Journal of Rural Health最新文献

{"title":"Rural and urban differences in family physician burnout before and during the COVID-19 pandemic","authors":"Sara C. Woolcock MPH, RDN,&nbsp;Davis G. Patterson PhD,&nbsp;Julia A. Dunn MSc,&nbsp;Lars E. Peterson MD, PhD,&nbsp;C. Holly A. Andrilla MS","doi":"10.1111/jrh.70051","DOIUrl":"https://doi.org/10.1111/jrh.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Understanding the different challenges rural and urban family physicians faced during the COVID-19 pandemic is essential for developing strategies to combat burnout. This study described the prevalence of burnout among rural and urban family physicians before and during the pandemic, examining physician and practice characteristics associated with burnout.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a repeated cross-sectional analysis of survey responses of 25,018 family physicians from the American Board of Family Medicine National Graduate Survey and Practice Demographic Survey from 3 time periods: pre-pandemic (January 2019-March 2020), early pandemic (April 2020-April 2021), and later pandemic (May 2021-June 2022). We used bivariate analyses and logistic regression to compare self-reported burnout in rural and urban family physicians over these time periods, controlling for physician and practice characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 43.5% of family physicians included in this study met the criteria for burnout. The burnout rate was slightly higher for rural physicians (45.2%) compared to urban physicians (43.2%), but not statistically significant. In the adjusted analyses, there was no association of rurality and burnout (adjusted risk ratio [aRR] 1.04, 95% CI 1.00-1.09). Family physicians in the later stage of the pandemic were more likely to report burnout than in the pre-pandemic stage (aRR 1.06, 95% CI 1.02-1.10).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found burnout was a pervasive concern among family physicians over the stages of the pandemic, although we found no differences in burnout between rural and urban family physicians. Addressing family physician burnout is crucial to maintaining a resilient rural primary care workforce.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing access to orthotic and prosthetic care in rural communities: Satisfaction with the Department of Veterans Affairs Mobile Prosthetic and Orthotic Care Program","authors":"Chelsea Leonard  ,&nbsp;William Feser  ,&nbsp;Lauren McKown  ,&nbsp;Emily Whitfield  ,&nbsp;George E. Kaufman  ,&nbsp;Daniel Abrahamson  ,&nbsp;Jessica Young","doi":"10.1111/jrh.70050","DOIUrl":"https://doi.org/10.1111/jrh.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the Veteran's Health Administration (VHA), rural Veterans who need orthotic and prosthetic (O&amp;P) care typically travel to urban VHA medical centers (VAMCs). This presents a barrier to receiving O&amp;P care, as travel may be burdensome due to medical or psychosocial issues. The VHA Mobile Prosthetic and Orthotic Care Program (MoPOC) removes access barriers to VHA O&amp;P care by providing care in rural VHA clinics or in Veterans’ homes. The goal of this evaluation was to understand if Veterans are satisfied with access to MoPOC care, MoPOC clinicians, and impacts of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a convergent mixed methods evaluation with a satisfaction survey and qualitative interviews among Veterans who received MoPOC care. Surveys were analyzed descriptively. Interviews were analyzed using rapid matrix analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We received 598 survey responses (36% response rate) from six MoPOC sites and conducted 35 interviews. Findings included high Veteran satisfaction with MoPOC clinicians, high satisfaction with MoPOC care, improved access to care, allowing Veterans to stay in the VHA for care, positive impacts on quality of life, and challenges related to timeliness of device delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion/significance</h3>\u0000 \u0000 <p>Veterans were satisfied with MoPOC and MoPOC increased access to care. Many Veterans reported that they would not have received O&amp;P care without MoPOC. This, along with the perceived quality of life impacts, indicates that expanding access to VHA O&amp;P care in rural areas benefits Veterans. Many Veterans preferred to receive care in the VHA, suggesting programs like MoPOC are preferable to outsourcing care to non-VHA settings. Ensuring timeliness of device delivery is a key challenge, and it is unknown how satisfaction of timeliness within the VHA compares to satisfaction with timeliness of device provision in other settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in rural and urban outcomes in populations with human papillomavirus–associated oropharyngeal cancers","authors":"Kale G. Mills BS,&nbsp;Nathan Farrokhian MD,&nbsp;Elizabeth Ablah PhD, MPH,&nbsp;Kevin J. Sykes PhD, MPH","doi":"10.1111/jrh.70048","DOIUrl":"https://doi.org/10.1111/jrh.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Importance</h3>\u0000 \u0000 <p>There is a need to understand how the increasing rate of HPV-positive oropharyngeal cancers may affect underresourced populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate possible disparities in survival and cause-specific mortality between rural and urban populations with HPV-associated oropharyngeal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Our retrospective cohort study utilized the Surveillance, Epidemiology, and End Results (SEER) Pharyngeal Cancer with HPV Status Database from 2006 to 2018.   Cox proportional hazard models and Kaplan–Meier curves were employed to evaluate the differences in overall survival and cause-specific mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>SEER data used in this study originate from a set of regional cancer registries located across the country.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Patients diagnosed with HPV-associated oropharyngeal cancer from 2006 through 2018 in the SEER HPV status database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome(s) and Measure(s)</h3>\u0000 \u0000 <p>The difference in overall survival and cause-specific mortality between rural and urban populations with HPV-associated oropharyngeal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 13,294 patients were included in our study, most of whom lived in urban counties (88.5%, <i>n</i> = 11,766), had a mean age of 60.6 years (SD = 9.6), and had a primary tumor site located in the tonsil (47.6%, <i>n</i> = 6328). Rural communities had a higher likelihood of all-cause mortality (hazard ratio [HR] 1.14, 95% confidence interval [CI], 1.02–1.29) compared to their urban counterparts. Additionally, rural residents had a higher probability of cause-specific mortality (HR 1.15, 95% CI, 1.01–1.32) compared to their urban counterparts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with HPV-associated oropharyngeal cancer who reside in rural areas were more likely to die when compared to their urban counterparts. More research is needed to determine the best way to mitigate this disparity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal cancer survival disparities in persistent poverty areas","authors":"Peter DelNero PhD,&nbsp;Mario Schootman PhD,&nbsp;Cheng Peng PhD,&nbsp;Mahima Saini B. Pharm,&nbsp;Emily Hallgren PhD,&nbsp;Jonathan Laryea MD,&nbsp;Chenghui Li PhD","doi":"10.1111/jrh.70045","DOIUrl":"https://doi.org/10.1111/jrh.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>We examined whether living in persistent poverty census tracts was associated with disparities in colorectal cancer (CRC) survival and whether the association varied between urban and rural settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using 2013–2019 state-wide cancer registry and 2013–2021 death records data, CRC patients were classified by tract-level persistent poverty and rural/urban status. Overall and CRC-specific survival were compared using Kaplan–Meier estimation and log-rank tests. Adjusted analyses were conducted using Cox proportional hazard and Fine-Gray competing risk models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>During the study period, 558 (53%) of 1055 CRC patients died in persistent poverty tracts versus 3117 (45%) of 6938 patients in nonpersistent poverty tracts. Of the 3675 deaths, 2269 (61.7%) were from CRC-specific causes. In unadjusted analysis, CRC patients in persistent poverty areas had a higher risk of all-cause (HR, 95%CI: 1.28, 1.17–1.40) and CRC-specific (HR, 95% CI: 1.17, 1.04–1.31) mortality. After covariates adjustment, the relationship between persistent poverty and all-cause mortality (HR, 95% CI: 1.17, 1.06–1.29) and non-CRC-specific mortality (HR, 95% CI: 1.34, 1.15–1.57) remained significant, but CRC-specific mortality did not. In subgroup analyses, persistent poverty was associated with increased overall mortality among urban tracts (HR, 95% CI: 1.22, 1.08–1.38), but not rural tracts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>After covariates adjustment, CRC patients in persistent poverty tracts are more likely to die of all causes and non-CRC causes but not CRC-specific causes than those in nonpersistent poverty areas, suggesting that differences in CRC-specific deaths may be partly attributed to demographics, geography, tumor characteristics, and treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The provision of tele-behavioral health services by critical access hospitals and short-term acute care hospitals during the COVID-19 public health emergency","authors":"Yvonne Jonk PhD,&nbsp;Heidi O'Connor MS,&nbsp;Sharita Thomas MPP,&nbsp;Chrisopher M. Shea PhD","doi":"10.1111/jrh.70047","DOIUrl":"https://doi.org/10.1111/jrh.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study examined how the telehealth (TH) flexibilities introduced during the COVID-19 public health emergency (PHE) affected in-person behavioral health (BH) and tele-behavioral health (TBH) patterns of use among Medicare Fee-for-Service beneficiaries receiving care at critical access hospitals (CAHs) and non-CAH short-term acute care hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the 2019–2021 5% Medicare Limited Data Set Outpatient and Carrier files to explore differences in TBH usage trends by hospital type in the pre-pandemic year of 2019 and during the pandemic (2020–2021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The percentage of hospitals providing TBH services significantly increased from 2019 to 2020–2021 (CAHs: 9% to 17%–23%; non-CAHs: 3% to 21%–22%). Although CAHs had higher TBH usage rates (i.e., the percentage of BH visits conducted through TH) than non-CAHs in the pre-pandemic period, usage rates among non-CAHs (7%–25%) outpaced CAHs (5%–16%) across all census regions—particularly in the Northeast—during the pandemic. In 2021, non-CAHs were able to sustain the use of TBH at higher levels than CAHs across all census regions except for the South.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While both CAHs and non-CAHs took advantage of the PHE TH flexibilities and significantly increased the likelihood and levels of TBH services, non-CAHs realized higher TBH usage rates than CAHs. The increase in the use of TBH visits was not enough to curb the decline in in-person BH visits during the pandemic. Given efforts to expand broadband and improve digital literacy in rural areas, TH continues to have great potential to reduce rural–urban BH differences in access to BH services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144550853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights into suicidality in rural communities: Lessons from Rawat et al. (2025) and perspectives from Alaska and Colorado","authors":"Ezra N. S. Lockhart PhD, LMFT, LAC","doi":"10.1111/jrh.70046","DOIUrl":"https://doi.org/10.1111/jrh.70046","url":null,"abstract":"","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520228","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":"Impact of rurality and the area deprivation index on outcomes of collaborative care for depression","authors":"Samuel T. Savitz PhD,&nbsp;Alanna M. Chamberlain PhD,&nbsp;Ruoxiang Jiang BSc,&nbsp;Sheharyar Sarwar DO,&nbsp;Mark D. Williams MD","doi":"10.1111/jrh.70044","DOIUrl":"https://doi.org/10.1111/jrh.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The Collaborative care model (CoCM) is the leading model for integrating behavioral health into primary care for patients with major depressive disorder (MDD). However, CoCM requires engagement and ongoing participation. We aimed to assess whether two area-based measures, the area-deprivation index (ADI) and rurality, were associated with enrollment, participation, and outcomes with CoCM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an observational analysis of Mayo Clinic patients eligible for CoCM: adults aged ≥18 years, empaneled in primary care, and with a PHQ-9 of ≥10. We operationalized ADI as quintiles with Q1 being least deprived and Q5 being most deprived and rurality using RUCA codes with two categories: urban and rural. We evaluated enrollment in CoCM, drop out defined by leaving the program early, the count and type of contacts with the care coordinator, and clinical improvement measured using the PHQ-9.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We identified 54,030 individuals with 16,532 (30.6%) residing in rural areas and 11,122 (20.6%) residing in the most deprived ADI quintile (Q5). Living in a rural area was associated with lower enrollment in CoCM (–2.3 percentage points [95% confidence interval (CI): –2.5, 2.2]), longer length in CoCM (18.6 days [95% CI: 5.7, 31.5]), more contacts with the care coordinator (1.1 contacts [95% CI: 0.2, 2.0]), and worse response and remission. In contrast, ADI Q5 was only associated with worse response and remission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rurality was associated with lower enrollment, greater engagement, and worse clinical outcomes. More work may be needed to address enrollment barriers for individuals living in rural areas to improve clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of California Proposition 56 on smoking behaviors across geographic residence","authors":"Courtney Keeler PhD,&nbsp;Alexa Colgrove Curtis PhD, MPH, APRN","doi":"10.1111/jrh.70041","DOIUrl":"https://doi.org/10.1111/jrh.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To explore the geographic impact of California's Proposition 56 (Prop 56) on smoking behaviors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified 61,193 respondents aged 21+ from the 2012–2018 California Behavioral Risk Factor Surveillance Survey. We constructed county identifiers indicating whether (1) a respondent lived in an urban, suburban, or rural county and (2) whether a respondent lived in a metropolitan statistical area (MSA) or not. Similarly, we created a binary variable indicating whether Prop 56 was in effect (Yes/No). We used a two-part model to estimate the association of Prop 56 with smoking participation among all adults and smoking intensity (average number of cigarettes smoked per day (CPD)) among current smokers. Models were run separately for each geographic subgroup. Additional covariates included sociodemographic characteristics and a time trend variable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Smoking prevalence was significantly different across geographic groups, with rates highest among the rural population group (13.8%) and lowest among the urban subgroup (9.1%). Similarly, rates of smoking intensity were significantly higher among non-urban populations, with average CPD highest among the rural population (10.66) and lowest among the urban subgroup (8.32). Regression models highlighted a negative association between Prop 56 and smoking participation only among the urban and MSA subgroups (<i>p</i> &lt; 0.001). We found no evidence of an association between the enactment of Prop 56 with average CPD for any geographic group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Public health experts, clinicians, and policymakers might consider additional interventions that can be implemented in tandem with pricing tools to help reduce observed geographic disparities in smoking among rural—and even suburban—communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic disparities in unpaid caregiving","authors":"Emma Kathryn Boswell MPH,&nbsp;Monique J. Brown PhD,&nbsp;Lorie Donelle PhD,&nbsp;Nicholas Yell PhD,&nbsp;Taryn Farrell MPH,&nbsp;Peiyin Hung PhD,&nbsp;Elizabeth Crouch PhD","doi":"10.1111/jrh.70039","DOIUrl":"https://doi.org/10.1111/jrh.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>An updated, nationally representative examination of rural–urban differences in the experiences, health, and well-being of caregivers is needed; previous research on this topic uses older data or has limited generalizability. This study examines rural–urban differences in the characteristics, experiences, and health of caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 2021–2022 Behavioral Risk Factor Surveillance System (<i>n</i> = 44,274 unpaid caregivers) was used, with rurality defined according to the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme. Chi-square tests compared rural–urban differences in these caregivers’ characteristics, including demographic factors, caregiving intensity (e.g., weekly hours spent caregiving, reason for caregiving, past-month ADL/IADL assistance), caregiver's health (e.g., general health status and past month physical health, mental health, and limited activity), and caregiver's health behavior (chronic illness, smoking status, binge drinking, and annual checkups).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Compared to urban caregivers, rural caregivers were more likely to have at least one chronic condition (58.3% vs. 53.2%; <i>p</i> &lt; 0.0001), be obese (42.9% vs. 37.5%; <i>p</i> &lt; 0.0001), be a smoker (24.2% vs. 15.5%; <i>p</i> &lt; 0.0001), and less likely to be a binge drinker (12.7% vs. 15.3%; <i>p</i> = 0.003). Compared to urban caregivers, rural caregivers were more likely to report their general health status as fair/poor (20.3% vs. 17.0%, <i>p</i> = 0.0003) and were more likely to report 14 or more days of poor physical health in the past month (15.6% vs. 12.0%, <i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Understanding geographic disparities in the experiences and context of unpaid caregiving is needed to improve their overall well-being and health. Future research will be necessary to determine factors associated with these outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phone-only mental health care within the Department of Veterans Affairs: Associations with rurality, age, sex, and clinical severity","authors":"Samantha L. Connolly PhD,&nbsp;Amber B. Amspoker PhD,&nbsp;Annette Walder MS,&nbsp;Kathleen M. Grubbs PhD,&nbsp;Liang Chen MD MS,&nbsp;Anthony H. Ecker PhD,&nbsp;Julianna B. Hogan PhD,&nbsp;Jan A. Lindsay PhD","doi":"10.1111/jrh.70043","DOIUrl":"https://doi.org/10.1111/jrh.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study explores factors associated with an increased likelihood of receiving mental health (MH) care exclusively via audio-only phone visits within the Department of Veterans Affairs (VA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Included patients had ≥1 VA MH outpatient encounter between October 1, 2021-September 30, 2022 and October 1, 2022-September 30, 2023. Patients were divided into a “phone only” group and an “all other” group, which encompassed all patients who did not exclusively receive phone care, including video and/or in-person care. Logistic regression models evaluated demographic and clinical predictors of receiving MH care via phone only.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sample included 1,156,146 patients; 49,125 (4.25%) in the phone only group and 1,107,021 (95.75%) in the all other group. The following were associated with greater odds of receiving MH care via phone only in a multivariate model, all <i>Ps</i>&lt;.0001: being highly rural (OR = 1.50), age 65+ (ORs ≥2.17), with fewer than 3 MH diagnoses (OR = 2.03), and &gt;50% of MH visits conducted by a medical MH provider (OR = 1.87).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients who were rural and older had greater odds of receiving MH care exclusively by phone. It will be important to assess whether this was by choice or whether they are experiencing barriers to accessing video or in-person care that could be addressed. Patients who were less clinically severe and were seen primarily by a medical MH provider were also more likely to receive phone-only care. Future research should examine the relative effectiveness of audio-only care as compared to video and in-person.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}