Journal of Rural Health最新文献

{"title":"The impact of patient–provider relationships on choosing between VA and VA-purchased care: A qualitative study of health care decision-making among rural veterans","authors":"Daniel D. Ball PhD,&nbsp;Anne G. Sadler PhD,&nbsp;Melissa J. Steffen MPH,&nbsp;Monica B. Paez BA,&nbsp;Michelle A. Mengeling PhD","doi":"10.1111/jrh.12804","DOIUrl":"10.1111/jrh.12804","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Since the Choice Act in 2014, many Veterans have had greater options for seeking Veteran Affairs (VA)-purchased care in the community. We investigated factors that influence rural Veterans’ decisions regarding where to seek care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We utilized semi-structured telephone interviews to query Veterans living in rural or highly rural areas of Midwestern states about their health care options, preferences, and experiences. Interviews were recorded and transcribed, thematically coded, and deductively analyzed using a socioecological approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Forty rural Veterans (20 men/20 women) ages 28–76 years completed interviews in 2019. We found that rural Veterans often spoke about their relationships and interactions with providers as an important factor in deciding where to seek care. They expressed three socioecological qualities of patient–provider relationships that affected their decisions: (1) personal level—rural Veterans traveled longer distances for more compatible patient–provider relationships; (2) interpersonal level—they sought stable patient–provider relationships that encouraged familiarity, trust, and communication; and (3) organizational level—they emphasized shared identities and expertise that fostered a sense of belonging with their provider. Participants also described how impersonal interactions, status differences, and staff turnover impacted their choice of provider and were disruptive to patient–provider relationships.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural Veterans’ interview responses suggest exploring innovative ways to measure socioecological dimensions (i.e., personal, interpersonal, and organizational) of access-related decisions and patient–provider relationships to better understand health care barriers and needs. Such measures align with the VA's Whole Health approach that emphasizes person-centered care and the value of social relationships to Veterans’ health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523235","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":"Understanding rural-urban differences in veterans’ internet access, use and patient preferences for telemedicine","authors":"Amy M. J. O'Shea PhD,&nbsp;Mikayla Gibson  ,&nbsp;James Merchant MS,&nbsp;Kelby Rewerts BS,&nbsp;Kelly Miell PhD,&nbsp;Peter J. Kaboli MD,&nbsp;Stephanie L. Shimada PhD","doi":"10.1111/jrh.12805","DOIUrl":"10.1111/jrh.12805","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The expansion of telemedicine (e.g., telephone or video) in the Veterans Health Administration (VA) raises concerns for health care disparities between rural and urban veterans. Factors impeding telemedicine use (e.g., broadband, digital literacy, age) disproportionally affect rural veterans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To examine veteran-reported broadband access, internet use, familiarity with, and preferences for telemedicine stratified by residential rurality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three hundred fifty veterans with a VA primary care visit in March 2022 completed a 30-min computer-assisted telephone interview. The sampling design stratified veterans by residential rurality (i.e., rural or urban) and how primary care was delivered (i.e., in-person or by video). Counts and weighted percentages are reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>After accounting for survey weights, 96.2% of respondents had in-home internet access and 89.5% reported functional connection speeds. However, rural- compared to urban-residing veterans were less likely to experience a telemedicine visit in the past year (74.1% vs. 85.2%; <i>p</i> = 0.02). When comparing telemedicine to in-person visits, rural versus urban-residing veterans rated them not as good (45.3% vs. 36.8%), just as good (51.1% vs. 53.1%), or better (3.5% vs. 10.0%) (<i>p</i> = 0.05). To make telemedicine visits easier, veterans, regardless of where they lived, recommended technology training (46.4%), help accessing the internet (26.1%), or provision of an internet-enabled device (25.9%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Though rural-residing veterans were less likely to experience a telemedicine visit, the same actionable facilitators to improve telemedicine access were reported regardless of residential rurality. Importantly, technology training was most often recommended. Policy makers, patient advocates, and other stakeholders should consider novel initiatives to provide training resources.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12805","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488212","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":"The role of comorbidities, medications, and social determinants of health in understanding urban-rural outcome differences among patients with heart failure","authors":"Emily P. Zeitler MD, MHS,&nbsp;Joanna Joly MD,&nbsp;Christopher G. Leggett PhD,&nbsp;Sandra L. Wong MD, MS,&nbsp;A. James O'Malley PhD,&nbsp;Sally A. Kraft MD, MPH,&nbsp;Matthew B. Mackwood MD, MPH,&nbsp;Sarah T. Jones MPH,&nbsp;Jonathan S. Skinner PhD","doi":"10.1111/jrh.12803","DOIUrl":"10.1111/jrh.12803","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>There is now a 20% disparity in all-cause, excess deaths between urban and rural areas, much of which is driven by disparities in cardiovascular death. We sought to explain the sources of these disparities for Medicare beneficiaries with heart failure with reduced ejection fraction (HFrEF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a sample of Medicare Parts A, B, and D, we created a cohort of 389,528 fee-for-service beneficiaries with at least 1 heart failure hospitalization from 2008 to 2017. The primary outcome was 30-day mortality after discharge; 1-year mortality, readmissions, and return emergency room (ER) admissions were secondary outcomes. We used hierarchical, logistic regression modeling to determine the contribution of comorbidities, guideline-directed medical therapy (GDMT), and social determinants of health (SDOH) to outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-day mortality rates after hospital discharge were 6.3% in rural areas compared to 5.7% in urban regions (<i>P</i> &lt; .001); after adjusting for patient health and GDMT receipt, the 30-day mortality odds ratio for rural residence was 1.201 (95% CI 1.164-1.239). Adding the SDOH measure reduced the odds ratio somewhat (1.140, 95% CI 1.103-1.178) but a gap remained. Readmission rates in rural areas were consistently lower for all model specifications, while ER admissions were consistently higher.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among patients with HFrEF, living in a rural area is associated with an increased risk of death and return ER visits within 30 days of discharge from HF hospitalization. Differences in SDOH appear to partially explain mortality differences but the remaining gap may be the consequence of rural-urban differences in HF treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12803","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693480","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 social and emotional protective factors and their association with child health and flourishing","authors":"Rose Y. Hardy PhD,&nbsp;Samantha J. Boch PhD, RN,&nbsp;Mattina A. Davenport PhD,&nbsp;Laura J. Chavez PhD,&nbsp;Kelly J. Kelleher MD","doi":"10.1111/jrh.12802","DOIUrl":"10.1111/jrh.12802","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Children in rural communities experience higher mortality rates and less access to health care services than those in urban communities. Protective factors like social support also vary by geography, but their contribution to differences in child health is understudied. Understanding geographic variation in protective health factors could provide insight into their impact on health and guide future intervention strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Research Objective</h3>\u0000 \u0000 <p>To examine protective factors’ association with child flourishing and child health status in rural and urban communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Publicly available data from the National Survey of Children's Health, 2018-2021, with nonmissing geographic data (N = 150,493) were used to assess the relationship between protective factors and child flourishing and health by rurality. Multivariate survey-weighted probit models examined these relationships, adjusting for child and caregiver characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>More than a third of children were not flourishing, according to parental report. An estimated 62% of rural children were flourishing compared to 66% of urban children (<i>P</i>&lt;0.001). Urban caregivers also were more likely to report better adult mental and physical health status. Nevertheless, rural children were reported to receive more social support than urban children, while their caregivers reported more emotional support and living in supportive and safe neighborhoods (<i>P</i>&lt;0.001). Rural caregivers reported more support from places of worship and less from counselors/other mental health care providers than urban caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite higher reported caregiver emotional support and child social support, fewer rural children are flourishing. Health systems and community organizations able to leverage these existing social and emotional protective factors in rural communities could help close this gap.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12802","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684330","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":"Understanding the impacts of rural hospital closures: A scoping review","authors":"Cody Lendon Mullens MD, MPH,&nbsp;J. Andres Hernandez MD, MBA,&nbsp;Jeevan Murthy BS,&nbsp;Steph Hendren MLIS,&nbsp;Whitney E. Zahnd PhD,&nbsp;Andrew M. Ibrahim MD, MSc,&nbsp;John W. Scott MD, MPH","doi":"10.1111/jrh.12801","DOIUrl":"10.1111/jrh.12801","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Rural hospitals are closing at unprecedented rates, with hundreds more at risk of closure in the coming 2 years. Multiple federal policies are being developed and implemented without a salient understanding of the emerging literature evaluating rural hospital closures and its impacts. We conducted a scoping review to understand the impacts of rural hospital closure to inform ongoing policy debates and research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search strategy was devised by library faculty to collate publications using the PRISMA extension for scoping reviews. Two coauthors then independently performed title and abstract screening, full text review, and study extraction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We identified 5054 unique citations and assessed 236 full texts for possible inclusion in our narrative synthesis of the literature on the impacts of rural hospital closure. Twenty total original studies were included in our narrative synthesis. Key domains of adverse impacts related to rural hospital closure included emergency medical service transport, local economies, availability and utilization of emergency care and hospital services, availability of outpatient services, changes in quality of care, and workforce and community members. However, significant heterogeneity existed within these findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Given the significant heterogeneity within our findings across multiple domains of impact, we advocate for a tailored approach to mitigating the impacts of rural hospital closures for policymakers. We also discuss crucial knowledge gaps in the evidence base—especially with respect to quality measures beyond mortality. The synthesis of these findings will permit policymakers and researchers to understand, and mitigate, the harms of rural hospital closure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41218077","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 differences in receipt of governmental rental assistance: Relationship to health and disability","authors":"Carrie Henning-Smith PhD, MPH, MSW,&nbsp;Alexis Swendener PhD,&nbsp;Katie Rydberg MPH,&nbsp;Megan Lahr MPH,&nbsp;Hawking Yam MS","doi":"10.1111/jrh.12800","DOIUrl":"10.1111/jrh.12800","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Housing is essential to health. Governmental rental assistance is one way to increase access to affordable housing, but little is known about how it varies by rural/urban location. This paper seeks to address that gap by examining rural/urban and within-rural differences in receipt of rental assistance, with particular attention differences by health and disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the 2021 National Health Interview Survey (n = 28,254) to conduct bivariate analyses to identify significant differences in receipt of rental assistance by rural/urban location. We then conducted logistic regression analyses to generate odds ratios of receiving rental assistance, adjusting for self-rated health, disability, sociodemographic characteristics, and the US Census region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>When limiting the sample to those who rent (20.6% of rural residents and 29.6% of urban residents), rural residents were nearly 5 percentage points more likely to receive rental assistance (13.1% vs 8.2%, <i>P</i>&lt;.001). Rural recipients of rental assistance were more likely to have a disability than urban residents (27.9% vs 20.3%, <i>P</i>&lt;.05) and were more likely to report fair/poor health (41.6% vs 31.4%, <i>P</i>&lt;.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural residents are less likely to rent their homes, but, among those who rent, they are more likely to receive governmental rental assistance. This may be reflective of the greater need for rental assistance among rural residents, who were in poorer health and of lower socioeconomic status than urban renters. As housing is essential to good health, policy attention must prioritize addressing a persistent and growing need for affordable housing in rural and urban areas alike.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12800","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41218076","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":"The Breast-Imaging Operations, Practices and Systems Inventory: A framework to examine mammography facility effects on screening in rural communities","authors":"Roger T. Anderson PhD,&nbsp;Marianne M. Hillemeier PhD,&nbsp;Fabian T. Camacho MS,&nbsp;Jennifer A. Harvey MD,&nbsp;Gloribel Bonilla MPH,&nbsp;George P. Batten PhD,&nbsp;Brenna Robinson M.Ed,&nbsp;Cara B. Safon MPH,&nbsp;Chris Louis PhD","doi":"10.1111/jrh.12798","DOIUrl":"10.1111/jrh.12798","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Develop and test a measurement framework of mammogram facility resources, policies, and practices in Appalachia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Survey items describing 7 domains of imaging facility qualities were developed and tested in the Appalachian regions of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. Medicare claims data (2016-2018) were obtained on catchment area mammogram services. Construct validity was examined from associations with facility affiliation, community characteristics, mammogram screening uptake, and market reach. Analyses were performed with <i>t</i>-tests and ANOVA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 192 (of 377) sites completed the survey. Five factors were initially selected in exploratory factor analysis (FA) and refined in confirmatory FA: capacity, outreach &amp; marketing, operational support, radiology review (NNFI = .94, GFI = 0.93), and diagnostic services (NNFI = 1.00, GFI = 0.99). Imaging capacity and diagnostic services were associated with screening uptake, with capacity strongly associated with catchment area demographic and economic characteristics. Imaging facilities in economically affluent versus poorer areas belong to larger health systems and have significantly more resources (<i>P</i> &lt; .001). Facilities in economically distressed locations in Appalachia rely more heavily on outreach activities (<i>P</i> &lt; .001). Higher facility capacity was significantly associated (<i>P</i> &lt; .05) with larger catchment area size (median split: 48.5 vs 51.6), mammogram market share (47.4 vs 52.7), and screening uptake (47.6 vs 52.4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A set of 18 items assessing breast imaging services and facility characteristics was obtained, representing policies and practices related to a facility's catchment area size, market share, and mammogram screening uptake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.12798","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41150583","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":"Non-operating revenue is an important source of funding for rural hospitals, especially those that are government-owned","authors":"Ariana Pitcher Master of Public Health—Health Policy,&nbsp;Ruoyu Zhang BS,&nbsp;Susie Gurzenda MS,&nbsp;George Pink PhD,&nbsp;Kristin Reiter PhD","doi":"10.1111/jrh.12797","DOIUrl":"10.1111/jrh.12797","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Non-operating revenue (NOR), derived from investments, contributions, government appropriations, and medical space rentals, can contribute to financial stability of hospitals by offsetting operating losses and improving profitability. NOR might benefit rural hospitals that often face intense financial pressures. However, little is known about how much rural hospitals rely on NOR and if certain organizational characteristics are associated with differences in NOR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Healthcare Cost Report Information System data from 2011 to 2019 were used to analyze sources of revenue among Critical Access Hospitals (CAHs) and Rural Prospective Payment System (R-PPS) hospitals through descriptive statistics and regression models. Reliance on NOR was measured by the percentage of total revenue from non-operating sources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Results indicate that both CAHs and R-PPS hospitals rely on NOR; however, CAHs have a higher percentage of total revenue derived from non-operating sources (3.2%) as compared to R-PPS hospitals (1.9%) (<i>p</i> &lt; 0.001). Government-owned hospitals have significantly higher reliance on NOR than other ownership types. System affiliation also influences reliance on NOR. Lastly, results suggest that NOR may play a role in improving overall profit margins.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As rural hospitals disproportionately face challenges related to declining profitability and the risk for closure, they may rely on NOR to continue to strengthen financial performance and provide health care to their communities. However, NOR is not guaranteed, and reliance on NOR further reiterates the value of stable, adequate reimbursement to guard against fluctuations in NOR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41122783","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 Veterans with HIV and Alcohol Use Disorder receive less video telehealth than urban Veterans","authors":"Alan Z Sheinfil PhD,&nbsp;Giselle Day MPH,&nbsp;Annette Walder MS,&nbsp;Julianna Hogan PhD,&nbsp;Thomas P. Giordano MD, MPH,&nbsp;Jan Lindsay PhD,&nbsp;Anthony Ecker PhD","doi":"10.1111/jrh.12799","DOIUrl":"10.1111/jrh.12799","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Alcohol use disorder (AUD) is highly prevalent among Veterans with HIV. Rural Veterans with HIV are at especially high risk for not receiving appropriate treatment. This retrospective cohort cross-sectional study aimed to investigate patterns of mental health treatment utilization across delivery modality among Veterans diagnosed with HIV and AUD. It was hypothesized that rural Veterans with HIV and AUD would receive a lower rate of mental health treatment delivered via video telehealth than urban Veterans with HIV and AUD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A national Veterans Health Association administrative database was used to identify a cohort of Veterans diagnosed with HIV and AUD (<i>N</i> = 2,075). Geocoding was used to categorize rural Veterans (<i>n</i> = 246) and urban Veterans (<i>n</i> = 1,829). Negative binomial regression models tested associations between rurality and mental health treatment delivered via face-to-face, audio-only, and video telehealth modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Results demonstrated that rural Veterans with HIV and AUD received fewer mental health treatment sessions delivered via telehealth than urban Veterans with HIV and AUD (incidence rate ratio = 0.62; 95% confidence intervals [0.44, 0.87]; <i>P</i> &lt; .01). No differences were found in terms of treatment delivered face-to-face or by audio-only.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rural Veterans with HIV and AUD represent a vulnerable subpopulation of Veterans who may most benefit from video telehealth. Efforts to increase access and improve the uptake of evidence-based mental health treatment delivered via video telehealth are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164712","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":"Perceptions of access to care after a rural hospital closure in an economically distressed county of Appalachian Tennessee","authors":"Amanda Letheren DrPH, MPH,&nbsp;Kathleen C. Brown PhD, MPH,&nbsp;Cristina S. Barroso DrPH, MPH,&nbsp;Carole R. Myers PhD, RN,&nbsp;Robert Nobles DrPH, MPH","doi":"10.1111/jrh.12794","DOIUrl":"10.1111/jrh.12794","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The rise in rural hospital closures has sparked concern about the potential loss of essential health care services for rural communities. It is crucial to incorporate the perspectives of community residents, which have been largely missing from the literature, when devising strategies to improve health care for this population. The purpose of this study was to describe community residents’ perceptions of access to care following a rural hospital closure in an economically distressed Appalachian county of Tennessee.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used a qualitative descriptive approach to illustrate how community residents perceive accessing care post hospital closure. We conducted semi-structured interviews with 24 community residents via telephone in May through August of 2020. Interviews were analyzed using conventional content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Five themes were identified based on Penchansky and Thomas’ framework of health care: accessibility, availability, affordability, accommodation, and acceptability. Accessibility was identified as the most common concern among participants. Specifically, participants perceived longer travel times to receive care, reduced availability of emergency and specialty care, increased costs associated with ambulance services, and extended wait times to see providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings provide a critical perspective to inform local leaders and policymakers on the impacts of a hospital closure in a rural community. As rural hospitals continue to close, it is crucial to develop multi-level, community-driven solutions to ensure access to care for rural communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10271484","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}