Journal of Rural Health最新文献

{"title":"Rural-specific identity and associations with lifestyle behaviors and well-being among rural cancer survivors","authors":"Kristina L. Tatum PsyD,&nbsp;Bonny B. Morris PhD, MSPH, RN,&nbsp;Trevin E. Glasgow PhD,&nbsp;Sam Mool (Julie) Lee BA,&nbsp;D. Jeremy Barsell MS,&nbsp;Kendall Fugate-Laus BS,&nbsp;Bernard F. Fuemmeler PhD, MPH","doi":"10.1111/jrh.12835","DOIUrl":"10.1111/jrh.12835","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Disparities in rural cancer survivors’ health outcomes are well-documented, yet the role of sociocultural aspects of rurality, such as rural identity, attitudes toward rurality, and social standing on health beliefs and behaviors remain unclear. This study aimed to address these gaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Rural cancer survivors (<i>N</i> = 188) completed a mailed/online survey. Regression analyses identified relationships among rural identity, negative attitudes toward rurality, and social standing with health outcomes, quality of life, cancer fatalism, and cancer information overload.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher rural identity was associated with believing everything causes cancer (OR = 1.58, <i>p</i> = 0.048), believing “there's not much you can do to lower your chances of getting cancer” (OR = 2.22, <i>p</i> = 0.002), and higher odds of being overloaded with cancer information (OR = 2.05, <i>p</i>  = 0.008). Negative attitudes toward rurality was linked with higher levels of perceived stress (<i>B</i> = 0.83, <i>p</i> = 0.001), and chronic pain (OR = 1.47, <i>p</i> = 0.039). Higher subjective social status was associated with perceived social support (<i>B</i> = 0.09, <i>p</i> = 0.016), better overall health (<i>B</i> = 0.13, <i>p</i> &lt; 0.001), lower levels of perceived stress (<i>B</i> = –0.38, <i>p</i> = 0.007), and chronic pain (OR = 0.80, <i>p</i> = 0.027).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Sociocultural factors of rurality were associated with indicators of quality of life, cancer fatalism, and information overload. Further exploration of the underlying mechanisms that drive these associations can help improve intervention targets for rural cancer survivors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12835","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332274","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 reinvestment: A path forward to addressing geographic health inequities","authors":"Michael Meit MA, MPH,&nbsp;Alana Knudson PhD","doi":"10.1111/jrh.12837","DOIUrl":"10.1111/jrh.12837","url":null,"abstract":"","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194962","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":"Community social vulnerability and the 340B Drug Pricing Program: Evaluating predictors of 340B participation among critical access hospital","authors":"Kelsey M. Owsley PhD, MPH,&nbsp;Saleema A. Karim PhD, MHA, MBA","doi":"10.1111/jrh.12833","DOIUrl":"10.1111/jrh.12833","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The federal 340B Drug Pricing Program allows eligible hospitals, including critical access hospitals (CAHs), to obtain outpatient drugs at a discounted rate. CAHs likely benefit from 340B participation because they are often under-resourced and serve at-risk patient populations. The objective of this study was to understand predictors of 340B program participation among CAHs, and how participation varies with community-level social vulnerability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a cross-sectional study design to assess the relationship between 340B participation in 2019 and community vulnerability status using 2018 data from the CDC's social vulnerability index (SVI) among acute care CAHs. Analyses used linear probability models adjusted for hospital-level characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>In bivariate analyses, CAHs participating in the 340B program had lower overall social vulnerability scores, relative to nonparticipating, eligible, and ineligible CAHs, respectively (43.8 vs. 48.7 vs. 64.7, <i>p</i> &lt; 0.10). In adjusted regression models, greater community vulnerability rankings due to socioeconomic status (–0.129, <i>p</i> &lt; 0.05) and minority status and language (–0.092, <i>p</i> &lt; 0.05) were associated with decreased 340B participation. Higher hospital operating margin was associated with increased 340B participation (0.163, <i>p</i> &lt; 0.05). Although the number of for-profit CAHs ineligible for 340B was small, they had the highest community-level social vulnerability score and lowest hospital operating margin on average.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CAHs located in areas of high community vulnerability are less likely to participate in the 340B program. Some vulnerable patient populations served by CAHs may be excluded from 340B program benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194961","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":"Bridging the rural-urban divide: An implementation plan for leveraging technology and artificial intelligence to improve health and economic outcomes in rural America","authors":"William B Weeks MD, PhD, MBA,&nbsp;Justin Spelhaug BA,&nbsp;James N Weinstein DO, MS,&nbsp;Juan M Lavista Ferres PhD, MS","doi":"10.1111/jrh.12836","DOIUrl":"10.1111/jrh.12836","url":null,"abstract":"&lt;p&gt;Rural residents have higher age-adjusted mortality and prevalence rates for cardiovascular disease, diabetes, cancer, unintentional injury, and stroke.&lt;span&gt;&lt;sup&gt;1-8&lt;/sup&gt;&lt;/span&gt; Those living in rural settings experience shorter lifespans&lt;span&gt;&lt;sup&gt;9-11&lt;/sup&gt;&lt;/span&gt; amplified by higher the premature mortality rates implicated in “deaths of despair.”&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; These longstanding rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health are increasing&lt;span&gt;&lt;sup&gt;11, 13&lt;/sup&gt;&lt;/span&gt; as is the “rural mortality penalty,”&lt;span&gt;&lt;sup&gt;14-16&lt;/sup&gt;&lt;/span&gt; which has tripled in the past two decades.&lt;span&gt;&lt;sup&gt;17&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;While “Health Care Access and Quality” was the primary health priority for rural America in Rural Healthy People 2010 and 2020, it dropped to the third most important priority in Rural Healthy People 2030. Over the past decade, both mental health and addiction have risen in relative importance for rural America, with “Economic Stability” debuting among the top 10 social determinant priorities.&lt;span&gt;&lt;sup&gt;18&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Utilization data indicate an increasing demand for telemedicine services in rural settings: the relatively low uptake of telepsychiatry services in rural settings prior to the COVID epidemic&lt;span&gt;&lt;sup&gt;19&lt;/sup&gt;&lt;/span&gt; and persistent rural-urban disparities in preventable acute care use suggest an unmet demand for high-quality ambulatory care in rural areas&lt;span&gt;&lt;sup&gt;20&lt;/sup&gt;&lt;/span&gt; and portend increasing reliance on telemedicine to improve rural residents’ healthcare access and health management.&lt;/p&gt;&lt;p&gt;Finally, rural districts reported significantly fewer students who have access to an internet-enabled device that is adequate for online learning and access to reliable broadband; given that inadequate broadband infrastructure is a critical barrier both to telehealth services provision and remote learning in rural settings, efforts to expand broadband access should focus on rural settings to ensure health and education equity.&lt;span&gt;&lt;sup&gt;21&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this context, access to healthcare among rural US residents is declining: rural hospitals are experiencing substantial financial distress,&lt;span&gt;&lt;sup&gt;22&lt;/sup&gt;&lt;/span&gt; closing at a faster rate than urban hospitals&lt;span&gt;&lt;sup&gt;23&lt;/sup&gt;&lt;/span&gt; (accounting for 71% of total hospital closures between 2017 and 2021),&lt;span&gt;&lt;sup&gt;24&lt;/sup&gt;&lt;/span&gt; and restricting the types of care that they offer if they remain open.&lt;span&gt;&lt;sup&gt;25, 26&lt;/sup&gt;&lt;/span&gt; These realities have direct adverse impact on local healthcare outcomes and indirect adverse impacts on the local economy: rural hospitals are important local employers and drivers of local economic health and their closures can reduce care access and create local economic chaos.&lt;span&gt;&lt;sup&gt;23, 27, 28&lt;/sup&gt;&lt;/span&gt; That rural residents disproportionately rely on emergency services and experience greater mortality for symptom-based conditions, underscores the impor","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12836","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194960","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":"What happens to rural hospitals during a ransomware attack? Evidence from Medicare data","authors":"Hannah T. Neprash PhD,&nbsp;Claire C. McGlave MPH,&nbsp;Katie Rydberg MPH,&nbsp;Carrie Henning-Smith PhD, MPH, MSW","doi":"10.1111/jrh.12834","DOIUrl":"10.1111/jrh.12834","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Hospitals are increasingly the target of cybersecurity threats, including ransomware attacks. Little is known about how ransomware attacks affect care at rural hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data on hospital ransomware attacks from the Tracking Healthcare Ransomware Events and Traits database, linked to American Hospital Association survey data and Medicare fee-for-service (FFS) claims data from 2016 to 2021. We measured Medicare FFS volume and revenue in the inpatient, outpatient, and emergency room setting—at the hospital-week level. We then conducted a stacked event study analysis, comparing hospital volume and revenue at ransomware-attacked and nonattacked hospitals before and after attacks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Ransomware attacks severely disrupted hospital operations—with comparable effects observed at rural versus urban hospitals. During the first week of the attack, inpatient admissions volume fell by 14.7% at rural hospitals (<i>P</i> = .04) and 16.9% at urban hospitals (<i>P</i> = .01)—recovering to preattack levels within 2-3 weeks. Outpatient visits fell by 35.3% at rural hospitals (<i>P</i>&lt;.01) and 22.0% at urban hospitals (<i>P</i> = .03) during the first week. Emergency room visits fell by 10.0% at rural hospitals (<i>P</i> = .04) and 19.3% at urban hospitals (<i>P</i> = .01). Travel time and distance to the closest nonattacked hospital was 4-7 times greater for rural ransomware-attacked hospitals than for urban ransomware-attacked hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ransomware attacks disrupted hospital operations in rural and urban areas. Disruptions of similar magnitudes may be more detrimental in rural areas, given the greater distances patients must travel to receive care and the outsized impact that lost revenue may have on rural hospital finances.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144487","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":"Primary care professionals’ perspectives on tailoring buprenorphine training for rural practice","authors":"Cheyenne Fenstemaker BS,&nbsp;Elizabeth A. Abrams MSPH,&nbsp;Benjamin Obringer BS,&nbsp;Katherine King BA,&nbsp;Lindsay Y. Dhanani PhD,&nbsp;Berkeley Franz PhD","doi":"10.1111/jrh.12832","DOIUrl":"10.1111/jrh.12832","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Buprenorphine is a highly effective medication for opioid use disorder (OUD) that remains substantially underutilized by primary care professionals (PCPs). This is particularly true in rural communities, which have fewer prescribers and significant access disparities. The Drug Enforcement Administration removed the X-waiver requirement in December 2022, yet many rural clinicians still report barriers to prescribing buprenorphine. In this study, we examined rural PCPs’ experiences with buprenorphine to identify tailored training strategies for rural practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Physicians, nurse practitioners, and physician associates practicing in rural Ohio counties were recruited through contacts at statewide health associations and health professions training programs. Twenty-three PCPs were interviewed about their perspectives on prescribing buprenorphine, including their training history.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>PCPs self-reported being motivated to respond to OUD. However, they also reported that current training efforts failed to equip them with the knowledge and resources needed to prescribe effectively, and that urban-focused training often alienated rural clinicians. Participants suggested tailoring training content to rural settings, using rural trainers, and bolstering confidence in navigating rural-specific barriers, such as resource deficits and acute opioid fatigue.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study found that current training on buprenorphine prescribing is inadequate for meeting the needs of rural PCPs. Tailored buprenorphine training is needed to improve accessibility and acceptability, and to better support the clinical workforce in communities disproportionately impacted by the opioid epidemic.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12832","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133070","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":"Critical lessons from a pragmatic randomized trial of home-based COVID-19 testing in rural Native American and Latino communities","authors":"Eliza Webber MPH,&nbsp;Sonia Bishop BS,&nbsp;Paul K. Drain MD, MPH,&nbsp;Virgil Dupuis BS,&nbsp;Lorenzo Garza  ,&nbsp;Charlie Gregor MPH,&nbsp;Laurie Hassell BS,&nbsp;Geno Ibarra  ,&nbsp;Larry Kessler ScD,&nbsp;Linda Ko PhD,&nbsp;Alison Lambert MD,&nbsp;Victoria Lyon MPH,&nbsp;Carly Rowe MSW,&nbsp;Michael Singleton PhD,&nbsp;Matthew Thompson MD, MHS,&nbsp;Teresa Warne MSc,&nbsp;Wendy Westbroek PhD,&nbsp;Alexandra Adams MD, PhD","doi":"10.1111/jrh.12830","DOIUrl":"10.1111/jrh.12830","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Native Americans and Latinos have higher COVID-19 infection and mortality rates and may have limited access to diagnostic testing. Home-based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID-19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A two-arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID-19 test kit registration and virtual swabbing support. The passive arm participants received standard-of-care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Overall, 63% of participants (<i>n</i> = 268) completed COVID-19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60 years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home-based testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CHW support led to higher COVID-19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12830","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050861","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":"Comparative effectiveness of two interventions to increase colorectal cancer screening among females living in the rural Midwest","authors":"Eric A. Vachon PhD,&nbsp;Mira L. Katz PhD,&nbsp;Susan M. Rawl PhD,&nbsp;Timothy E. Stump MS,&nbsp;Brent Emerson PhD(c),&nbsp;Ryan D. Baltic MPH,&nbsp;Erika B. Biederman PhD,&nbsp;Patrick O. Monahan PhD,&nbsp;Carla D. Kettler MS,&nbsp;Electra D. Paskett PhD,&nbsp;Victoria L. Champion PhD","doi":"10.1111/jrh.12828","DOIUrl":"10.1111/jrh.12828","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess the comparative effectiveness of a tailored, interactive digital video disc (DVD) intervention versus DVD plus patient navigation (PN) intervention versus usual care (UC) on the uptake of colorectal cancer (CRC) screening among females living in Midwest rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>As part of a larger study, 663 females (ages 50–74) living in rural Indiana and Ohio and not up-to-date (UTD) with CRC screening at baseline were randomized to one of three study groups. Demographics , health status/history, and beliefs and attitudes about CRC screening were measured at baseline. CRC screening was assessed at baseline and 12 months from medical records and self-report. Multivariable logistic regression was used to determine whether females in each group were UTD for screening and which test they completed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adjusted for covariates, females in the DVD plus PN group were 3.5× more likely to complete CRC screening than those in the UC group (odds ratio [OR] 3.62; 95% confidence interval [CI]: 2.09, 6.47) and baseline intention to receive CRC screening (OR 3.45, CI: 2.21,5.42) at baseline. Adjusting for covariates, there was no difference by study arm whether females who became UTD for CRC screening chose to complete a colonoscopy or fecal occult blood test/fecal immunochemical test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many females living in the rural Midwest are not UTD for CRC screening. A tailored intervention that included an educational DVD and PN improved knowledge, addressed screening barriers, provided information about screening test options, and provided support was more effective than UC and DVD-only to increase adherence to recommended CRC screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933868","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 disparities in health care delivery for children with medical complexity and moderating effects of payer, disability, and community poverty","authors":"Mary Arakelyan MPH,&nbsp;Seneca D. Freyleue MS,&nbsp;Andrew P. Schaefer PhD,&nbsp;Andrea M. Austin PhD,&nbsp;Erika L. Moen PhD,&nbsp;A. James O'Malley PhD,&nbsp;David C. Goodman MD, MS,&nbsp;JoAnna K. Leyenaar MD, PhD, MPH","doi":"10.1111/jrh.12827","DOIUrl":"10.1111/jrh.12827","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Children with medical complexity (CMC) may be at increased risk of rural–urban disparities in health care delivery given their multifaceted health care needs, but these disparities are poorly understood. This study evaluated rural–urban disparities in health care delivery to CMC and determined whether Medicaid coverage, co-occurring disability, and community poverty modified the effects of rurality on care delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study of 2012–2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire included CMC &lt;18 years. Health care delivery measures (ambulatory clinic visits, emergency department visits, acute care hospitalizations, total hospital days, and receipt of post-acute care) were compared for rural- versus urban-residing CMC in multivariable regression models, following established methods to evaluate effect modification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Of 112,475 CMC, 7307 (6.5%) were rural residing and 105,168 (93.5%) were urban residing. A total of 68.9% had Medicaid coverage, 33.9% had a disability, and 39.7% lived in communities with &gt;20% child poverty. In adjusted analyses, rural-residing CMC received significantly fewer ambulatory visits (risk ratio [RR] = 0.95, 95% confidence interval [CI]: 0.94–0.96), more emergency visits (RR = 1.12, 95% CI: 1.08–1.16), and fewer hospitalization days (RR = 0.90, 95% CI = 0.85–0.96). The estimated modification effects of rural residence by Medicaid coverage, disability, and community poverty were each statistically significant. Differences in the odds of having a hospitalization and receiving post-acute care did not persist after incorporating sociodemographic and clinical characteristics and interaction effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural- and urban-residing CMC differed in their receipt of health care, and Medicaid coverage, co-occurring disabilities, and community poverty modified several of these effects. These modifying effects should be considered in clinical and policy initiatives to ensure that such initiatives do not widen rural–urban disparities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913920","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 disparities and trends in utilization of palliative care services among US patients with metastatic breast cancer","authors":"Jincong Q. Freeman MPH, MS,&nbsp;Adam W. Scott BS,&nbsp;Ted O. Akhiwu MBBS, MPH","doi":"10.1111/jrh.12826","DOIUrl":"10.1111/jrh.12826","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess trends and rural–urban disparities in palliative care utilization among patients with metastatic breast cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the 2004–2019 National Cancer Database. Palliative care services, including surgery, radiotherapy, systemic therapy, and/or other pain management, were provided to control pain or alleviate symptoms; utilization was dichotomized as “yes/no.” Rural–urban residence, defined by the US Department of Agriculture Economic Research Service's Rural–Urban Continuum Codes, was categorized as “rural/urban/metropolitan.” Multivariable logistic regression was used to examine rural–urban differences in palliative care use. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Of 133,500 patients (mean age 62.4 [SD = 14.2] years), 86.7%, 11.7%, and 1.6% resided in metropolitan, urban, and rural areas, respectively; 72.5% were White, 17.0% Black, 5.8% Hispanic, and 2.7% Asian. Overall, 20.3% used palliative care, with a significant increase from 15.6% in 2004–2005 to 24.5% in 2008–2019 (7.0% increase per year; <i>p</i>-value for trend &lt;0.001). In urban areas, 23.3% received palliative care, compared to 21.0% in rural and 19.9% in metropolitan areas (<i>p</i> &lt; 0.001). After covariate adjustment, patients residing in rural (AOR = 0.84; 95% CI: 0.73–0.98) or metropolitan (AOR = 0.85, 95% CI: 0.80–0.89) areas had lower odds of having used palliative care than those in urban areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this national, racially diverse sample of patients with metastatic breast cancer, the utilization of palliative care services increased over time, though remained suboptimal. Further, our findings highlight rural–urban disparities in palliative care use and suggest the potential need to promote these services while addressing geographic access inequities for this patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906770","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}