-sectional study examined whether residents in all disciplines at different hospitals perceived equivalent improvement in professional competency after this programme. METHODS We recruited all 2283 residents who enrolled in the programme in 2013. Before graduation, the residents reported their perceived competency improvement as the primary outcome and their hospital of residency, awareness of the programme's requirements and policies, and demographic information as explanatory variables. We ran multivariate linear regressions and mixed-effect multilevel regression to examine whether the hospital type and the university affiliation were associated with perceived improvement. RESULTS A total of 2208 residents completed the survey. Although the adjusted multilevel regression analysis showed that the improvement scores at tertiary specialty hospitals and tertiary general hospitals were lower than those at secondary general hospitals, the difference was not statistically significant. No variance in improvement scores could be explained by the hospital type or university affiliation. CONCLUSION Receiving residency training at hospitals that were traditionally less resourced did not compromise educational quality based on the perception of the residents.
Collapse
Affiliation(s)
- Yao He
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Wenji Qian
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China.,Administrative Office, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lu Shi
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Kan Zhang
- Department of Science and Education, Shanghai Health Commission, Shanghai, China
| | - Jiayan Huang
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| |
Collapse
|
14
|
Kirkman JM, Bentley SA, Armitage JA, Woods CA. Could adoption of the rural pipeline concept redress Australian optometry workforce issues? Clin Exp Optom 2019; 102:566-570. [PMID: 30801801 DOI: 10.1111/cxo.12873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/07/2018] [Accepted: 12/30/2018] [Indexed: 11/26/2022] Open
Abstract
People living in rural and remote areas have poorer ocular health outcomes compared with those living in metropolitan areas. Reasons for this are multiple and complex but access to care is consistently reported as a defining factor. The geographic maldistribution of eye-care professionals is a major obstacle for regional, rural and remote Australians seeking care. Research from the medical profession suggests adopting the 'rural pipeline' concept to address the issue of maldistribution. This approach appears to have had some success in medicine, and involves recruiting students from a rural background, exposing students to rural practice through placements and offering graduates incentives and support to practice rurally. Lessons could be learnt from the medical field as there is a dearth of literature describing the utilisation of the rural pipeline in allied health. However, given the differences between professions it cannot be assumed factors and results will be the same. A greater understanding is required to determine whether optometry is a profession which may benefit from the rural pipeline concept.
Collapse
Affiliation(s)
- Jacqueline M Kirkman
- Deakin Optometry, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Sharon A Bentley
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Craig A Woods
- Deakin Optometry, School of Medicine, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
15
|
Lee YH, Lu CW, Huang CT, Chang HH, Yang KC, Kuo CS, Chang YK, Hsu CC, Huang KC. Impact of a home health care program for disabled patients in Taiwan: A nationwide population-based cohort study. Medicine (Baltimore) 2019; 98:e14502. [PMID: 30762778 PMCID: PMC6408017 DOI: 10.1097/md.0000000000014502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the impact of home health care (HHC) for disabled patients.We conducted a nationwide population-based retrospective cohort study. A total of 5838 disabled patients with HHC were identified to match by propensity score with 15,829 disabled patients without HHC receiving tube or catheter care (tracheostomy tube, nasogastric tube, urinary catheter, cystostomy tube, nephrostomy tube) or stage 3 or 4 pressure sore care from the Taiwanese National Health Insurance Research Database between 2005 and 2009. After 1:1 matching, 2901 subjects in the HHC group and 2901 subjects in the non-HHC group were selected and analyzed. Generalized estimating equations (GEEs) were used to compare the risk of health outcomes (rate of hospitalization and emergency services use) and the healthcare expenditure between the 2 groups.Compared to those in the non-HHC group, the patients in the HHC group had significantly higher risk for hospitalization (odds ratio [OR] = 18.43, 95% confidence interval [CI]: 15.62-21.75, P < .001) and emergency services use (OR = 3.72, 95% CI: 3.32-4.17, P < .001) 1 year before the index date. However, 1 year after the index date, the risk for hospitalization (OR = 1.6, 95% CI: 1.41-1.83, P < .001) and emergency services use (OR = 1.16, 95% CI: 1.04-1.30, P < .05) attenuated significantly. Regarding the comparison of total healthcare expenditure 1 year before and after the index date, our study showed an insignificant decrease of US$1.5 per person per day and a significant increase of US$5.2 per person per day (P < .001) in the HHC and non-HHC groups, respectively.The HHC for disabled patients has a potential role to reduce hospitalization and emergency services use. Besides, the improvement of healthcare quality through HHC was not accompanied by increased healthcare expenditure. The clinical impact of HHC emphasizes the importance for public health officials to promote HHC model to meet the needs of disabled patients.
Collapse
Affiliation(s)
- Yi-Hsuan Lee
- Department of Family Medicine
- Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch
- Department of Family Medicine, National Taiwan University Hospital
| | - Chia-Wen Lu
- Department of Family Medicine, National Taiwan University Hospital
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei
| | - Chi-Ting Huang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli
| | - Hao-Hsiang Chang
- Department of Family Medicine, National Taiwan University Hospital
| | - Kuen-Cheh Yang
- Department of Family Medicine
- Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch
- Department of Family Medicine, National Taiwan University Hospital
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei
| | - Chia-Sheng Kuo
- Department of Family Medicine
- Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch
- Department of Family Medicine, National Taiwan University Hospital
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei
| | - Yu-Kang Chang
- Department of Medical Research, Tung's Taichung Metro Harbor Hospital
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli
- Department of Health Services Administration, China Medical University, Taichung
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine
- Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch
- Department of Family Medicine, National Taiwan University Hospital
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli
| |
Collapse
|
16
|
Burrow S, Goldberg L, Searle J, Aston M. Vulnerability, Harm, and Compromised Ethics Revealed by the Experiences of Queer Birthing Women in Rural Healthcare. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:511-524. [PMID: 30402734 DOI: 10.1007/s11673-018-9882-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
Phenomenological interviews with queer women in rural Nova Scotia reveal significant forms of trauma experienced during labour and birth. Situating the accounts of participants within both phenomenological and intersectional analyses reveals harms enabled by structurally embedded heteronormative and homophobic healthcare practices and policies. Our account illustrates the breadth and depth of harm experienced and outlines how these violate core ethical principles and values in healthcare.
Collapse
Affiliation(s)
- Sylvia Burrow
- Cape Breton University, 5300 Grand Lake Road, Sydney, NS.B1P 6L2, Canada.
| | - Lisa Goldberg
- Dalhousie University, 5869 University Avenue, Halifax, NS B3H 4R2, Canada
| | - Jennifer Searle
- Dalhousie University, 5869 University Avenue, Halifax, NS B3H 4R2, Canada
| | - Megan Aston
- Dalhousie University, 5869 University Avenue, Halifax, NS B3H 4R2, Canada
| |
Collapse
|
17
|
Chen A, Lo Sasso AT, Richards MR. Supply-side effects from public insurance expansions: Evidence from physician labor markets. HEALTH ECONOMICS 2018; 27:690-708. [PMID: 29194846 DOI: 10.1002/hec.3625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 08/29/2017] [Accepted: 10/24/2017] [Indexed: 06/07/2023]
Abstract
Medicaid and the Child Health Insurance Programs (CHIP) are key sources of coverage for U.S. children. Established in 1997, CHIP allocated $40 billion of federal funds across the first 10 years but continued support required reauthorization. After 2 failed attempts in Congress, CHIP was finally reauthorized and significantly expanded in 2009. Although much is known about the demand-side policy effects, much less is understood about the policy's impact on providers. In this paper, we leverage a unique physician dataset to examine if and how pediatricians responded to the expansion of the public insurance program. We find that newly trained pediatricians are 8 percentage points more likely to subspecialize and as much as 17 percentage points more likely to enter private practice after the law passed. There is also suggestive evidence of greater private practice growth in more rural locations. The sharp supply-side changes that we observe indicate that expanding public insurance can have important spillover effects on provider training and practice choices.
Collapse
Affiliation(s)
- Alice Chen
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Anthony T Lo Sasso
- School of Public Health, Health Policy and Administration, Institute of Government and Public Affairs, University of Illinois-Chicago, Chicago, IL, USA
| | | |
Collapse
|
18
|
López CM, Qanungo S, Jenkins C, Acierno R. Technology as a Means to Address Disparities in Mental Health Research: A Guide to "Tele-Tailoring" your Research Methods. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2018; 49:57-64. [PMID: 30034085 PMCID: PMC6052868 DOI: 10.1037/pro0000176] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We must include rural participants in health-related research if we are to address health-related disparities and inequity, particularly in mental health. However, the first step of the research process, in person, witnessed, signed informed consent is often a limiting factor and insurmountable barrier to precisely the type of research (e.g., telehealth) designed to overcome barriers of geographic distance and travel time. Telehealth, or the provision of medical care or services to patients by means of audio/video and procedure-specific technology, addresses some barriers to health created by rurality by making health care professionals more accessible to patients. A logical complement to telehealth is "teleconsent." Teleconsent can be defined as using remote, facial integrated identity verification to allow (a) remote guidance of participants through consent documents, and (b) digital signing by all parties, obviating the need for in person signed consent. The ability to review and sign consent documents via telehealth with synchronous viewing is a novel, innovative means by which to overcome the initial significant barrier to recruitment of rural participants into healthcare research. By leveraging the growing capabilities of telehealth, teletailoring studies can improve the efficiency of research recruitment and facilitate the consent process for under-represented populations in research. Strategies for implementation are clearly relevant to increasing the success of clinical trial recruitment.
Collapse
Affiliation(s)
| | - Suparna Qanungo
- College of Nursing, Medical University of South Carolina, SC
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, SC
| | - Ron Acierno
- College of Nursing, Medical University of South Carolina, SC
| |
Collapse
|
19
|
Dickson MF, Staton M, Tillson M, Leukefeld C, Webster JM, Oser CB. The Affordable Care Act and Changes in Insurance Coverage and Source of Health Care among High-risk Rural, Substance-using, Female Offenders Transitioning to the Community. J Health Care Poor Underserved 2018; 29:843-863. [PMID: 30122668 PMCID: PMC6130194 DOI: 10.1353/hpu.2018.0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study examines health care coverage and health care among rural, drug-involved female offenders under the Affordable Care Act (ACA) compared with pre-ACA and whether being insured is associated with having a usual source of care. METHODS This study involved random selection, screening, and face-to-face interviews with drug-using women in three rural Appalachian jails. Analyses focused on participants who had completed a three-month follow-up interview after release from jail (N=371). RESULTS Analyses indicated that women released after ACA implementation were more likely than those released pre-implementation to be insured. A multivariate logistic regression model showed that being insured was significantly related to having a usual health care source during community re-entry. CONCLUSIONS Results demonstrate the benefits of the ACA, signaling important implications for public health in rural communities and the criminal justice system, including targeting underserved groups during incarceration and providing information about and resources for health care enrollment.
Collapse
Affiliation(s)
| | - Michele Staton
- Center on Drug and Alcohol Research, University of Kentucky
- Department of Behavioral Science, University of Kentucky
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky
- College of Social Work, University of Kentucky
| | - Carl Leukefeld
- Center on Drug and Alcohol Research, University of Kentucky
- Department of Behavioral Science, University of Kentucky
| | - J. Matthew Webster
- Center on Drug and Alcohol Research, University of Kentucky
- Department of Behavioral Science, University of Kentucky
| | - Carrie B. Oser
- Center on Drug and Alcohol Research, University of Kentucky
- Department of Sociology, University of Kentucky
| |
Collapse
|
20
|
Parlier AB, Galvin SL, Thach S, Kruidenier D, Fagan EB. The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:130-140. [PMID: 28767498 DOI: 10.1097/acm.0000000000001839] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE To examine the literature documenting successes in recruiting and retaining rural primary care physicians. METHOD The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention. RESULTS The authors' proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work-life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice. CONCLUSIONS Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences.
Collapse
Affiliation(s)
- Anna Beth Parlier
- A.B. Parlier was research project coordinator, Center for Research, Mountain Area Health Education Center, Asheville, North Carolina, at the time of writing. As of August 2017, she will be a graduate student, Psychology Department, Virginia Commonwealth University, Richmond, Virginia. S.L. Galvin is director of research, Center for Research, Mountain Area Health Education Center, Asheville, North Carolina, and adjunct assistant professor, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. S. Thach is director of clinical and community outreach, Western North Carolina Rural Health Initiative, Mountain Area Health Education Center, Asheville, North Carolina. D. Kruidenier is research and clinical librarian, Center for Research, Mountain Area Health Education Center, Asheville, North Carolina. E.B. Fagan is chief education officer, Mountain Area Health Education Center (MAHEC), assistant program director, Family Medicine Residency Program, MAHEC, and assistant medical director, Department of Family Medicine, MAHEC, Asheville, North Carolina. He is also associate professor, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | | | | | | | | |
Collapse
|
21
|
Carvajal MJ. A theoretical framework for the interpretation of pharmacist workforce studies throughout the world: The labor supply curve. Res Social Adm Pharm 2017; 14:999-1006. [PMID: 29567087 DOI: 10.1016/j.sapharm.2017.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/06/2017] [Accepted: 11/27/2017] [Indexed: 11/12/2022]
Abstract
Despite geographic, financial, and cultural diversity, publications dealing with the pharmacist workforce throughout the world share common concerns and focus on similar topics. Their findings are presented in the literature in a seemingly unrelated way even though they are connected to one another as parts of a comprehensive theoretical structure. The purpose of this paper is to develop a theoretical model that relates some of the most salient topics addressed in the international literature on pharmacist workforce. The model is developed along two fundamental ideas. The first identifies the shape and location of the pharmacist's labor supply curve as the driving force behind all workforce decisions undertaken by pharmacists; the second argues that gender and age differences are two of the most important factors determining the shape and location of this supply curve. The paper then discusses movements along the curve attributed to changes in the wage rate, as well as displacements of the curve attributed to disparities in personal characteristics, investments in human capital, job-related preferences, opinions and perceptions, and institutional rigidities. The focus is on the individual pharmacist, not on groups of pharmacists or the profession as a whole. Works in multiple countries that address each topic are identified. Understanding these considerations is critical as employers' failure to accommodate pharmacists' preferences for work and leisure are associated with negative consequences not only for them but also for the healthcare system as a whole. Possible consequences include excessive job turnover, absenteeism, decreased institutional commitment, and lower quality of work.
Collapse
Affiliation(s)
- Manuel J Carvajal
- Nova Southeastern University, College of Pharmacy, Department of Sociobehavioral and Administrative Pharmacy, 3200 South University Drive, Fort Lauderdale, FL 33328-2018, USA.
| |
Collapse
|
22
|
Factors influencing recruitment and retention of professional nurses, doctors and allied health professionals in rural hospitals in KwaZulu Natal. Health SA 2017. [DOI: 10.1016/j.hsag.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
23
|
McDonald YJ, Goldberg DW, Scarinci IC, Castle PE, Cuzick J, Robertson M, Wheeler CM. Health Service Accessibility and Risk in Cervical Cancer Prevention: Comparing Rural Versus Nonrural Residence in New Mexico. J Rural Health 2017; 33:382-392. [PMID: 27557124 PMCID: PMC5939944 DOI: 10.1111/jrh.12202] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/14/2016] [Accepted: 06/24/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown. METHODS Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P < .05) was used to determine if differences were significant and Cohen's r to measure effect. FINDINGS Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P < .001). CONCLUSION Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar).
Collapse
Affiliation(s)
- Yolanda J McDonald
- Department of Geography, College of Geosciences, Texas A&M University, College Station, Texas
| | - Daniel W Goldberg
- Department of Geography, College of Geosciences, Texas A&M University, College Station, Texas
- Department of Computer Science & Engineering, Dwight Look College of Engineering, Texas A&M University, College Station, Texas
| | - Isabel C Scarinci
- Division of Preventive Medicine, School of Medicine, University of Alabama, Birmigham, Alabama
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Michael Robertson
- Department of Pathology, House of Prevention Epidemiology (HOPE), University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Cosette M Wheeler
- Department of Pathology, House of Prevention Epidemiology (HOPE), University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| |
Collapse
|
24
|
Batsis JA, Whiteman KL, Lohman MC, Scherer EA, Bartels SJ. Body Mass Index and Rural Status on Self-Reported Health in Older Adults: 2004-2013 Medicare Expenditure Panel Survey. J Rural Health 2017; 34 Suppl 1:s56-s64. [PMID: 28295614 DOI: 10.1111/jrh.12237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/17/2017] [Accepted: 02/03/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE To ascertain whether rural status impacts self-reported health and whether the effect of rural status on self-reported health differs by obesity status. METHODS We identified 22,307 subjects aged ≥60 from the Medical Expenditure Panel Survey 2004-2013. Body mass index (BMI) was categorized as underweight, normal, overweight, or obese. Physical and mental component scores of the Short Form-12 assessed self-reported health status. Rural/urban status was defined using metropolitan statistical area. Weighted regression models ascertained the relative contribution of predictors (including rural and BMI) on each subscale. FINDINGS Mean age was 70.7 years. Rural settings had higher proportions classified as obese (30.7 vs 27.6%; P < .001), and rural residents had lower physical health status (41.7 ± 0.3) than urban (43.4 ± 0.1; P < .001). Obese or underweight persons had lower physical health status (39.5 ± 0.20 and 37.0 ± 0.82, respectively) than normal (44.7 ± 0.18) or overweight (44.6 ± 0.16) persons (P < .001). BMI category stratification was associated with differences in physical health between rural/urban by BMI. Individuals classified as underweight or obese had lower physical health compared to normal, while the differences were less pronounced for mental health. No differences in mental health existed between rural/urban status. A BMI * rural interaction was significant for physical but not mental health. CONCLUSIONS Rural residents report lower self-reported physical health status compared to urban residents, particularly older adults who are obese or underweight. No interaction was observed between BMI and rural status.
Collapse
Affiliation(s)
- John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
| | - Karen L Whiteman
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.,Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.,Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Emily A Scherer
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Stephen J Bartels
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire.,Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
25
|
Waddimba AC, Scribani M, Krupa N, May JJ, Jenkins P. Frequency of satisfaction and dissatisfaction with practice among rural-based, group-employed physicians and non-physician practitioners. BMC Health Serv Res 2016; 16:613. [PMID: 27770772 PMCID: PMC5075400 DOI: 10.1186/s12913-016-1777-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 09/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Widespread dissatisfaction among United States (U.S.) clinicians could endanger ongoing reforms. Practitioners in rural/underserved areas withstand stressors that are unique to or accentuated in those settings. Medical professionals employed by integrating delivery systems are often distressed by the cacophony of organizational change(s) that such consolidation portends. We investigated the factors associated with dis/satisfaction with rural practice among doctors/non-physician practitioners employed by an integrated healthcare delivery network serving 9 counties of upstate New York, during a time of organizational transition. METHODS We linked administrative data about practice units with cross-sectional data from a self-administered multi-dimensional questionnaire that contained practitioner demographics plus valid scales assessing autonomy/relatedness needs, risk aversion, tolerance for uncertainty/ambiguity, meaningfulness of patient care, and workload. We targeted medical professionals on the institutional payroll for inclusion. We excluded those who retired, resigned or were fired during the study launch, plus members of the advisory board and research team. Fixed-effects beta regressions were performed to test univariate associations between each factor and the percent of time a provider was dis/satisfied. Factors that manifested significant fixed effects were entered into multivariate, inflated beta regression models of the proportion of time that practitioners were dis/satisfied, incorporating clustering by practice unit as a random effect. RESULTS Of the 473 eligible participants. 308 (65.1 %) completed the questionnaire. 59.1 % of respondents were doctoral-level; 40.9 % mid-level practitioners. Practitioners with heavier workloads and/or greater uncertainty intolerance were less likely to enjoy top-quintile satisfaction; those deriving greater meaning from practice were more likely. Higher meaningfulness and gratified relational needs increased one's likelihood of being in the lowest quintile of dissatisfaction; heavier workload and greater intolerance of uncertainty reduced that likelihood. Practitioner demographics and most practice unit characteristics did not manifest any independent effect. CONCLUSIONS Mutable factors, such as workload, work meaningfulness, relational needs, uncertainty/ambiguity tolerance, and risk-taking attitudes displayed the strongest association with practitioner satisfaction/dissatisfaction, independent of demographics and practice unit characteristics. Organizational efforts should be dedicated to a redesign of group-employment models, including more equitable division of clinical labor, building supportive peer networks, and uncertainty/risk tolerance coaching, to improve the quality of work life among rural practitioners.
Collapse
Affiliation(s)
- Anthony C Waddimba
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA. .,Columbia University College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA.
| | - Melissa Scribani
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA
| | - Nicole Krupa
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA
| | - John J May
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA.,Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
| | - Paul Jenkins
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA
| |
Collapse
|
26
|
Shannon CK, Price SS, Jackson J. Predicting Rural Practice and Service to Indigent Patients: Survey of Dental Students Before and After Rural Community Rotations. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.10.tb06200.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Jodie Jackson
- Institute for Community and Rural Health; Robert C. Byrd Health Sciences Center; West Virginia University
| |
Collapse
|
27
|
Paul DL, McDaniel RR. Facilitating telemedicine project sustainability in medically underserved areas: a healthcare provider participant perspective. BMC Health Serv Res 2016; 16:148. [PMID: 27112268 PMCID: PMC4845495 DOI: 10.1186/s12913-016-1401-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background Very few telemedicine projects in medically underserved areas have been sustained over time. This research furthers understanding of telemedicine service sustainability by examining teleconsultation projects from the perspective of healthcare providers. Drivers influencing healthcare providers’ continued participation in teleconsultation projects and how projects can be designed to effectively and efficiently address these drivers is examined. Methods Case studies of fourteen teleconsultation projects that were part of two health sciences center (HSC) based telemedicine networks was utilized. Semi-structured interviews of 60 key informants (clinicians, administrators, and IT professionals) involved in teleconsultation projects were the primary data collection method. Results Two key drivers influenced providers’ continued participation. First was severe time constraints. Second was remote site healthcare providers’ (RSHCPs) sense of professional isolation. Two design steps to address these were identified. One involved implementing relatively simple technology and process solutions to make participation convenient. The more critical and difficult design step focused on designing teleconsultation projects for collaborative, active learning. This learning empowered participating RSHCPs by leveraging HSC specialists’ expertise. Conclusions In order to increase sustainability the fundamental purpose of teleconsultation projects needs to be re-conceptualized. Doing so requires HSC specialists and RSHCPs to assume new roles and highlights the importance of trust. By implementing these design steps, healthcare delivery in medically underserved areas can be positively impacted.
Collapse
Affiliation(s)
- David L Paul
- Department of Business Information and Analytics, Daniels College of Business, University of Denver, Denver, Colorado, USA.
| | - Reuben R McDaniel
- McCombs School of Business, The University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
28
|
Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access. J Immigr Minor Health 2016; 19:939-946. [DOI: 10.1007/s10903-016-0417-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Stabler ME, Long DL, Chertok IRA, Giacobbi PR, Pilkerton C, Lander LR. Neonatal Abstinence Syndrome in West Virginia Substate Regions, 2007-2013. J Rural Health 2016; 33:92-101. [PMID: 26879950 DOI: 10.1111/jrh.12174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The opioid epidemic is a public health threat with consequences affecting newborns. Neonatal Abstinence Syndrome (NAS) is a constellation of withdrawal symptoms resulting primarily from in utero opioid exposure. The purpose of this study was to examine NAS and drug-specific trends in West Virginia (WV), where rurality-related issues are largely present. METHODS The 2007-2013 WV Health Care Authority, Uniform Billing Data were analyzed for 119,605 newborn admissions with 1,974 NAS diagnoses. NAS (ICD9-CM 779.5) and exposure diagnostic codes for opioids, hallucinogens, and cocaine were utilized as incidence rate (IR) per 1,000 live births. FINDINGS Between 2007 and 2013, NAS IR significantly increased from 7.74 to 31.56 per 1,000 live births per year (Z: -19.10, P < .0001). During this time period, opioid exposure increased (Z: -9.56, P < .0001), while cocaine exposure decreased (Z: 3.62, P = .0003). In 2013, the southeastern region of the state had the highest NAS IR of 48.76 per 1,000 live births. NAS infants were more likely to experience other clinical conditions, longer hospital stay, and be insured by Medicaid. CONCLUSIONS Statewide NAS IR increased 4-fold over the study period, with rates over 3 times the national annual averages. This alarming trend is deleterious for the health of WV mother-child dyads and it strains the state's health care system. Therefore, WV has a unique need for prenatal public health drug treatment and prevention resources, specifically targeting the southeastern region. Further examination of maternal drug-specific trends and general underutilization of neonatal exposure ICD-9-CM codes is indicated.
Collapse
Affiliation(s)
- Meagan E Stabler
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - D Leann Long
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Ilana R A Chertok
- School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Peter R Giacobbi
- Department of Sport Sciences with Joint Appointment to Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Courtney Pilkerton
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Laura R Lander
- Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
30
|
Chin HB, Kramer MR, Mertens AC, Spencer JB, Howards PP. Differences in Women's Use of Medical Help for Becoming Pregnant by the Level of Urbanization of County of Residence in Georgia. J Rural Health 2016; 33:41-49. [PMID: 26769080 DOI: 10.1111/jrh.12172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Our goal was to determine if there are differences by place of residence in visiting a doctor for help getting pregnant in a population-based study. METHODS Using data from the Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women's Study, a cohort study of fertility outcomes in reproductive-aged women in Georgia, we fit models to estimate the association between geographic type of residence and seeking help for becoming pregnant. FINDINGS The prevalence of visiting a doctor for help getting pregnant ranged from 13% to 17% across geographic groups. Women living in suburban counties were most likely to seek medical care for help getting pregnant compared with women living in urbanized counties (adjusted prevalence ratio (aPR) = 1.14, 95% CI: 0.74-1.75); among women who reported infertility this difference was more pronounced (aPR = 1.59, 95% CI: 1.00-2.53). Women living in rural counties were equally likely to seek fertility care compared with women in urbanized counties in the full sample and among women who experienced infertility. CONCLUSIONS Women living in urban and rural counties were least likely to seek infertility care, suggesting that factors including but not limited to physical proximity to providers are influencing utilization of this type of care. Increased communication about reproductive goals and infertility care available to meet these goals by providers who women see for regular care may help address these barriers.
Collapse
Affiliation(s)
- Helen B Chin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ann C Mertens
- Aflac Cancer Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica B Spencer
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
31
|
McCarthy E, Ye C, Smith M, Kurtycz DFI. Molecular testing and cervical screening: will one test fit all? J Am Soc Cytopathol 2016; 5:331-338. [PMID: 31042544 DOI: 10.1016/j.jasc.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cervical screening has undergone significant changes in recent years, with molecular human papillomavirus (HPV) testing for HPV 16 and 18 at the forefront of clinical practice. But is molecular testing more effective than morphologic testing for cervical screening? Does current information on HPV hold true across all populations? As a public health laboratory serving high-risk, underserved populations, these remain important considerations for our practice. MATERIALS AND METHODS The subject population largely consisted of young women within 200% or less of the poverty line. Correlation of Papanicolaou and HPV results was performed via retrospective review, focusing on Papanicolaou cases with high-grade diagnoses and an associated HPV test using the cobas 4800 HPV test. Secondary HPV testing and typing was performed via PCR at an outside laboratory for 205 cases with sufficient residual material and negative for HPV 16/18 by cobas. RESULTS Of 20,211 cytology tests reviewed from July 2013 to May 2015, 521 were diagnosed as high-grade; 387 had concurrent HPV tests. Of those with concurrent HPV tests, 58% (225 of 387) of the high-grade Papanicolaou cases were not HPV 16/18 positive; furthermore, no HPV was detected in 14% (55 of 387) of these cases. Secondary testing revealed the presence of 25 unique genotypes. CONCLUSIONS With recent emphasis on molecular HPV testing, the results of this review are concerning. As we move forward with evolution of cervical screening practices, it will be important to explore these questions for the continued quality and integrity of women's health services.
Collapse
Affiliation(s)
- Erin McCarthy
- Section of Cytology, Disease Prevention Division, University of Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
| | - Changhong Ye
- Section of Cytology, Disease Prevention Division, University of Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
| | - Michele Smith
- Section of Cytology, Disease Prevention Division, University of Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
| | - Daniel F I Kurtycz
- Section of Cytology, Disease Prevention Division, University of Wisconsin State Laboratory of Hygiene, Madison, Wisconsin; Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| |
Collapse
|
32
|
Anderson TJ, Saman DM, Lipsky MS, Lutfiyya MN. A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings. BMC Health Serv Res 2015; 15:441. [PMID: 26423746 PMCID: PMC4590732 DOI: 10.1186/s12913-015-1053-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 09/11/2015] [Indexed: 11/20/2022] Open
Abstract
Background By examining 2013 County Health Rankings and Roadmaps data from the University of Wisconsin and the Robert Wood Johnson Foundation, this paper seeks to add to the available literature on health variances between United States residents living in rural and non-rural areas. We believe this is the first study to use the Rankings data to measure rural and urban health differences across the United States and therefore highlights the national need to address shortfalls in rural healthcare and overall health. The data indicates that U.S. residents living in rural counties are generally in poorer health than their urban counterparts. Methods We used 2013 County Health Rankings data to evaluate differences across the six domains of interest (mortality, morbidity, health behaviors, clinical care, social and economic factors, and physical environment) for rural and non-rural U.S. counties. This is a cross-sectional study employing chi-square analysis and logit regression. Results We found that residents living in rural U.S. counties are more likely to have poorer health outcomes along a variety of measurements that comprise the County Health Rankings’ indexed domains of health quality. These populations have statistically significantly (p ≤ 0.05) lower scores in such areas as health behavior, morbidity factors, clinical care, and the physical environment. We attribute the differences to a variety of factors including limitations in infrastructure, socioeconomic differences, insurance coverage deficiencies, and higher rates of traffic fatalities and accidents. Discussions The largest differences between rural and non-rural counties were in the indexed domains of mortality and clinical care. Conclusions Our analysis revealed differences in health outcomes in the County Health Rankings’ indexed domains between rural and non-rural U.S. counties. We also describe limitations and offer commentary on the need for more uniform measurements in the classification of the terms rural and non-rural. These results can influence practitioners and policy makers in guiding future research and when deciding on funding allocation.
Collapse
Affiliation(s)
- Timothy J Anderson
- Essentia Institute of Rural Health, 502 E. 2nd Street, Duluth, MN, 55805, USA.
| | - Daniel M Saman
- Essentia Institute of Rural Health, 502 E. 2nd Street, Duluth, MN, 55805, USA.
| | - Martin S Lipsky
- Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, UT, 84095, USA.
| | - M Nawal Lutfiyya
- National Center for Interprofessional Practice and Education, University of Minnesota-Twin Cities Campus, MMC 501 Mayo, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| |
Collapse
|
33
|
Shealy KM, Davidson TM, Jones AM, Lopez CM, de Arellano MA. Delivering an Evidence-Based Mental Health Treatment to Underserved Populations Using Telemedicine: The Case of a Trauma-Affected Adolescent in a Rural Setting. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
34
|
Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev 2015; 2015:CD005314. [PMID: 26123126 PMCID: PMC6791300 DOI: 10.1002/14651858.cd005314.pub3] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The inequitable distribution of health professionals, within countries, poses an important obstacle to the optimal functioning of health services. OBJECTIVES To assess the effectiveness of interventions aimed at increasing the proportion of health professionals working in rural and other underserved areas. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, including specialised register of the Cochrane Effective Practice and Organisation of Care Group; March 2014), MEDLINE (1966 to March 2014), EMBASE (1988 to March 2014), CINAHL (1982 to March 2014), LILACS (February 2014), Science Citation Index and Social Sciences Citation Index (up to April 2014), Global Health (March 2014) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (June 2013). We also searched reference lists of all papers and relevant reviews identified, and contacted authors of relevant papers regarding any further published or unpublished work. SELECTION CRITERIA Randomised trials, non-randomised trials, controlled before-and-after studies and interrupted time series studies evaluating the effects of various interventions (e.g. educational, financial, regulatory or support strategies) on the recruitment or retention, or both, of health professionals in underserved areas. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and assessed full texts of potentially relevant studies for eligibility. Two review authors independently extracted data from eligible studies. MAIN RESULTS For this first update of the original review, we screened 8945 records for eligibility. We retrieved and assessed the full text of 125 studies. Only one study met the inclusion criteria of the review. This interrupted time series study, conducted in Taiwan, found that the implementation of a National Health Insurance scheme in 1995 was associated with improved equity in the geographic distribution of physicians and dentists. We judged the certainty of the evidence provided by this one study very low. AUTHORS' CONCLUSIONS There is currently limited reliable evidence regarding the effects of interventions aimed at addressing the inequitable distribution of health professionals. Well-designed studies are needed to confirm or refute findings of observational studies of educational, financial, regulatory and supportive interventions that might influence healthcare professionals' decisions to practice in underserved areas. Governments and medical schools should ensure that when interventions are implemented, their impacts are evaluated using scientifically rigorous methods to establish the true effects of these measures on healthcare professional recruitment and retention in rural and other underserved settings.
Collapse
Affiliation(s)
- Liesl Grobler
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241TygerbergCape TownWestern CapeSouth Africa8000
| | - Ben J Marais
- University of SydneyMarie Bashir Institute for Infectious Diseases and BiosecuritySydneyAustralia
- University of SydneyChildren’s Hospital at WestmeadSydneyAustralia
| | - Sikhumbuzo Mabunda
- University of Cape Town/Western Cape Department of HealthP.O. Box 768RondeboschSouth Africa7701
| | | |
Collapse
|
35
|
Richards MR, Saloner B, Kenney GM, Rhodes KV, Polsky D. Availability of New Medicaid Patient Appointments and the Role of Rural Health Clinics. Health Serv Res 2015; 51:570-91. [PMID: 26119695 DOI: 10.1111/1475-6773.12334] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the willingness to accept new Medicaid patients among certified rural health clinics (RHCs) and other nonsafety net rural providers. DATA SOURCES Experimental (audit) data from a 10-state study of primary care practices, county-level information from the Area Health Resource File, and RHC information from the Center for Medicare and Medicaid Services. STUDY DESIGN We generate appointment rates for rural and nonrural areas by patient-payer type (private, Medicaid, self-pay) to then motivate our focus on within-rural variation by clinic type (RHC vs. non-RHC). Multivariate linear models test for statistical differences and assess the estimates' sensitivity to the inclusion of control variables. DATA COLLECTION The primary data are from a large field study. PRINCIPAL FINDINGS Approximately 80 percent of Medicaid callers receive an appointment in rural areas-a rate more than 20 percentage points greater than nonrural areas. Importantly, within rural areas, RHCs offer appointments to prospective Medicaid patients nearly 95 percent of the time, while the rural (nonsafety net) non-RHC Medicaid rate is less than 75 percent. Measured differences are robust to covariate adjustment. CONCLUSIONS Our study suggests that RHC status, with its alternative payment model, is strongly associated with new Medicaid patient acceptance. Altering RHC financial incentives may have consequences for rural Medicaid enrollees.
Collapse
Affiliation(s)
- Michael R Richards
- Leonard Davis Institute of Health Economics, Colonial Penn Center, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Karin V Rhodes
- Perelman School of Medicine, Center for Emergency Care Policy & Research, University of Pennsylvania, Philadelphia, PA
| | - Daniel Polsky
- Wharton School and Perelman School of Medicine, Leonard Davis Institute of Health Economics, Colonial Penn Center, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
36
|
Shannon CK, Jackson J. Validity of Medical Student Questionnaire Data in Prediction of Rural Practice Choice and Its Association With Service Orientation. J Rural Health 2015; 31:373-81. [PMID: 26032782 DOI: 10.1111/jrh.12123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The validity of medical student projection of, and predictors for, rural practice and the association of a measure of service orientation, projected practice accessibility to the indigent, were investigated. METHODS West Virginia (WV) medical student online pre- and postrural rotation questionnaire data were collected during the time period 2001-2009. Of the 1,517 respondent students, submissions by 1,271 met the time interval criterion for inclusion in analyses. Subsequent WV licensing data were available for 461 in 2013. These 2 databases were used to assess for validity of projection of rural practice, for predictors of rural practice, and for student projected accessibility of the future practice to indigent patients. FINDINGS There were statistically significant associations between both pre- and postrotation projections of rural practice and subsequent rural practice. The most significant independent predictors of rural practice were student rural background, reported primary care intent, prediction of rural practice and projection of greater accessibility of the future practice to indigent patients. For scoring of practice access, there were trends for higher scoring by rural students and rural practitioners, with greater pre-post increases for those with urban hometowns. CONCLUSIONS This study demonstrates the utility of medical student questionnaires for projections of numbers of future rural physicians. It suggests that students with a rural background, rural practice intent, or greater service orientation are more likely to enter rural practice. It also suggests that students, particularly those with urban hometowns, are influenced by rural rotation experiences in forecasting greater practice accessibility and in entering rural practice.
Collapse
Affiliation(s)
- C Ken Shannon
- Department of Family Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia.,Physician Assistant Studies Program, Alderson Broaddus University, Philippi, West Virginia
| | - Jodie Jackson
- Institute for Community and Rural Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
37
|
Rafiei S, Arab M, Rashidian A, Mahmoudi M, Rahimi-Movaghar V. Factors Influencing Neurosurgeons' Decision to Retain in a Work Location: A Qualitative Study. Glob J Health Sci 2015; 7:333-51. [PMID: 26156906 PMCID: PMC4803915 DOI: 10.5539/gjhs.v7n5p333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/10/2014] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Physician retention is a serious concern to have an effective and efficient health system; the key challenge is how best to encourage and retain health providers in their work location. There have been considerable studies on factors influencing physicians' retention but little research has been conducted in Iran. This study aims to determine the affecting factors from neurosurgeons' viewpoint to support policy makers in proposing a sort of evidence based retention strategies. METHODS We conducted semi structured interviews with 17 neurosurgeons working in 9 provinces of Iran between September and November 2014. We included physicians remaining to work in a particular community for at least 3 years and asked them about the factors influenced their decision to retain in a work place. Data were thematically analyzed using "framework approach" for qualitative research. RESULTS Satisfaction with monetary incentives, availability of adequate clinical infrastructure in a community and appropriate working condition were most commonly cited factors mentioned by all participants as key reasons for retention. Furthermore elements which contributed to the quality of living condition, personal background and incentives, family convenience were emphasized by majority of them. A small number of participants mentioned opportunity for continuing learning and updating knowledge as well as supportive organizational policies as important motivators in a workplace. CONCLUSION Ministry of Health and Medical Education (MOHME) should consider a multifaceted and holistic approach to improve neurosurgeons' retention in their work location. Our findings suggests a combination of financial remuneration, establishment of adequate hospitals and clinical facilities, collaborative working environment with reasonable workload, proper living condition, family support and facilities for professional development to be employed as an effective strategy for promoting physicians' retention.
Collapse
|
38
|
Understanding shortages of sufficient health care in rural areas. Health Policy 2014; 118:201-14. [DOI: 10.1016/j.healthpol.2014.07.018] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 07/07/2014] [Accepted: 07/25/2014] [Indexed: 11/22/2022]
|
39
|
Andsager JL, Chen L, Miles S, Smith CC, Nothwehr F. Nutrition Information In Community Newspapers: Goal Framing, Story Origins, and Topics. HEALTH COMMUNICATION 2014; 30:1013-1021. [PMID: 25256633 DOI: 10.1080/10410236.2014.914620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Obesity rates are high in the rural United States. Because small communities often have few health care practitioners, nutrition news in community newspapers may be a useful source of information. This content analysis of a random sample of 164 nutrition stories from 10 community newspapers in the rural West North Central Midwest was guided by concepts from goal-framing theory. Locally generated stories comprised nearly half of the sample, suggesting that nutrition is a salient topic in many rural communities. Hedonic frames related to food enjoyment were twice as frequent as health improvement frames. Results suggest food promotion was the most common topic of nutrition stories, with guidelines for a healthy diet appearing about half as often. Stories about a healthy diet and food promotion were most often written locally. Findings are discussed with recommendations for improvement of community news coverage of nutrition.
Collapse
Affiliation(s)
- Julie L Andsager
- a School of Journalism & Electronic Media , University of Tennessee
| | | | | | | | | |
Collapse
|
40
|
Hines R, Markossian T, Johnson A, Dong F, Bayakly R. Geographic residency status and census tract socioeconomic status as determinants of colorectal cancer outcomes. Am J Public Health 2014; 104:e63-71. [PMID: 24432920 DOI: 10.2105/ajph.2013.301572] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the impact of geographic residency status and census tract (CT)-level socioeconomic status (SES) on colorectal cancer (CRC) outcomes. METHODS This was a retrospective cohort study of patients diagnosed with CRC in Georgia for the years 2000 through 2007. Study outcomes were late-stage disease at diagnosis, receipt of treatment, and survival. RESULTS For colon cancer, residents of lower-middle-SES and low-SES census tracts had decreased odds of receiving surgery. Rural, lower-middle-SES, and low-SES residents had decreased odds of receiving chemotherapy. For patients with rectal cancer, suburban residents had increased odds of receiving radiotherapy, but low SES resulted in decreased odds of surgery. For survival, rural residents experienced a partially adjusted 14% (hazard ratio [HR] = 1.14; 95% confidence interval [CI] = 1.07, 1.22) increased risk of death following diagnosis of CRC that was somewhat explained by treatment differences and completely explained by CT-level SES. Lower-middle- and low-SES participants had an adjusted increased risk of death following diagnosis for CRC (lower-middle: HR = 1.16; 95% CI = 1.10, 1.22; low: HR = 1.24; 95% CI = 1.16, 1.32). CONCLUSIONS Future efforts should focus on developing interventions and policies that target rural residents and lower SES areas to eliminate disparities in CRC-related outcomes.
Collapse
Affiliation(s)
- Robert Hines
- Robert Hines and Frank Dong are with the Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita. At the time of the study, Talar Markossian was with the Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Asal Johnson is with the Center for International Studies, Georgia Southern University. Rana Bayakly is with the Chronic Disease, Healthy Behaviors and Injury Epidemiology Section, Health Protection Division, Georgia Department of Public Health, Atlanta
| | | | | | | | | |
Collapse
|
41
|
Reply to letter: "perforated appendicitis: does rural residency really explain the delay?". Ann Surg 2013; 259:e59. [PMID: 24368642 DOI: 10.1097/sla.0000000000000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Abstract
OBJECTIVES To examine hospitalizations and length of stay (LOS) for infants aged <1 year in rural and urban counties, hypothesizing that infants living in rural counties experience significantly different hospital use compared with urban infants. METHODS Birth certificates for infants born in California hospitals between 1993 and 2005 and surviving to discharge were linked to hospital discharge records and death certificates during the first year of life, resulting in a study population of >6.4 million. Hospitalizations, cumulative LOS, readmission rates, and mortality were compared by using univariate and multivariable analysis for infants living in small rural, large rural, small urban, and large urban counties. Odds of hospitalization and cumulative LOS were also examined for common infant diagnoses. RESULTS Infants living in increasingly rural counties experienced decreasing rates of hospitalization and decreasing number of hospitalized days during the first year of life. Infants living in small rural counties experienced 370 hospital days per 1000 infants compared with 474 hospital days per 1000 infants living in large urban counties. In multivariable analysis, infants in large urban counties experienced increased odds of hospitalization (odds ratio: 1.20 [95% confidence interval: 1.06-1.36]) and increased hospitalized days (incidence risk ratio: 1.17 [95% confidence interval: 1.06-1.29]) compared with infants in small rural counties. For most common diagnoses, urban residence was associated with either increased odds of hospitalization or increased cumulative LOS. CONCLUSIONS Infants living in rural California counties experienced decreased hospital utilization, including decreased hospitalization and decreased LOS, compared with infants living in urban counties.
Collapse
Affiliation(s)
| | - Scott A. Lorch
- Division of Neonatology and Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
43
|
Cole AM, Jackson JE, Doescher M. Urban-rural disparities in colorectal cancer screening: cross-sectional analysis of 1998-2005 data from the Centers for Disease Control's Behavioral Risk Factor Surveillance Study. Cancer Med 2012; 1:350-6. [PMID: 23342284 PMCID: PMC3544460 DOI: 10.1002/cam4.40] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/27/2012] [Accepted: 10/01/2012] [Indexed: 12/14/2022] Open
Abstract
Despite the existence of effective screening, colorectal cancer remains the second leading cause of cancer death in the United States. Identification of disparities in colorectal cancer screening will allow for targeted interventions to achieve national goals for screening. The objective of this study was to contrast colorectal cancer screening rates in urban and rural populations in the United States. The study design comprised a cross-sectional study in the United States 1998-2005. Behavioral Risk Factor Surveillance System data from 1998 to 2005 were the method and data source. The primary outcome was self-report up-to-date colorectal cancer screening (fecal occult blood test in last 12 months, flexible sigmoidoscopy in last 5 years, or colonoscopy in last 10 years). Geographic location (urban vs. rural) was used as independent variable. Multivariate analysis controlled for demographic and health characteristics of respondents. After adjustment for demographic and health characteristics, rural residents had lower colorectal cancer screening rates (48%; 95% CI 48, 49%) as compared with urban residents (54%, 95% CI 53, 55%). Remote rural residents had the lowest screening rates overall (45%, 95% CI 43, 46%). From 1998 to 2005, rates of screening by colonoscopy or flexible sigmoidoscopy increased in both urban and rural populations. During the same time, rates of screening by fecal occult blood test decreased in urban populations and increased in rural populations. Persistent disparities in colorectal cancer screening affect rural populations. The types of screening tests used for colorectal cancer screening are different in rural and urban areas. Future research to reduce this disparity should focus on screening methods that are acceptable and feasible in rural areas.
Collapse
Affiliation(s)
- Allison M Cole
- Department of Family Medicine, University of Washington, Seattle, Washington, USA.
| | | | | |
Collapse
|
44
|
Distribution of American Congress of Obstetricians and Gynecologists Fellows and Junior Fellows in Practice in the United States. Obstet Gynecol 2012; 119:1017-22. [DOI: 10.1097/aog.0b013e31824cfe50] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
Wang F. Measurement, Optimization, and Impact of Health Care Accessibility: A Methodological Review. ANNALS OF THE ASSOCIATION OF AMERICAN GEOGRAPHERS. ASSOCIATION OF AMERICAN GEOGRAPHERS 2012; 102:1104-1112. [PMID: 23335813 PMCID: PMC3547595 DOI: 10.1080/00045608.2012.657146] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite spending more than any other nation on medical care per person, the United States ranks behind other industrialized nations in key health performance measures. A main cause is the deep disparities in access to care and health outcomes. Federal programs such as the designations of Medically Underserved Areas/Populations and Health Professional Shortage Areas are designed to boost the number of health professionals serving these areas and to help alleviate the access problem. Their effectiveness relies first and foremost on an accurate measure of accessibility so that resources can be allocated to truly needy areas. Various measures of accessibility need to be integrated into one framework for comparison and evaluation. Optimization methods can be used to improve the distribution and supply of health care providers to maximize service coverage, minimize travel needs of patients, limit the number of facilities, and maximize health or access equality. Inequality in health care access comes at a personal and societal price, evidenced in disparities in health outcomes, including late-stage cancer diagnosis. This review surveys recent literature on the three named issues with emphasis on methodological advancements and implications for public policy.
Collapse
Affiliation(s)
- Fahui Wang
- Department of Geography & Anthropology, Louisiana State University
| |
Collapse
|
46
|
Stoller EP, Grzywacz JG, Quandt SA, Bell RA, Chapman C, Altizer KP, Arcury TA. Calling the doctor: a qualitative study of patient-initiated physician consultation among rural older adults. J Aging Health 2011; 23:782-805. [PMID: 21311048 PMCID: PMC3130826 DOI: 10.1177/0898264310397045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Guided by Leventhal's self-regulatory model and Cockerham's theory of health lifestyles, we explore two questions regarding physician consultation among elderly rural adults: What symptom characteristics prompt patient-initiated physician consultation? Do participants' accounts of responses to symptoms, including the decision to consult a physician, incorporate descriptions of change over time? METHOD We analyze data from semistructured in-depth interviews with 62 older rural adults. RESULTS Accounts of decisions to initiate contact with physicians support prior research. Some symptoms encouraged immediate consultation; others prompted periods of monitoring and lay management. Physicians were most often contacted if changes were new, unusually severe, persisted or worsened, or failed to respond to lay treatment. DISCUSSION We characterize participants' responses to symptoms as bricolages to highlight their construction from available materials. Incorporating the integrating concept of bricolage and Cockerham's emphasis on both general dispositions and symptom-specific responses represents an important extension of Leventhal's conceptualization of illness behavior, including patient-initiated physician consultation.
Collapse
Affiliation(s)
- Eleanor Palo Stoller
- Research Professor, Department of Sociology, Box 7808, Wake Forest University, Winston-Salem, NC 27109, (336) 643-0973
| | - Joseph G. Grzywacz
- Associate Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, North Carolina 27157-1084, (336) 716-2237
| | - Sara A. Quandt
- Professor, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, (336) 716-6015
| | - Ronny A. Bell
- Professor, Department of Epidemiology and Prevention, Division of Public Health Sciences; Director, Maya Angelou Center for Health Equity, Wake Forest University Health Sciences, Medical Center Blvd, Winston-Salem, NC 27157-1063, (336) 716-9736
| | - Christine Chapman
- Project Manager, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest university School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, (336) 713-4340
| | - Kathryn P. Altizer
- Associate Project Manager, Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1084, (336) 716-1839
| | - Thomas A. Arcury
- Professor and Vice Chair for Research, Department of Family and Community Medicine; Director, Center for Worker Health, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1084, (336) 716-9438
| |
Collapse
|
47
|
Abstract
OBJECTIVE To determine whether rural patients are more likely to present with perforated appendicitis compared with urban patients. BACKGROUND Appendiceal perforation has been associated with increased morbidity, length of hospital stay, and overall health care costs. Recent arguments suggest that high rates of appendiceal rupture may be unrelated to the quality of hospital care, and rather associated with inadequate access to surgical care. METHODS We performed a retrospective cohort study of 122,990 patients with acute appendicitis from the Nationwide Inpatient Sample from 2003 to 2004. International Classification of Diseases diagnosis 9 (ICD-9) codes were used to determine appendiceal perforation. Urban influence codes from the US Department of Agriculture were used to determine rural versus urban status. Univariate and multivariate analyses were used to determine patient and hospital factors associated with perforation. RESULTS Overall, 32.07% of patients presented with perforation. Rural patients were more likely than urban patients to present with perforation (35.76% vs. 31.48%). Factors associated with perforation in multivariate analysis were age more than 40 years, male gender, transfer from another facility, black race, poorest 25th percentile, Charlson score of 3 or higher, and rural residence. Thirty percent of rural patients were treated in urban hospitals. Rural patients treated at urban hospitals were more likely to present with perforation compared with rural patients treated at rural hospitals (OR = 1.23). CONCLUSIONS Patients from rural areas have higher rates of perforation with acute appendicitis than urban patients. This difference persists when accounting for other factors associated with perforation. These differences in perforation rates suggest disparities in access to timely surgical care.
Collapse
|
48
|
Whitacre BE, Pace V, Hackler JB, Janey M, Landgraf CE, Pettit WJ. An evaluation of osteopathic school programs designed to promote rural location by graduates. INT J OSTEOPATH MED 2011. [DOI: 10.1016/j.ijosm.2010.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
49
|
Abstract
CONTEXT Recruiting and retaining physicians is a challenge in rural areas. Growing up in a rural area and completing medical training in a rural area have been shown to predict decisions to practice in rural areas. Little is known, though, about factors that contribute to physicians' decisions to locate in very sparsely populated areas. PURPOSE In this study, we investigated whether variables associated with rural background and training predicted physicians' decisions to practice in very rural areas. We also examined reasons given for plans to leave the study state. METHODS Physicians in the State of Wyoming (N = 693) completed a questionnaire assessing their background, current practice, and future practice plans. FINDINGS Being raised in a rural area and training in nearby states predicted practicing in very rural areas. High malpractice insurance rates predicted planning to move one's practice out of state rather than within state. CONCLUSIONS Rural backgrounds and training independently predict practice location decisions, but high malpractice rates are the most crucial factor in future plans to leave the state.
Collapse
Affiliation(s)
- Carolyn M Pepper
- Department of Psychology, University of Wyoming, Laramie, Wyoming 82071, USA.
| | | | | |
Collapse
|
50
|
The Role of Local Health Departments in Providing Sexually Transmitted Disease Services and Surveillance in Rural Communities. J Community Health 2010; 36:204-10. [DOI: 10.1007/s10900-010-9298-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|