bluuebunny/crossref_metadata_2025 huggingface dataset:
The Rural‐Urban Distribution of Health Professionals in Georgia*
Authors: Wright J. Stephen , Jablonowski Adam R.
Published: April 2008

In this paper, the rural/urban geographic distribution of licensed health professionals living in the state of Georgia is examined. Using 1983 data from the State Examining Boards, 13 health professions were studied to determine rural and urban differences. Three indicators of ruralness were used to classify county of residence: (1) metropolitan/nonmetropolitan, (2) metropolitan proximity, and (3) size of county population. Results from data analyses indicate a severe geographic maldistribution of health professionals. With all three indicators, 11 of the 13 professions had urban rates of professionals‐to‐population substantially higher than the corresponding rural rates. A linear configuration seems to illustrate the relationship between the availability of health professionals and the ruralness of the county—as the county becomes more rural, the number of health professionals per population decreases. The percentage increase in physicians since 1968 and nurses since 1979 in nonmetropolitan counties was slightly higher than in metropolitan counties, indicating that this gap is closing somewhat. The most severe rural/urban differences in the number of professionals which per population were found in the more specialized health professions per tended to be the smallest in terms of numbers of members (e.g., occupational therapists, psychologists, speech pathologists/audiologists, podiatrists, opticians and physical therapists). These differences ranged up to a 20 plus‐fold difference. Physicians, chiropractors, dentists, physician assistants and registered nurses also had relatively large rural/urban differences but less than the more specialized professions.
Comparisons of Two Types of Nonphysician Providers Using Episode Based Data*
Authors: Dunn Earl V. , Higgins Chris A.
Published: April 2008

Using episode based data, analysis of those patients with diagnoses of upper respiratory infection or laceration seen in a remote setting revealed that the medical care given by nurse practitioners and minimally trained indigenous health aides was comparable in relation to management and outcome. Specifically, the average number of visits per episode, the length of episodes and the percentage of patients who subsequently developed complications were similar for the nurses and the health aides. Although both the nurses and the health aides managed over 90 percent of the patients independently, the health aides were more likely to communicate, refer or transfer the patient to the care of another provider. These findings, if applicable to medical problems in general, imply that nonphysician providers in a remote setting can give quality care and can be trained to manage conditions appropriately, if the needed' back‐up is available.
Trauma in Tourist Towns*
Authors: Waller Julian A. , Brink Susan
Published: April 2008

Communities with major recreational attractions tend to be rural and to have high injury experience both because of environmental hazards unique to rural areas and because they attract urban visitors who may be unfamiliar with the area andits roads, engaging in activities for which they are poorly prepared, and using equipment that is rented, in poor condition, or even of inherently hazardous design or construction. Alcohol abuse by visitors is often aproblem. Once injured, visitors may have difficulty gaining access to emergency care andwhen received, such care may be limited in both quantity and quality. While the influx of visitors to rural areas brings jobs and income, it also may bring crowding, violence, unintentional injury and other stresses. Most rural recreational communities do not actively plan as a community to deal with these problems, but rather approach them piecemeal and with limited communication among all necessary participants. Such planning is essential if progress is to be made.
Social Supports of the Rural Widowed Elderly*
Authors: Matthews Anne Martin
Published: April 2008

A brief demographic profile of rural aging in Canada is provided along with an overview of Canadian research findings on the rural aged in general. The findings from a study of 152 widowed residents of two urban and two rural communities in southern Ontario, Canada, are reported. Three measures of social support were used: i.e., perceived support, patterns of support, and preferred sources of support. The data indicate many more similarities than differences in the social support patterns of this sample of rural and urban widowed elders. Where differences did emerge, the rural widowed reported higher levels of frequency of contact with support members. The rural elderly, however, also had lower socio‐economic status and had been widowed for a shorter period of time. Thus, some of the differences between the support patterns of the rural and urban widowed were accounted for by background differences, rather than by residential location per se. Despite these findings, the respondents perceived that living in a rural area was an advantage in widowhood.
The Need to Train Physicians for Rural Primary Health Care in Latin America: Some Family Medicine Experiences*
Authors: Hale Frank A.
Published: April 2008

ABSTRACT: Training strategies to prepare physicians for rural primary care generally have not been a feature of medical education in Latin America. The emergence of family medicine as a specialty discipline has resulted in a number of primary care educational initiatives which are designed to give students or residents the knowledge and skills necessary to practice in rural settings. Specific programs in Mexico, Colombia, Chile, and Argentina are identified and discussed. These programs were selected because they raise a number of educational and manpower planning issues which teachers of family medicine and rural primary care need to address if the long‐term viability of these programs is to be achieved. These issues include: the role of the community as an educational laboratory, the supervision of community‐based learning experiences, the development of strong clinical and community health promotion skills, the reinforcement of positive primary care learning throughout training, and the development of rural health role models. Manpower planning issues to be addressed include: developing a more precise identity for the primary care physician, a re‐examination of the pasantia or year of required community service, developing closer ties between the medical schools and the Ministries of Health and other institutional employers of physicians, and encouraging successful programs to share their experiences with others.
Neuquen, Argentina: Provincial Health Policies and Their Results*
Authors: Leonfanti Fernando L. , Chiesa Maria Elena
Published: April 2008

ABSTRACT: A case study of the creation and implementation of a four‐tier, integrated system of health care services in a sparsely populated, rural province in Argentina is described and discussed. Begun in 1970 in a diverse geographical area with a tradition of poor health status and inadequate health care resources, the provincial government set out to develop the human, physical and technological resources needed to provide a system of preventive and curative services appropriate to the health care needs of its residents. Innovative programs included training in management techniques, and epidemiological perspective of high risk, an emphasis on personnel development through a rural general medicine residency and an expanded nursing program as well as programs to attack infectious diseases, poor sanitation and dental problems were all developed in response to the distinctive features of the physical and social environment of the province. Improvements in traditional health indicators are reviewed and attributed to the program and administrative structures that were developed.
Rural‐Urban Differences in Access to Iowa Child Health Services*
Authors: Levey Linda M. , Curry James P. , Levey Samuel
Published: April 2008

Indicators of access, utilization, and quality of available child health services as well as health status were obtained through a telephone survey of Iowa households with children under age six. These indicators were compared for rural‐urban subsamples within an AFDC sample drawn from Iowa Department of Human Service files (N=637), and within poverty (N=129) and nonpoverty groups (N=631) drawn from the population of all households in the state with children under age six. About 55 percent of all households studied were rural. Rural households were generally larger than urban households, more likely to be intact maritally, white, and earning a living from farming. The findings support the hypothesis that place of residence has an impact on access, utilization, and quality of child health services over and above family income, although not always to the disadvantage of rural children. Typical problems for rural children, irrespective of income, were access to pediatric care, greater travel time to providers, and discontinuity of well care and sick care. Rural children in all income groups had lower seat belt use than urban children; they were also less likely to have well visits and their providers showed less attentiveness to behavioral and developmental issues at these visits. Rural residency exacerbated problems in access to care for low income children, who were less likely to be eligible for AFDC/ Medicaid than their urban counterparts. Medicaid coverage, however, did not eliminate rural‐urban differences in receiving desired medical care.
Delivering Comprehensive Health Education Programs for Farmers in a Primary Care Setting*
Authors: Hartye James K. , Mathis Norma
Published: April 2008

ABSTRACT: A comprehensive health education series was provided for a group of farmers from a small farming community in western North Carolina. At one year after the program, the participants were surveyed. Between 70 and 100 percent of them felt that they learned something useful from each of the four sessions. The participants also noted behavior changes since the program; from 26.3 percent based on the pulmonary program to 90.9 percent based on the skin protection program. The retention of information and level of impact on health‐related behaviors warrants further development and testing of this approach to agricultural occupational health education.
The Rural Dental Health Program: The Long‐Range Effect of a School‐Based Enriched Dental Health Program on Children's Oral Health*
Authors: Bentley J. Marvin , Feldman Cecile , Oler Jacqueline
Published: April 2008

ABSTRACT: In November 1985, 406 children ages 15 to 19 were clinically examined, answered survey questions covering dental attitudes and behaviors, and were tested to determine their dental knowledge. This group included 56 percent of the 725 first through third graders who participated in the Rural Dental Health Program beginning in the fall of 1975. The Rural Dental Health Program was a study designed, in part, to measure the effect of a school‐based dental health program on the oral health of children in a rural, underserved Pennsylvania county. Measures taken on 406 children, six and one‐half years after the educational program ended were used to test for its possible long‐term impact on oral health. Evidence obtained from analysis of covariance supports the hypothesis that dental health education had a positive effect on children's oral health.
Farming: Primary Prevention for Hypertension? Effects of Employment Type on Blood Pressure*
Authors: Gold Marthe R. , Franks Peter
Published: April 2008

ABSTRACT: We report findings from the first stage of a community‐oriented primary care approach initiated in a financially depressed agricultural area of upstate New York that sought to characterize the causes of relatively increased cardiovascular and cerebrovascular mortality in the region. This report focuses on 633 people aged 16 years and older employed in two adjacent towns. They were surveyed for standard sociodemographic data, information about utilization of and barriers to health care and preventive services, cardiovascular risk factors, and blood pressure measurements. Compared to other workers, those in farming had significantly more low income households, less education, less preventive care, more out‐of‐pocket expenses, and ate more eggs. After adjustment for other independent variables, farmers had significantly lower mean blood pressure (3.24 mm Hg, 95 percent confidence interval [CI] = 1, 5.5) than the other occupational groups. Age was a significant predictor of mean blood pressure for nonfarmers (.25 mm Hg/yr., CI = 0.18,0.32), but not for farmers (.09 mm Hg/yr., CI = ‐0.03, 0.21). These results are congruent with previous studies that have shown decreased cardiovascular morbidity and mortality among farmers. Investigations into the culture of “farm‐life” may provide approaches to the primary prevention of hypertension, beyond those suggested by a focus on individual risk factors.
Closure of Rural Hospital Obstetric Units in Missouri*
Authors: Lawhorne Larry , Zweig Steven
Published: April 2008

ABSTRACT: We studied 65 rural hospitals in Missouri that provided obstetric services in 1986. The hospitals were divided into three groups on the basis of their physician obstetric staff: family or general practitioners only (38 hospitals), family practitioners and obstetricians (22 hospitals), and obstetricians only (five hospitals). From birth certificate data, we detected a decline in the mean number of births in all groups of rural hospitals comparing 1980‐1983 with 1984–1987. Births in family practice only hospitals declined most over the past four years (35%), whereas there was only a 4 percent decline in the number of births to rural Missouri women. In 1987, 10 of the 38 family practice only hospital obstetric units closed due to loss of physician services, whereas none of the other hospitals stopped providing obstetric care (X2= 8.40, p < 0.005). These findings suggest that rural hospitals with family and general practitioners exclusively on their obstetric staffs are at significant risk of closing their obstetric units.
Rebuilding a Rural Obstetrical Program: A Case Study*
Authors: Reimer Galen M.
Published: April 2008

ABSTRACT: The rebuilding of an obstetrical department of a small rural hospital (40 beds) in rural Nevada is described. The number of births at the hospital increased from 20 in 1981 to more than 300 for the past four years. The market share of obstetrical patients in the county increased from less than 10 percent in 1981, to an average of 80 percent for the last five years. The five major steps contributing to the success of this rebuilding program are described. Obstetrical malpractice liability insurance and the shaky financial viability of rural hospitals are discussed as the two major threats to rebuilding a rural obstetrical program. The experience in this setting suggests that rural residents want and desire local obstetrical care and that a team approach can rebuild a rural obstetrical capacity in a relatively short time.
The Effect of a Preterm Birth Prevention Program in 17 Rural and Three Urban Counties in Northwest North Carolina*
Authors: Moore Mary Lou , Buescher Paul A. , Meis Paul J. , Michielutte Robert , Ernest J.M. , Sharp Penny
Published: April 2008

ABSTRACT: The results of a program of low birthweight prevention in 17 rural (20,727 births) and three urban counties (15,561 births) for calendar years 1985 and 1986 are described. Records for women in the program were matched with birth certificate data by computer. Rural and urban women in and out of the program were compared by race on the following risk factors: age less than 18 years, unmarried, education less than 12 years, Medicaid recipient, not WIC recipient, inadequate prenatal care, and previous fetal or live born death. Adjusting for these risk factors, logistic regression was used to estimate program effects on low birthweight (LBW), very low birthweight (VLBW), and preterm low birthweight (PLBW) among rural women. There was a statistically significant difference (p ≤ 0.01) favoring women in the program for very low birthweight and preterm low birthweight in white women, and low birthweight and preterm low birthweight in nonwhite women. The differences in rural areas exceed those in urban areas for all but one mean, very low birthweight births among white women.
The Iowa Hospital Visitation Program: Does Outreach Education Affect Management of Neonatal Resuscitation?*
Authors: Hein Herman A. , Lathrop Susan S.
Published: April 2008

ABSTRACT: Thirty‐nine Iowa hospitals were visited by a perinatal education team to improve management of neonatal resuscitation. Patient care was evaluated by reviewing medical records according to pre‐established performance standards. Following patient‐care review, educational programs were offered to physicians and nurses. The hospitals were first visited from July 1982 until June 1984. Follow‐up visits were made during the next two years. Management of neonates born in meconium was initially inadequate, but improved during the second period. Similarly, the conduct of other neonatal care practices showed statistically significant improvement over time (including assisted ventilation, hypoglycemia screening, cardiac massage, temperature maintenance, and record documentation). Only treatment of hypoglycemia failed to show significant change. We discuss why a cause and effect relationship cannot be claimed even though the desired effect of the educational intervention was achieved.
Provision of Comprehensive Perinatal Services through Rural Outreach: A Model Program*
Authors: Bahry Vera Jo , Fullerton Judith T. , Lops Vanda R.
Published: April 2008

ABSTRACT: A university‐based program of perinatal care was extended to serve a spectrum of underserved populations through both urban and rural outreach. The program centered on the use of a multidisciplinary health care team comprised of a physician, nurse‐midwife, health educator, social worker, nutritionist, pediatric nurse‐practitioner, and patient case manager for health service delivery. It emphasized a decentralized service model with central referral and management of high‐risk problems. The program has become a model for perinatal access and is reflected in current state legislation. The implementation of this program in four geographically rural communities is presented. Selected indices of perinatal outcome are presented, with San Diego County, CA, and national statistics as comparisons.
Federal Programs Affecting Rural Perinatal Health Care
Authors: Bacchi Donna , Phillips Dawn , Kessel Woodie , Smith David
Published: April 2008

ABSTRACT: Access to perinatal health care in rural communities often depends on such factors as the availability, cost, and acceptability of services. The federal government has been providing rural perinatal health care both directly and indirectly, through grants for service delivery or research and through direct payment for service. The various federal programs supporting perinatal health care in rural communities are described, and what may need to be done in the future is discussed.
The Effect of Physician Dispensing on Visit Compliance and Blood Pressure Control in a Rural Family Practice Clinic*
Authors: Lawborne Larry W.
Published: April 2008

ABSTRACT: Physician dispensing of drugs is making a comeback in the United States. Critics charge that physician dispensing for profit represents a conflict of interest and removes the normal checks and balances that exist when a physician writes a prescription later filled by a pharmacist. Proponents justify dispensing because it is more convenient for patients, because it assures that patients will receive the brand name ordered, and because it improves compliance. This retrospective chart review examines visit compliance and blood pressure control in a cohort of treated hypertensive adults attending a family practice clinic where patients were given the choice of either physician‐dispensed drugs or prescriptions. Over an 18 month period 61 of 77 patients (79%) in the dispensed group met criteria for visit compliance, compared with 22 of 45 patients (49%) in the prescription group (P<0.001, chi‐square). Sixty‐five of 77 patients (84%) in the dispensed group achieved adequate blood pressure control as did 36 of 45 patients (80%) in the prescription group. Patients were equally distributed between the dispensed and the prescription groups with respect to age, sex, and antihypertensive regimen. The study implies that physician dispensing improves one measure of patient compliance but that the improvement in compliance may not necessarily improve outcome. This discrepancy between compliance and outcome is not an unusual finding in the compliance literature. Prospective studies are needed to elucidate the effect of dispensing on patient satisfaction, patient care, and medical costs.
Locational Decisions of Physicians in Rural North Carolina*
Authors: Rhodes James F. , Day Frederick A.
Published: April 2008

ABSTRACT: Recent literature suggests that there is a rural‐urban imbalance of doctors in the United States. In order to investigate this maldistribution, a survey was conducted of 504 physicians in eastern North Carolina. The objective was to determine the factors which most influenced doctors' decisions to locate their practice. A conceptual framework was used to highlight the influence of the community, medical schools and the physician's personal preferences. A discriminant analysis of rural and urban physicians revealed the doctor's personal characteristics to be most important, followed by community and medical school factors. In particular, physicians raised in smaller communities showed a greater preference for practicing in rural areas. Tactics for recruiting rural doctors and other policy recommendations are suggested.
Research Reviews
Authors: Cordes Sam M.
Published: April 2008

Selected Annotations: Medicine Use Among the Rural Elderly. T. R. Sharpe and A. R. Barbe

Selected Annotations: Use of Marijuana Among Rural High School Students: A Test of a Facilitative‐Constraint Model. W. R. Goe, T. L. Napier, and D. C. Bachtel

Selected Annotations: Early Adolescent Alcohol Abuse in Rural Northern Michigan. P. D. Sarvela and E. J. McClendon

Selected Annotations: The New Environment for Rural HMOs. J. B. Christianson, M. Shadle, M. M. Hunter, S. Hartwell, and J. McGee

Selected Annotations: Changes in the Distribution of Physicians in Rural Areas of Minnesota, 1965–85. T. Dennis
Recruitment and Retention of Rural Physicians: Issues for the 1990s*
Authors: Crandall Lee A. , Dwyer Jeffrey W. , Duncan R. Paul
Published: April 2008

This paper briefly describes a number of structural and economic changes in the profession of medicine and in the rural medical care delivery system that have occurred since about 1970. Changes in the national physician supply; in the training, work, and practice characteristics of physicians; in the demographic characteristics of physicians; in the medical resources available in rural communities; and in federal and state support for the provision of medical services are noted. Four conceptual models that underlie physician recruitment and retention programs for small towns and rural communities are described. These include affinity models, which attempt to recruit rural persons into training or foster interest in rural practice among trainees; economic incentive models, which address reimbursement or payment mechanisms to increase economic rewards for rural practice; practice characteristics models, which address technical, collegial, referral, and other structural barriers to rural practice; and indenture models, which recruit temporary providers in exchange for scholarship support, loan forgiveness, or licensure. Examples of applications of each model are provided and the effects of changes in the medical care system on the effectiveness of each model are assessed. Finally, it is argued that elements of an optimal model for the recruitment of physicians to rural practice include the promotion of medical careers among rural high school students, the provision of financial and cultural support for their training, the development of technical and collegial support systems, and the limited use of indenture mechanisms to meet the needs of the most impoverished or isolated rural settings.
Is There a Role for the Small Rural Hospital?*
Authors: Hart L. Gay , Amundson Bruce A. , Rosenblaff Roger A. , Hart L. Gary , Amundson Bruce A. , Rosenblatt Roger A.
Published: April 2008

Rural hospitals represent almost half of all short‐stay nonfederal general hospitals in the United States, but have been more severely affected than their urban counterparts by changes in reimbursement, regulation, and technology. Two hundred and six rural community hospitals closed during thefirst nineyears of the 1980s, and the rate of closure is accelerating. Using secondary data sources to examine the structure, role, and content of rural hospitals, small rural hospitals are described and compared to larger and nonrural hospitals. Rural hospitals differ systematically from other hospitals in the United States, with smaller daily censuses, lower occupation rates, shorter lengths of stay, and disproportionately high shares of Medicare patients. They are dominated by very small institutions, with more than 1,000 rural hospitals having fewer than 50 beds. Small rural hospitals offer a core of basic services to the populations they serve. Emergency, obstetric, and newborn services are virtually ubiquitous in rural hospitals of all sizes, and they are also more likely to offer long‐term nursing and home care services than urban hospitals of similar size. The inpatient diagnostic and procedural mix of these institutions demonstrates that they provide care for common medical and surgical conditions of low complexity. Rural hospitals are also relatively inexpensive, representing only 6 percent of total expenditures for hospital care. Given their central role in supporting the provision of health services to rural areas, the apparent appropriateness of the conditions they treat, and their relatively modest cost, it would seem reasonable to use federal policy to stabilize our previous investment in these institutions.
Strategic Adaptations to PPS by Rural Hospitals: Implications for Theory and Research*
Authors: Smith Howard L. , Piland Neill F.
Published: April 2008

Medicare's Prospective Payment System (PPS) has introduced a new environment in which hospitals must either alter their strategies for delivering services or face closure. This is a challenge for rural hospitals that often lack the resources and supportive economic climate of their urban counterparts. Few guidelines are available to assist rural hospitals in responding organizationally to PPS‐induced constraints. This article examines the plight of rural hospitals from the perspective of strategic adaptation. A conceptual framework is proposed for studying strategic adaptations to PPS by rural hospitals. The implications for developing a sound research methodology are also discussed. On the basis of this research agenda, it may be possible to clarify how rural hospitals should adapt to PPS (and similar) constraints now, and in the future.
Evaluating Rural Nurses for Preparation in Implementing Nutrition Interventions*
Authors: Lindseth Glenda
Published: April 2008

ABSTRACT: With the increase in wellness programs, earlier hospital discharges, higher health care costs, and more home health care, rural nurses are required to generalize their practices and draw from a more extensive knowledge base. The purpose of this study was to examine nursing interventions, specifically nutrition education practices, based on nutrition knowledge that is used in health promotion. A stratified random sample of rural nurses from hospitals, nursing homes, and community health agencies in North Dakota was invited to participate in this study. Data were obtained via questionnaires. The questionnaire consisted of two parts: the first analyzing demographic data and the second analyzing nutrition knowledge. Nutrition information requests were received by 90.9 percent of the practicing registered nurses. The community/public health nurses had the highest nutrition knowledge scores while medical‐surgical hospital nurses had the lowest nutrition knowledge scores. With nutrition information and education being a frequently sought intervention by the rural health client, it would seem that registered nurses should be highly prepared and knowledgeable to meet these clients' needs.
Community Financed and Operated Health Services: The Case of the Ajo‐Lukeville Health Service District*
Authors: Lopes Phillip M. , Nichols Andrew W.
Published: April 2008

ABSTRACT: The concept of a health service district, as a variation of the special tax district, is described and discussed. Tax districts have traditionally been used to support both capital construction (revenue bonds) and operational expenses of single‐purpose governmental entities. The health service district, where authorized by state laws, may be used by local areas to subsidize the delivery of ambulatory health care. A particular case, the Ajo‐Lukeville Health Service District in Arizona, illustrates what can be accomplished by this mechanism with the cooperation of local residents and outside agencies. Both the process of establishing such a district and the outeome of the Ajo‐Lukeville experience is described. Reasons why health service districts may prove potentially attractive at this time are reviewed. Impediments to the development of more health service districts are also explored, including the lack of technical assistance, an inadequate awareness of the potential of health service districts, and the absence of a widespread orientation toward community financed and controlled health care. Movement in this direction should facilitate the development of additional health service districts.
Rural Hospitals under PPS: A Five‐Year Study
Authors: Davis Raymond G. , Zeddies Timothy C. , Zimmerman Mary K. , McLean Robert A.
Published: April 2008

ABSTRACT: This research examines the impact of prospective payment (PPS) on the financial performance of Kansas hospitals, which are predominantly rural. Financial ratios are presented and regressed on bed size and year. The data suggest that bed size has the strongest effect on financial viability. There are indications of a delayed effect of PPS on the rural, smallest hospitals (fewer than 25 beds), suggesting that non‐operating sources of revenue (local property tax mill levies) are being used to subsidize them in the short term. Small hospitals appear to be delaying all capital and long‐term costs to survive. The research suggests that the effect of PPS may be long term.
An Exploratory Study of the Correlates of Intent to Quit among Certified Registered Nurse Anesthetists in North Dakota*
Authors: Szigeti Elvira , Largent Rebecca N. , Eberhardt Bruce J.
Published: April 2008

Certified registered nurse anesthetists (CRNAs) provide the majority of anesthesia services in rural hospitals. Some services provided by CRNAs are routine, while others are for emergency conditions. The effect of the current nurse shortage on the potential pool of nurse anesthetists becomes a critical concern when considering the nature of CRN A services in rural areas. This study investigated the potential factors that relate to the desire of CRN As to continue practicing in rural hospitals of North Dakota. All CRNAs licensed in North Dakota (n = 125) were mailed survey questionnaires. Approximately five weeks later responses were received from 54 respondents for an overall return rate of 43 percent. Correlational analyses were used to examine responses of the subjects. A moderate degree of relationship was found among the work‐related variables. The average interscale correlation, calculated using an r to transformation, for the seven work‐related variables was 0.47. Overall, pay and promotion satisfaction exhibited strong (r > 0.60) correlations with turnover intentions. Supervisory satisfaction was only moderately (r=‐0.33) related to intention to quit. These results are discussed in terms of their implications for the management of CRN As in rural hospitals. Revised salary schedules, clinical ladders for promotions, supervisory training, and the identification of potential performance constraints are suggested as areas in which rural hospitals should focus attention in an attempt to manage turnover in CRNAs.
Children and Pregnant Women*
Authors: Lawhorne Larry , Zweig Steven , Tinker Hope
Published: April 2008

ABSTRACT: A review of the literature of the 1980s reveals that women living in rural America are at risk for receiving inadequate prenatal and maternal care. Documented risk factors include poverty and concomitant lack of medical insurance, residence in the most restrictive Medicaid states, and loss of local services including the closure of obstetric units of rural hospitals and the decision by local physicians to discontinue obstetrics. A prominent factor in a physician's decision to stop providing maternity care is the escalating cost of medical liability insurance; however, other forces are also at work, including interference with personal and family activities, disruption of other aspects of professional life (e.g., office schedule), inadequate reimbursement, and an inability to keep up with advancing technology. A research agenda for the 1990s should be consistent with previous recommendations and must stimulate the development of new programs that will induce the maximum number of providers to again offer high quality perinatal care to rural women. Other items on the 1990s research agenda include: (1) the clarification of the impact of lost perinatal services in rural areas, (2) the effects of travel time and distance on perinatal outcomes and cost of care, (3) the effect of loss of obstetric services on other health care services for women and children, and (4) comparisons of regionalized versus centralized systems for the provision of perinatal services.
Occupational Health and the Rural Worker: Agriculture, Mining and Logging*
Authors: Pratt David S.
Published: April 2008

ABSTRACT: More than 50 million Americans live in rural areas. These rural residents often work for small businesses or in the extraction industries (farming, mining, and logging). Because of the size of the businesses, the mandate of the Occupation Safety and Health Administration (OSHA) does not cover these workers and they are seldom afforded the same protection as urban workers. This review focuses on the special health problems facing farm workers, farmers, miners, and loggers. Farm workers are often ill and are affected by psychological illness, injuries, parasites, skin diseases, and the dangers of agrichemicals. Farm owners also face the hazards of stress and have very high rates of suicide. In addition, they are often injured on the job and suffer the highest rate of job related fatality of any work group. The complex farm environment presents a continuons threatto the lungs. This danger has worsened with the increased use of confinement buildings for poultry, hogs, and cattle. As farming has changea with increased mechanization, attendant medical problems have arisen. These “illnesses of innovation” are important. Mining and logging also are dangerous occupations with acute and chronic problems including respiratory illness, vascular problems, and malignancy. The decade of the 1990s must be one of increased attention to rural occupational health care and research.
Alternative Models for the Delivery of Rural Health Services*
Authors: Christianson Jon B. , Grogan Colleen M.
Published: April 2008

ABSTRACT: A number of alternatives to the solo, fee‐for‐service physician model have been pursued in an attempt to alleviate some of the specific problems associated with the delivery of primary care in rural areas. This article reviews and critiques the literature published in the 1980s for four alternative models: organized group practices, community health centers, community‐oriented primary care and managed care systems. The review examines the strengths and shortcomings of the existing literature, and identifies high‐priority research areas for each model. These four alternative models were introduced and promoted during the 1970s with little in the way of research evidence to support them. The subsequent literature pertaining to their performance was primarily descriptive. Of the quantitative studies, many utilized 1970s data. Therefore, the effects of the many environmental changes in rural areas during the 1980s on the viability of these models is unknown. In addition, little, if anything, is known about the life cycle of these models. While longitudinal, cross‐organizational studies present several logistic difficulties and require considerable resources for data collection, they hold the promise of extending the existing knowledge concerning alternative models beyond its present state.
Financing Rural Health and Medical Services*
Authors: Straub LaVonne A.
Published: April 2008

ABSTRACT: The provision and utilization of health care services in rural areas are tied directly to the structure of financing. The model of rural health care shaped by federal policies over three decades was significantly altered by changes during the 1980s. With reactions of third‐party payers to health care costs rising faster than inflation, the difficulty of accommodating access to care and cost efficiency in provision became evident. This review begins with the literature on patient services and capital financing of rural hospitals, then continues with the financing of clinics, community centers, and other supply forms. Research during the 1980s provides insight into the effects of various financing policies on the supply of services. The demand for health care in rural areas is characterized by less generous third‐party coverage, leaving residents paying a larger share of their incomes for care than do urban residents. As a consequence, access to care is especially difficult for low‐income and elderly people, heavily dependent upon government financing. Third‐party payers have severely reduced cost shifting as a mechanism for taking care of the health care needs of a sizable share of the population, thereby placing providers in an uncomfortable position. Several potential and more formalized financing options for replacing cost shifting are discussed. Several important changes will take place with rural‐focused legislation enacted in the late 1980s. These are used to present a rural financing research agenda for the 1990s.
Mental Health and Rural America: A Decade Review*
Authors: Wagenfeld Morton O.
Published: April 2008

ABSTRACT: This article reviews research findings in rural mental health services during the past 10 years. Specifically considered are the prevalence of mental disorder in rural areas and aspects of the organization of mental health services delivery. Gaps in knowledge are identified and a research agenda is proposed.
Education of Nurses for Rural Practice
Authors: Pickard Myrna R.
Published: April 2008

There is an excitement about the potential for nursing to make a difference in meeting rural health needs in the 1990s. Work places are attempting to respond to salary compressions and offering more autonomy for nursing over its own practice. There is better communication among hospital administrators, physicians, and nurses. Schools of nursing are more responsive to the needs of nontraditional students, and the federal and state governments are working together to find solutions. Innovation and creativity are key ingredients in our approach to ensuring rural nurse providers for the future.
Education for Rural Health Services Administration
Authors: Duncan R. Paul
Published: April 2008

This section briefly describes the administrative needs of rural health services delivery entities, especially hospitals. It then reviews the educational processes in which health administrators are trained, with a focus on changes that have emerged during the 1980s. The final section examines the extent to which the educational programs are consistent with the needs of rural environments, and provides some suggested strategies for the coming decade.
Hospital‐Sponsored Rural Health Clinics: An Effective Diversification Alternative for Rural Hospitals*
Authors: Bell Timothy L. , Bell Sharon L.
Published: April 2008

ABSTRACT: Changes in rural health care are resulting in new challenges for the administrators of rural hospitals. The lack of available care, economic deterioration, and demographic changes in rural America are contributing factors to rural health care problems and are detrimental to the financial well‐being of rural hospitals. Diversification is becoming commonplace in these hospitals as administrators seek strategies to gain financial viability for their facilities. The concept of hospital‐sponsored rural health clinics is more than a decade old, yet there are fewer than 30 such clinics nationwide. Reasons for the underutilization of such clinics may include the lack of knowledge that such clinics exist as well as inadequate information describing the establishment, operation, and financial feasibility of the clinics. The hospital‐sponsored rural health clinic “concept” will be introduced, including potential benefits of such clinics to both the hospital and the communities they serve, factors to be considered in developing such a system, and problems that may arise in this development. This article presents a case study of how one rural hospital incorporated such clinics into its long‐range plans.
The Merger of Rural Primary Care and Home Health Services*
Authors: Zuckerman Howard S. , Smith Dean G.
Published: April 2008

ABSTRACT: The merger of rural primary care and home health services offers the potential for increasing the administrative efficiency of health care, and thereby enhancing the quality of care and increasing access to services, particularly health promotion. However, the proposed benefits of any merger can only be realized if the merger process is successfully completed. An analysis of the factors that were important in a case study of successful and unsuccessful mergers of rural health centers and home health care agencies in northeastern Vermont is presented. Three components were found to be necessary to start the merger process: complementary needs, opportunity, and common philosophy. The involvement and support of key individuals was crucial to sustaining merger interest. Good communication throughout the process contributed substantially to the maintenance of both community and staff support. Others considering similar mergers should recognize that the process of consolidating organizations and satisfying regulations takes some time to complete.
Rural Youth Disability Prevention Project Survey: Results from 169 Iowa Farm Families
Authors: Hawk Cheryl , Gay Jane , Donham Kelley J.
Published: April 2008

ABSTRACT: Agriculture is now the most hazardous occupation in the United States and it is the only one in which children not only comprise a significant part of the work force, but also live and play at the work site. Annually, 23,500 pediatric agricultural injuries are reported, with nearly 300 fatalities (Rivara, 1985). The Rural Youth Disability Prevention Project was designed to use innovative, community‐oriented methods to address the unique problems of child safety in agriculture. Toward this end, a survey instrument was designed to gather data both to assist in program development and to serve as a pretest for the subsequent evaluation. Analysis of these data indicated several issues to target for intervention efforts. One is lack of supervision—more than 40 percent of children who operate equipment do so unsupervised. Approximately 30 percent of children more than 3 years old play alone in work areas, and 80 percent of these children play near machinery in operation. Another issue is operation of farm machinery by very young children—respondents' children began operating equipment at an average age of 12 years. Coupling this with the finding that the parents believe their children are not capable of operating equipment until age 15 exemplifies the most important issue, the disparity between parents' levels of safety knowledge and safety behavior. Using the survey data to increase local involvement, efforts are being directed toward facilitating an ongoing, community‐sponsored intervention program to empower farm families to effect their own solutions.
Cultivating Physician Relations to Enhance Rural Hospital Utilization
Authors: Smith Howard L. , Piland Neill F.
Published: April 2008

ABSTRACT: Rural hospitals are searching for new strategies to enhance utilization in view of constraints introduced by prospective payment and other environmental pressures. Developing physician relations is an approach that is reportedly leading to better hospital‐physician collaboration and subsequently to improved utilization. This paper examines rural hospital‐physician relations and the association with utilization. The findings suggest that rural hospitals emphasize quality care as well as diagnostic and treatment equipment procurement as methods for building relationships with physicians. These strategies are correlated with efforts to build a larger medical staff. Higher rural hospital utilization, in terms of occupancy, discharges and patient days provided, is associated with a larger medical staff. The results suggest that rural hospitals' attempts to cultivate physician relations have the potential for making significant differences in utilization outcomes. However, the linkages between utilization and physician relations are complex and require further research.
A Multivariate Assessment of the Effects of Residence on Infant Mortality*
Authors: Clarke Leslie L. , Coward Raymond T.
Published: April 2008

ABSTRACT: This research examines the relationship between residence and infant mortality. The purpose of the study was to identify the effects of maternal residence on infant mortality, using a multivariate model which included both individual and county‐level variables known to be associated with suboptimal birth outcome. Data on all births in Florida during 1987 were drawn from birth and infant death certificates. In addition, information concerning county sociodemographic structure and medical resources were gathered and linked to the individual records. After examining the distributions of selected risk variables across a five‐category measure of residence (from most urban to most rural), a logit model was estimated to predict the odds of an infant death associated with maternal residence. At the bivariate level, rural residents were found to have increased odds of an infant death compared to residents of all other residence categories. Second, a logit model was estimated that controlled for the influence of important maternal, infant, and county risk characteristics. The results of this second, more fully specified model indicate that residence did not have an independent direct effect on infant mortality when the influence of the other risk factors was controlled. We conclude that although residence does not influence infant mortality directly, it does influence mortality indirectly through its association with key risk factors. In particular, because population characteristics and medical resources are differentially distributed across rural and urban areas, residence remains an important factor to be considered when predicting health outcomes. The implications of these findings for polcy‐makers and health planners, as well as for health services researchers, are also discussed.