Journal of Rural Health最新文献

{"title":"Missed opportunities for human papillomavirus vaccination using Iowa's Immunization Registry Information System","authors":"Ona R. Loper MPH,&nbsp;Jessica M. Schultz MPH,&nbsp;Bethany F. Kintigh RN,&nbsp;Donald J. Callaghan BA, CPH","doi":"10.1111/jrh.12839","DOIUrl":"10.1111/jrh.12839","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Adolescent human papillomavirus (HPV) vaccination rates continue to remain lower than other adolescent vaccines, both nationwide and in Iowa. This study examined predictors of missed opportunities for first-dose HPV vaccine administrations in Iowa in order to conduct more targeted outreach and improve adolescent HPV vaccine uptake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted to identify predictors of missed opportunities for first-dose HPV vaccination in Iowa adolescents using Iowa's Immunization Registry Information System. The study population included 154,905 adolescents aged 11-15 years between 2019 and 2022. Missed opportunity for first-dose HPV vaccination was defined as a vaccination encounter where an adolescent received a Tdap and/or MenACWY vaccine but did not receive the first-dose HPV vaccine during the same encounter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Over a third of the study population experienced a missed opportunity for HPV vaccination between 2019 and 2022. Missed opportunity for vaccination was most common among individuals living in a rural county (aOR = 1.36), underinsured adolescents (aOR = 1.74), males (aOR = 1.12), teens 13-15 years of age (aOR = 1.76), and White race and non-Hispanic ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study builds on previously reported predictors of missed opportunity for HPV vaccination in adolescents. Increased understanding of provider needs and barriers to administering HPV vaccination and further analysis of how the Vaccines for Children Program can play a role in HPV vaccination uptake is necessary to improve HPV vaccination rates among adolescents in Iowa and more specifically in rural communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"40 4","pages":"645-654"},"PeriodicalIF":3.1,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140812859","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":"How rural is All of Us? Comparing characteristics of rural participants in the National Institute of Health's All of Us Research Program to other national data sources","authors":"Janessa M. Graves PhD, MPH,&nbsp;Shawna R. Beese PhD, RN,&nbsp;Demetrius A. Abshire PhD, RN,&nbsp;Kevin J. Bennett PhD, MS","doi":"10.1111/jrh.12840","DOIUrl":"10.1111/jrh.12840","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The National Institute of Health's <i>All of Us</i> Research Program represents a national effort to develop a database to advance health research, especially among individuals historically underrepresented in research, including rural populations. The purpose of this study was to describe the rural populations identified in the <i>All of Us</i> Research Program using the only proxy measure currently available in the dataset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Currently, the <i>All of Us</i> Research Program provides a proxy measure of rurality that identifies participants who self-reported delaying care due to far travel distances associated with living in rural areas. Using the <i>All of Us</i> Controlled Tier Dataset v6, we compared sociodemographic and health characteristics of <i>All of Us</i> rural participants identified via this proxy to rural US residents from nationally representative data sources using chi-squared tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>3.1% of 160,880 <i>All of Us</i> participants were rural, compared to 15%-20% of US residents based on commonly accepted rural definitions. Proportionally more rural <i>All of Us</i> participants reported fair or poor health status, history of cancer, and history of heart disease (<i>P</i>&lt;.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The <i>All of Us</i> measure may capture a subset of underserved participants who live in rural areas and experience health care access barriers due to distance. Researchers who use this proxy measure to characterize rurality should interpret their findings with caution due to differences in population and health characteristics using this proxy measure rural compared to other commonly used rural definitions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"40 4","pages":"745-751"},"PeriodicalIF":3.1,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12840","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140834190","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":"Tobacco use disparities in rural communities","authors":"Ellen J. Hahn PhD,&nbsp;Amanda Bucher BA,&nbsp;Kathy Rademacher BA,&nbsp;Whitney Beckett BS,&nbsp;LeeAnn Taylor BS,&nbsp;Audrey Darville PhD,&nbsp;Melinda J. Ickes PhD","doi":"10.1111/jrh.12838","DOIUrl":"10.1111/jrh.12838","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This exploratory study described facilitators and barriers to reducing tobacco disparities in 2 small rural communities and identified ways to reduce tobacco use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a descriptive design using qualitative methods. We created a resource database for 2 rural Kentucky counties, using a Culture of Health Framework. We recruited 16 organizational stakeholders serving low-socioeconomic populations and conducted focus groups and key informant interviews. We also completed key informant interviews with 7 tobacco users. Lastly, we tailored Community Action Plans for each county based on the data and then solicited feedback from the key stakeholders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The 2 counties were similar in population size, but County A had fewer resources than County B, and the stakeholders expressed differences toward tobacco use and quitting. County A stakeholders talked most about the protobacco culture and that tobacco users accept the risks of smoking outweighing the benefits of quitting; they also expressed concerns about youth use and the influences of family, society, and industry. County B stakeholders described ambivalence about the health effects of use and quitting. County A's Action Plan identified an opportunity to build Community Health Worker-delivered tobacco treatment into a new school-based health center. County B's Action Plan focused on reaching tobacco users by providing incentives for participation and tailoring messages to different audiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tobacco control resources and stakeholder perspectives vary in small rural communities, implying a need for tailored approaches. Tobacco users in rural areas are a critical population to target with cessation resources.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"40 4","pages":"738-744"},"PeriodicalIF":3.1,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561040","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-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":"40 4","pages":"623-633"},"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":"40 4","pages":"760-761"},"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":"40 4","pages":"720-727"},"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":"40 4","pages":"762-765"},"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":"40 4","pages":"728-737"},"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":"40 4","pages":"671-680"},"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":"40 4","pages":"709-719"},"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}