Journal of Rural Health最新文献

{"title":"Measuring disparities to emergency medicine with 200 million voter records: The case of rural hospital closures","authors":"Michael E. Shepherd PHD,&nbsp;Christian Cox PHD,&nbsp;Derek A. Epp PHD","doi":"10.1111/jrh.70019","DOIUrl":"https://doi.org/10.1111/jrh.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Distance to health service providers is related to increased mortality risk and decreased service utilization. However, existing studies of distance to services often rely either on aggregated measures of distance or small samples of survey respondents. Nationwide individual data from 200 million Americans are used to assess various demographic groups’ distances to open acute hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We gathered the exact location of every open acute hospital from the UNC Cecil G. Sheps Center and the Department of Health and Human Services. We merged this information with data on 200 million voters from the L2 voter file for 2020. We calculate each registered voters’ distance to the nearest open hospital in kilometers by demographic, region, and state Medicaid expansion status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The average American adult is 5 miles from the nearest hospital. Native Americans and rural White Americans face the longest distances to medical services. Lower-income adults face longer distances than higher-income adults. Those over 65 are roughly 10% farther away in comparison to those 18-40. Registered Republicans are 30% farther than registered Democrats. Recent hospital closures in states that have yet to expand Medicaid have contributed to all of these disparities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lower-income and older Americans, groups that tend to have worse health overall, face the longest travel distances to hospitals—perhaps contributing to income and age-based health disparities. Native Americans and rural whites, who themselves experience considerable health hardship, also have significant travel burdens to receive hospital care. Registered Republicans have longer travels to emergency care than Democrats, adding to recent research on partisan health disparities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statewide implementation for medications for opioid use disorder (MOUD) in urban and rural emergency departments","authors":"Margaret Greenwood-Ericksen MD, MSc,&nbsp;Mary Blasi MS,&nbsp;Brandon J. Warrick MD,&nbsp;James Cotton MD,&nbsp;Eric Ketcham MD,&nbsp;Cindy Ketcham RN,&nbsp;Sally Wait BSN,&nbsp;Rachel Abeyta BFA,&nbsp;Douglas Ziedonis MD, MPH,&nbsp;Julie G. Salvador PhD","doi":"10.1111/jrh.70011","DOIUrl":"https://doi.org/10.1111/jrh.70011","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medications for opioid use disorder (MOUD) programs in Emergency Departments (EDs) are feasible and effective, but uptake lags despite rising overdose deaths. NM Bridge partners with hospitals across highly rural New Mexico to guide implementation for ED-based MOUD using a Dissemination &amp; Implementation (D&amp;I) approach. This manuscript describes NM Bridge's outcomes in its first three years (2020–2023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NM Bridge offers partner hospitals a D&amp;I intervention called implementation facilitation (IF) to guide their implementation of ED-based MOUD. The IF intervention has three mechanisms: (1) trainings, (2) a guiding blueprint (implementation plan), and (3) biweekly meetings. Each hospital receives tailored trainings, builds a team of champions who lead the work in the blueprint and are supported in biweekly meetings by the NM Bridge team. Successful implementation is defined as hospitals completing trainings, prescribing buprenorphine from the ED, and providing a warm hand-off to outpatient treatment. Primary outcomes include buprenorphine prescriptions written, clinicians trained, and peer support workers (PSW) hired.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 10/2020 to 12/2023, NM Bridge recruited 34 hospitals, engaged 12, with six fully participating. In engaged hospitals (8 rural, 4 urban), 100% recognized MOUD as a vital practice, but all reported barriers of locums staffing, &lt;25% <i>x</i>-waivered clinicians, and stigma. The six participating hospitals (4 rural, 2 urban) achieved 100% of IF mechanisms, variable blueprint (implementation plan) achievement, and 100% successfully implemented MOUD. This resulted in a 52.3% increase in buprenorphine prescriptions [728 patients (592 rural, 136 urban)], 144 clinicians trained, and 50% of EDs hiring a PSW.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implementation facilitation of ED-based MOUD programs was successful across six diverse hospitals, in a highly rural state.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural–urban movement and stability in relation to minority stress-related factors, tobacco norms, and tobacco use among a sample of US sexual minority-identifying young adults","authors":"Katelyn F. Romm PhD,&nbsp;Erin A. Vogel PhD,&nbsp;Patricia A. Cavazos-Rehg PhD,&nbsp;Carla J. Berg PhD, MBA","doi":"10.1111/jrh.70016","DOIUrl":"https://doi.org/10.1111/jrh.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Sexual minority young adults (SMYAs) residing in rural (vs. urban) areas report higher tobacco use rates. Less work has assessed associations of rural–urban residential movement/stability with SMYAs’ tobacco use and factors driving these associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 2023 survey data from 1082 US SMYAs (aged 18–34). Multivariable regressions controlling for sociodemographics examined associations of: (1) rural–urban movement/stability (urban stability, rural–urban movement, rural stability [REF]) with minority stress-related factors (mental health symptoms, internalized stigma), perceived tobacco norms (peer tobacco use, social acceptability of tobacco use), and tobacco use (past-month cigarette, e-cigarette, any tobacco use, number of products used); and (2) minority stress-related factors and tobacco norms with tobacco use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Relative to SMYAs reporting rural stability, those reporting rural–urban movement and urban stability displayed lower odds of any tobacco use and mental health symptoms, and less peer tobacco use. Those reporting rural–urban movement also reported lower odds of cigarette use and less internalized stigma. Peer tobacco use was associated with higher odds of cigarette and any tobacco use; reporting ≥ moderate mental health symptoms and greater internalized stigma and social acceptability was associated with higher odds of cigarette use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These novel findings provide preliminary evidence that, relative to their SM peers who reside in rural areas, SMYAs who move from rural to urban areas may experience less minority stress-related factors and lower tobacco use norms, which may reduce risk for cigarette and other tobacco use. Findings highlight the need for public health messaging interventions targeting SMYAs in rural communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural Health Research in the 21st Century: One Health Considerations","authors":"Eugene J. Lengerich VMD, MS","doi":"10.1111/jrh.70015","DOIUrl":"https://doi.org/10.1111/jrh.70015","url":null,"abstract":"&lt;p&gt;I read with interest the commentary on rural health research in the 21st century by Moloney and associates in the December 16, 2024 issue of Journal of Rural Health.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In the commentary, the authors begin with the premise that “rural health research…has faced significant challenges in defining rural area, methodological constraints in studying dispersed populations, and complex social and cultural factors.” The authors present reasonable 21st-century digital and technologic solutions for these challenges.&lt;/p&gt;&lt;p&gt;The purpose of the present commentary is to offer additional considerations on rural health research in the 21st century, especially addressing the “complexity of rural socio-cultural dynamics.”&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The present commentary draws from my experience in the Commonwealth of Pennsylvania, where I currently conduct rural health research and, along with my wife, manage a small farm that has been in her family for over 50 years.&lt;/p&gt;&lt;p&gt;I agree that there is definitional inconsistency for “rural.”&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While use of a quantified definition (e.g., based upon the US Census) of a geopolitical area offers objectivity, socioeconomic and cultural components are also important to a rural definition. First, areas not designated by the US Census or another organization as “rural” may have a “rural” economic base, such as agriculture. For example, greenhouse, nursery, and agritourism are often agriculture enterprises in non-rural areas. Second, classification of a geopolitical area may change even though the people who reside there may not. Six of the 67 counties in Pennsylvania classified by the 2013 Rural-Urban Continuum Codes (RUCC) classification as nonmetropolitan (RUCC designation of 4+) or metropolitan changed with the 2023 RUCC classification: one nonmetropolitan county changed to metropolitan status while five metropolitan counties changed to nonmetropolitan status.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Finally, rural identity may be associated with a sense of place, culture and longevity among the residents.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; While it is necessary to quantify characteristics (e.g., population density, health care facilities) of geopolitical areas, the socioeconomic and cultural characteristics of the people who reside there may be not be consistent with the area's designation and introduce misclassification bias.&lt;/p&gt;&lt;p&gt;Recently, the Federal Reserve Bank of Philadelphia created the Reliance Index to quantify the importance that hospitals and higher education institutions play in regional economies.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; While most of their 524 US regions are metropolitan, the initiative identifies nonmetropolitan regions, including the northern, southern, and western nonmetropolitan regions in Pennsylvania. The average Reliance Index for these three nonmetropolitan regions was 0.59, substantially lower than the 1.0 for the United States. These data quantify the lack of a traditional anchor","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143602532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural–urban differences in opioid prescribing in the Veterans Health Administration","authors":"Rena E. Courtney PhD,&nbsp;Brian C. Lund PharmD,&nbsp;Katherine Hadlandsmyth PhD","doi":"10.1111/jrh.70014","DOIUrl":"https://doi.org/10.1111/jrh.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To determine whether higher rates of opioid prescribing among rural Veterans in the Veterans Health Administration (VHA), previously observed through 2016, persisted through 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>National VHA administrative data were used to contrast opioid prescribing between urban and rural Veterans for annual veteran cohorts from 2016 through 2023. The primary prescribing metric was per capita volume expressed as morphine milligram equivalents (MME). Prescribing metrics were contrasted between urban and rural Veterans using Wilcoxon signed rank tests and odds-ratios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Per capita opioid prescribing was 35% higher among rural Veterans (1275 MME) than urban Veterans (943 MME) in 2016. While overall volume decreased markedly by 2023, opioid prescribing remained higher among rural Veterans (391 MME vs. 270 MME), by 45%. The largest difference was attributable to long-term recipients, which accounted for 325 MME of the 332 MME difference (98%) during 2016 and 118 of the 121 MME difference (98%) in 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher rates of opioid prescribing among rural Veterans have persisted through 2023, largely driven by differences in long-term prescribing. This may indicate a need for enhanced access to nonpharmacological management options for chronic pain among rural Veterans. Leveraging existing resources within VHA such as the Whole Health System may enhance pain care for rural Veterans.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“I'm tired of seeing my friends die”: Barriers and facilitators to participating in clinical trials among rural people who use drugs in the United States","authors":"Kathryn E. Lancaster PhD,&nbsp;Angela T. Estadt PhD,&nbsp;Madison N. Enderle MPH,&nbsp;Todd P. Korthuis MD,&nbsp;April M. Young PhD","doi":"10.1111/jrh.70009","DOIUrl":"https://doi.org/10.1111/jrh.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Participation in clinical trials among people who use drugs (PWUD) in rural areas remains disproportionately low compared to those in urban communities. Our objective was to describe the barriers and facilitators to clinical trial participation among this understudied and underserved population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured in-depth interviews among rural PWUD in Kentucky, Ohio, and Oregon. Using the Ickovics and Meisler framework, we classified factors associated with participation in clinical trials among rural PWUD into five categories: the individual, trial and intervention characteristics, participant-trial staff relationship, clinical trial setting, and features of the disease. We used inductive qualitative analysis methods to identify salient themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Thirty-five rural participants (median age: 39, 51% men) completed in-depth interviews. Facilitators for rural clinical trial participation were mainly situated within the individual, trial and intervention characteristics, and clinical trial setting. Individual characteristics, such as altruistic motivations to help their communities and peers, as well as trial and intervention characteristics like visit reminders and resource assistance, were the most frequently noted facilitators of clinical trial participation. In contrast, participation barriers were mainly related to participant-trial staff relationships and disease features. Judgmental and untrustworthy trial staff, along with involvement in the criminal legal system, were obstacles to clinical trial participation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individual, intrapersonal, and logistical factors described by rural PWUD must be addressed to enhance the participation and retention of this population in clinical trials. Successful clinical trial participation may contribute to equitable access to essential health services by PWUD in rural communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The rural disadvantage – prostate cancer outcomes of rural and urban patients over 25 years","authors":"Patrick Albers MD,&nbsp;Guocheng Huang MD,&nbsp;Safaa Bashir MBBS,&nbsp;Nikhile Mookerji MD,&nbsp;Jacob Bennett BSc,&nbsp;Stacey Broomfield PhD,&nbsp;Anaïs Medina Martín PhD,&nbsp;Sunita Ghosh PhD,&nbsp;Adam Kinnaird MD, PhD","doi":"10.1111/jrh.70008","DOIUrl":"https://doi.org/10.1111/jrh.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Prostate cancer is a common malignancy among men, with disparities based on the geographic location. This study aims to evaluate long-term trends in prostate cancer outcomes among rural and urban populations within a universal health care system, providing insights into the persistent disparities in cancer-specific mortality despite supposed equal access to medical coverage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted using data from the Alberta Cancer Registry (January 1, 1999 to December 31, 2022) and the Alberta Prostate Cancer Research Initiative (APCaRI) (July 1, 2014 to June 7, 2024). There were 45,602,119 person-years from the Alberta Cancer Registry and 8932 men from APCaRI. The exposure was the place of residence, categorized as urban or rural, based on postal codes at the time of diagnosis and death. The primary outcome was prostate cancer-specific mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Rural men were diagnosed at an older age (66.7 vs. 68.9, <i>p</i>&lt;0.001) and had higher age-adjusted prostate cancer-specific mortality compared to urban men (52.0 vs. 37.6 deaths per 100,000, <i>p</i>&lt;0.001). Though both groups showed improvements over time, rural areas consistently had higher age-adjusted mortality rates. Despite a 38% relative increase in prostate cancer specific mortality, rural patients had minimal, though statistically significant differences in PSA (9% vs. 11% &gt;20, <i>p</i> = 0.008), stage (40% vs. 46% T2–T4, p&lt;0.001) and Gleason Grade Group (11% vs. 14% ≥4, <i>p</i>&lt;0.001) at diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study reveals that rural men experienced significantly worse prostate cancer outcomes compared to urban men. These findings highlight the need for targeted health care interventions to improve access to care in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural–urban differences in mental health and psychotherapy use among veterans with military sexual trauma: A retrospective cohort study","authors":"Derrecka M. Boykin Ph.D.,&nbsp;Laura Haney Ph.D.,&nbsp;Amber B. Amspoker Ph.D.,&nbsp;Annette Walder M.S.,&nbsp;Natalie Hundt Ph.D.","doi":"10.1111/jrh.70013","DOIUrl":"https://doi.org/10.1111/jrh.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The present study examined differences in the mental health outcomes and psychotherapy use of rural Veterans with military sexual trauma (MST), as compared to their urban peers, given rural Veterans’ increased risk for delayed or missed care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed Veterans Health Administration (VHA) administrative data for 311,917 Veterans with a history of MST. Veterans were classified as rural/highly rural (30.25%) or urban (69.75%) based on VHA Rural-Urban Commuting Area codes. Rural-urban differences were assessed for mental health disorders and service use across 4 VHA clinic types (i.e., integrated Primary Care-Mental Health Clinic, General Mental Health Clinic, Posttraumatic Stress Disorder Clinical Team, Substance Use Disorder Clinic) using logistic regression models adjusted for age. Analysis of covariance models compared differences in utilization intensity among Veterans with at least 1 encounter in the designated clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Compared to urban Veterans with MST, rural Veterans with MST were more likely to be diagnosed with an anxiety disorder but less likely to be diagnosed with posttraumatic stress disorder, depression, bipolar disorder, alcohol use disorder, and other substance use disorder. As expected, rural Veterans with MST were less likely to receive individual and group psychotherapy services, regardless of the VHA clinic type, than their urban counterparts. Notably, rural Veterans remained in individual and group treatment longer than urban Veterans across nearly all clinics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Further investigation into challenges and opportunities to improve mental health care initiation among rural Veterans with MST is a critical next step in optimizing their well-being and quality of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of rural–urban differences in hospitalization for ambulatory care-sensitive conditions: Analysis of linked survey, hospitalization, and tax data from Canada","authors":"Yihong Bai PhD,&nbsp;Saverio Stranges MD, PhD,&nbsp;Sisira Sarma PhD","doi":"10.1111/jrh.70010","DOIUrl":"https://doi.org/10.1111/jrh.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospitalizations for ambulatory care sensitive conditions (ACSCs) reflect the efficiency of the primary care system, as these are preventable with timely and effective management of chronic conditions. We examined ACSC hospitalization trends in Canada's rural and urban areas, excluding Quebec, from 2007 to 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The data came from Canadian Community Health Surveys linked with hospitalizations and household income tax records. The study focused on adults aged 18–74 years and used logit and zero-inflated Poisson models to analyze ACSC hospitalizations and costs. A non-linear decomposition method quantified explained and unexplained rural–urban gaps in ACSC hospitalizations and costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found persistent disparities in ACSC hospitalizations between rural and urban areas, although the gap has narrowed since 2010. Even after adjusting for socio-demographic factors, chronic conditions, and risky health behaviors, rural–urban disparities in ACSC rates remained, highlighting unequal access to primary care in rural areas. The decomposition results revealed that the disparities were driven mainly by differences in the observed characteristics. Further investigation revealed that disparities were due to populations with lower income and education, and residents in Atlantic provinces.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study underscores the importance of a strong primary care system to minimize ACSC-related hospitalizations in rural Canada. Our results highlight the benefits of primary care reforms undertaken by provinces over the past decade in reducing rural–urban gaps in ACSC hospitalizations. Future policy interventions targeting disadvantaged populations, such as those with lower income and education, are vital for reducing avoidable hospitalizations and enhancing population health outcomes in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural maternal health interventions: A scoping review and implications for best practices","authors":"Rachel D'Amico Gordon MD, MPH,&nbsp;Alyson Kishi BS,&nbsp;Jordyn A Brown MPH,&nbsp;Christiane Voisin MSLS,&nbsp;Nicole Thomas PhD, MS,&nbsp;Sean R Riley MSc, MA,&nbsp;Naleef Fareed PhD,&nbsp;Alicia Bunger PhD,&nbsp;Shannon L Gillespie PhD, RN,&nbsp;Kartik K Venkatesh MD, PhD,&nbsp;Lisa Juckett PhD, OTR/L,&nbsp;Seuli Bose Brill MD","doi":"10.1111/jrh.70007","DOIUrl":"https://doi.org/10.1111/jrh.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Maternal health outcomes in rural areas of the United States are persistently poor, with pregnant individuals in rural areas facing complex health care obstacles. Interventions adapted to the needs of rural patients are critical to mitigate worsening health disparities. To inform future efforts in this field, we conducted a scoping review, given the complex and diverse nature of existing interventions, to synthesize the literature on rural maternal health interventions, analyze mechanisms to improve care, and identify barriers and facilitators to intervention implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a scoping review of peer-reviewed literature across six databases for maternal health interventions in rural populations. Relevant studies were analyzed for study setting, intervention type, impact on maternal health outcomes, and facilitation and barriers of intervention implementation mapped to the Consolidated Framework for Implementation Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We identified 64 studies published between 2010 and 2024 through comprehensive database searches relevant to our review. We determined six proposed mechanisms of action via thematic analysis across the pregnancy continuum: increased care connection, social support, care frequency, education, self-efficacy, and positive reinforcement. While the facilitators and barriers to implementation varied across the six themes, common facilitators included state-level buy in, integration of community partnerships, cultural humility in study design, and dedicated interdisciplinary teams. Common barriers included lapses in insurance, transportation difficulties, and communication challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our review shares lessons that future interventions and policies can build upon to improve peripartum care for individuals living in rural communities. Further work is needed to address intersectional disparities in rural maternal health and ensure equitable implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}