bluuebunny/crossref_metadata_2025 huggingface dataset:
Rural Health Policy Community Decision‐making About Critical Access Hospitals: Lessons Learned From Montana's Medical Assistance Facility Program
Authors: Shreffler M. Jean , Capalbo Susan M. , Flaherty Robert J. , Heggem Chris
Published: April 2008

Abstract: Limited‐service hospitals have been used as a means of maintaining health care services in rural communities with full‐service hospitals at risk of closure. The Medical Assistance Facility (MAF) limited‐service hospital model has been implemented in 12 communities in Montana and has been evaluated by the Health Care Financing Administration as a viable alternative to a full‐service hospital in frontier communities. The 1997 federal Critical Access Hospital (CAH) legislation is the most recent nationwide alternative for maintaining health care in rural communities, and it incorporates many of the features of the MAF model. The purpose of this study was to examine rural community decision making regarding MAF conversion from the perspectives of key informants who were involved in the decision‐making process. A descriptive multiple case study design was used. Data were obtained through interviews with community members during site visits. The research focused on identification of local issues that were influential in the decision to convert to or reopen as an MAF, features of the MAF model that made it a locally acceptable alternative, and elements that characterized the decision‐making process. The issues found to be influential in the conversion decision and the features that made the MAF locally acceptable were those that made the provision of basic services more stable and sustainable. The study suggests that programs to maintain health care services in isolated communities should allow for and encourage an expanded role for non‐physician providers. The lessons learned from the communities included in this study are instructive to rural communities nationwide that are considering a CAH as well as to policymakers, researchers, and regional and national health care decision makers.
Treatment of Depression in Rural Arkansas: Policy Implications for Improving Care
Authors: Rost Kathryn , Fortney John , Zhang Mingliang , Smith Jeffrey , Smith Ir. G. Richard Smith
Published: April 2008

Abstract: Policy‐makers have long suspected that greater barriers to care result in depressed rural residents being less likely to receive high‐quality treatment. This study recruited 470 depressed community residents in a 1992 telephone survey, followed 95 percent of them through one year, and abstracted additional data on their health care utilization from insurance claims, medical and pharmacy records. Bivariate and multivariate models demonstrated that during the year following the baseline, there were no significant rural‐urban differences in the rate (probability of any outpatient depression treatment), type (probability of receiving general medical depression care only), or quality (completion of guideline‐concordant acute‐stage care) of outpatient depression treatment. Annual expenditures for outpatient depression treatment were lower for rural subjects compared with their urban counterparts. Rural subjects had 3.05 times the odds of being admitted to a hospital for physical problems and 3.06 times the odds of being admitted to a hospital for mental health problems during the year following baseline compared with urban subjects. Cost‐offset analyses demonstrate that every dollar invested in depression treatment was associated with a $2.61 decrease in the cost of treating physical problems in depressed rural residents. Limited insurance coverage and limited availability of services were the most significant barriers to specialty and general medical outpatient treatment for depression in both rural and urban residents. More than 80 percent of depressed residents in both rural and urban areas visited a primary care provider during the year following baseline. The potential cost offset of depression treatment in rural populations plus the improvement in productivity observed in both rural and urban populations indicate that it may be economically possible to improve quality of care for depression without bankrupting an already strained health care budget.
Emerging Behavioral Strategies for the Prevention of HIV in Rural Areas
Authors: Lawrence Janet S. St.
Published: April 2008

Abstract: HIV/AIDS prevention efforts have been concentrated in urban areas, despite increases in HIV in non metropolitan areas. This study reviews behavioral prevention programs initiated in rural areas and programs that could be adapted for rural contexts. Outcomes from these interventions demonstrate that preventive interventions at the population, community, targeted populations subgroups, and small group levels can reduce high‐risk behavior in rural environments and are cost effective to deliver.
Service Use of Rural and Urban Medicaid Beneficiaries Suffering From Depression: The Role of Supply
Authors: Lambert David , Agger Marc , Hartley David
Published: April 2008

Abstract: Despite the prevalence and consequence of depression in rural areas, the literature on treating depression in rural areas is relatively scarce and inconclusive. The use of mental health services by rural people suffering from depression and the role that supply may play in explaining these differences are not well understood. Understanding these issues for rural Medicaid beneficiaries is important as Medicaid managed care for physical and behavioral health care is expanded to rural areas. This study compares the mental health service use of rural and urban Medicaid beneficiaries, ages 18 to 64, in Maine suffering from depression and examines what influence mental health and primary care supply have in explaining observed differences. Two models are used to estimate the use of ambulatory mental health services: (1) a logit likelihood estimate of whether a beneficiary uses any outpatient mental health services for depression; (2) an ordinary least squares regression estimating the number of annualized ambulatory mental health care visits among users. Rural beneficiaries suffering from depression have lower utilization than urban beneficiaries. Rural and urban Aid for Families with Dependent Children (AFDC)‐ and Supplemental Security Income (SSU‐beneficiaries suffering from depression rely more on mental health than on general health care providers to receive ambulatory mental health care. Rural beneficiaries (AFDC and SSI) rely relatively more on general health care providers than urban beneficiaries. Multivariate analysis suggests that mental health supply and patient‐level factors, but not primary care supply, account for utilization differences. This article describes the need to better understand factors limiting participation of primary care providers and to study the role of supply across multiple states.
Cardiovascular Disease Risk Factors and Obesity of Rural and Urban Elementary School Children
Authors: McMurray Robert G. , Harrell Joanne S. , Bangdiwala Shrikant I. , Deng Shibing
Published: April 2008

Abstract: Previous studies on the influence of a rural/urban setting on the prevalence of cardiovascular disease risk factors in children have not sufficiently controlled for socioeconomic status, race, gender, and perhaps, may not have included a representative sample of rural and urban children. This study compared the cardiovascular disease risk factors and rate of obesity of children living in rural and urban settings. It also determined the magnitude of the effect of the rural/urban setting on cardiovascular disease risk factors and obesity when controlling for race, socioeconomic status, and gender. The subjects were 2,113 third‐ and fourth‐grade children; 962 from an urban setting and 1,151 from a rural setting. Height, weight, skinfolds, resting blood pressure, and total cholesterol levels were measured. Aerobic power (pV02max) was estimated from cycle ergomerty. Physical activity and smoking history were obtained from a questionnaire. Clustering analyses using adjustment for sample error indicated that total cholesterol, blood pressure, smoking, and physical activity levels of rural and urban children were not different (P>0.10); however, body mass index and sum of skinfolds was greater for rural youth (P<0.004). Logistic regression indicated that rural children had a 54.7 percent increased risk of obesity (P=0.0001). This study's results indicate that, in children, a rural setting is associated with obesity, but not with the major risk factors associated with cardiovascular disease.
Economic Impact of Hospital Closure on Small Rural Counties, 1984 to 1988: Demonstration of a Comparative Analysis Approach
Authors: Probst Janice C. , Samuels Michael E. , Hussey James R. , Berry David E. , Ricketts Thomas C.
Published: April 2008

Abstract: Hospital closure in a rural community may affect the locale's economic prospects as well as the health of its residents. Studies of economic effects have primarily relied on modeling techniques rather than observation of actual change. This study demonstrates the use of a comparative analysis approach for estimating the economic effects of hospital closure on small rural counties. The experiences of 203 small rural counties at which a hospital closed between 2984 and 2988 was compared with a matched group of counties at which no closure took place. “Comparable” counties were selected based on seven scales measuring the similarity between a closure county and potential comparisons. Three scales examined population and economic characteristics in the year before closure; two scales measured change throughout a three‐year period preceding closure; and two scales measured change throughout a five‐year period preceding closure. Closure effects were measured through a multivariate analysis of the post‐closure economic history of closure and comparison counties. The key assumption is that similar counties should have similar experiences over time. v an event occurs within some of these counties but not others, this event should have visible effects. Comparative analysis suggested that earned income in closure counties (excluding farming and mining income) was lower than in comparison counties subsequent to closure and that labor force growth was similarly affected. A comparative analysis approach produces results that parallel those obtained from economic modeling and should be considered for further research.
The Geographic Distribution of AIDS in the United States: Is There a Rural Epidemic?
Authors: Steinberg Shari , Fleming Patricia
Published: April 2008

Abstract: The goal of this study was to examine where people with acquired immune deficiency syndrome (AIDS) in the United States live and the degree to which AIDS is present in rural areas. AIDS cases reported to the Centers for Disease Control and Prevention (CDC) in 1996 were categorized by metropolitan statistical area (MSA) size and compared to the general population. Data were analyzed by region, race/ethnicity and risk exposure; AIDS incidence rates were compared over time by MSA size. Relative to the U.S. population, AIDS cases were disproportionately black (43 percent vs. 11 percent), male (80 percent vs. 48 percent), and from the Northeast (32 percent vs. 20 percent). In all regions, a greater proportion of AIDS cases reside in large MSAs compared with the general population. Risk exposures differ little by MSA size, except in the Northeast. The proportion of people with AIDS who reside in large MSAs exceeds the proportion of the population in those areas, especially when race/ethnicity is considered. AIDS rates have increased in non‐MSAs relative to large MSAs, yet do not indicate that the epidemic is increasing rapidly in rural areas. Fewer AIDS cases are reported from smaller communities, yet require medical and social services that may burden the rural health care system.
Quality‐of‐Care Challenges for Rural Health
Authors: Moscovice Ira , Rosenblatt Roger
Published: April 2008

Abstract: The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their bad health care meets certain basic standards. Unless rural providers can document that the quality of local health care meets objective external standards, third‐party payers might refuse to contract with rural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve the measurement of health care quality in a rural setting, a number of issues specific to the rural environment must be addressed, including small sample sizes (volume and outcome issues), limited data availability, the ability to define rural health service areas, rural population preferences and the lower priority of formal quality‐of‐care assessment in shortage areas. Several current health policy initiatives have substantial implications for monitoring and measuring the quality of rural health services. For example, to receive community acceptance and achieve fiscal stability, critical access hospitals (CAHs) must be able to document that the care they provide is at least comparable to that of their predecessor institutions. The expectations for quality assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban areas, there will be an inevitable collision between the ability to provide care and the ability to measure quality. As desirable as it might be to have a national standard for health care quality, this is not an attainable goal. The spectrum and content of rural health care are different from the spectrum and content of care provided in large cities. Accrediting agencies, third‐party carriers and health insurance purchasers need to develop rural health care quality standards that are practical, useful and affordable.
Postgraduate Medical Education for Rural Family Practice in Canada
Authors: Rourke James T. B.
Published: April 2008

Abstract: Canada is a large country with a diverse and spread‐out rural population. Compared to their urban counterparts, rural Canadians have fewer family doctors and dramatically fewer specialists, and they face other significant geographic barriers to accessing health care. This paper describes the milieu of the rural physician in Canada and reports on efforts to develop a postgraduate medical education model for rural family practice that will produce more physicians with the knowledge, skills and interest to practice in small and mid‐sized communities. Key recommendations of the College of Family Physicians of Canada include: providing earlier and more extensive rural medicine experience for all undergraduate medical students, developing rural postgraduate training programs, providing third‐year optional special and advanced rural family medicine skills training and making advanced family medicine skills training competency‐based and nationally accredited.
The National Area Health Education Center Program and Primary Care Residency Training
Authors: Bacon Thomas J. , Baden Daniel J. , Coccodrilli Louis D.
Published: April 2008

Abstract: The Area Health Education Center (AHEC) program was established in 1972 to improve the supply, distribution, retention and quality of primary care and other health practitioners in medically underserved areas. Through academic/community partnerships, regional AHECs offer a broad array of educational programs for students, residents and practicing health professionals. With primary care medical education a core part of AHEC programs, AHECs have been involved in decentralized residency training from the outset, with particular attention to family medicine. This paper provides an overview of the national AHEC program, its core components and its support for primary care residency training. Although AHECs have achieved considerable success in training primary care physicians for their respective states, continued refinements of programs are needed to address the needs of the most rural and underserved communities.
The Role of Critical Access Hospital Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
Authors: Dalton Kathleen , Slifkin Rebecca T. , Howard Hilda A.
Published: April 2008

Abstract: This article examines rural hospitals that potentially qualify as critical access hospitals (CAH) and identifies facilities at substantial financial risk as a result of Medicare's expansion of prospective payment systems (PPS) to nonacute settings. Using Health Care Financing Administration (HCFA) cost reports from the federal year ending Sept. 30, 1996, combined with county‐level sociodemographic data from the Area Resource File (ARF), characteristics of potential CAHs were identified and their finances analyzed to determine whether they could benefit from the cost‐based reimbursement rules applicable to CAH status. Rural hospitals were identified as potential CAHs if they met a combination of federal and state criteria for necessary providers. Rural facilities were classified as “at risk” if they had poor financial ratios in conjunction with high levels of dependence on outpatient, home‐care or skilled nursing services. Almost 30 percent of all rural hospitals were identified as potential CAHs. Ninety percent of potential CAH facilities were identified as “at risk” by at least one of five possible risk criteria, and one‐third were identified by at least three. Of those classified “at risk,” 48 percent might not benefit from conversion to CAH because their inpatient Medicare reimbursement would likely be less under CAH payment rules than under their current PPS payment rules. Many potential CAHs were doing well under inpatient PPS because they were sole community hospitals (SCH) and were therefore eligible for special adjustments to the PPS rates. The Rural Hospital Flexibility Act would be more beneficial to the population of isolated rural hospitals if those eligible for both CAH and SCH status were given the option of retaining their SCH inpatient payment arrangements while still qualifying for outpatient cost‐based reimbursement.
Do Rural and Urban Children Have Comparable Asthma Care Utilization?
Authors: Yawn Barbara P. , III Arch G. Mainous , Love Margaret M. , Hueston William
Published: April 2008

This study compares asthma‐related health care visits and drug therapy for rural and nonrural Kentucky children with Medicaid health insurance in 1995. The 8,634 children with asthma had a mean age of 5.7 years. Ninety‐two percent made at least one asthma office visit, and 13 percent were hospitalized. The urban and rural patterns of care for childhood asthma varied in some potentially important ways. Urban children were twice as likely as rural children to see an asthma specialist (5 percent vs. 2.5 percent, P<0.05), 2.7 times as likely to receive asthma care in an emergency department (19 percent vs. 7 percent, P<0.01) and 1.4 times as likely to receive oral steroids (16 percent vs. 12 percent, P=0.04). If given inhaled anti‐inflammatory medication, rural children were more likely to receive inhaled steroids while urban children were more likely to receive cromoglycates.
Equipment Dealers’Perceptions of a Community‐based Rollover Protective Structures Promotion Campaign
Authors: Struttmann Timothy W. , Brandt Vickie A. , Morgan Susan E. , Piercy Larry R. , Cole Henry P.
Published: April 2008

Farming is one of the most hazardous occupations, and tractor overturns are the leading cause of agricultural fatalities. This article examines a community‐based injury intervention designed to increase the number of rollover protective structures (ROPS) and seat belts on tractors and to promote safe operation of farm tractors in two counties. Equipment dealers who sell retrofit ROPS kits to farmers were a critical component of the intervention. Interviews were conducted with dealers after the 31‐month intervention period to understand their perceptions, any difficulties they experienced as a result of the project and how a similar project could be improved. Comments were analyzed in relation to theories of persuasion. Results indicated that dealers believed the intervention was successful in producing behavior change among some farmers. Dealers also provided important insights into why some farmers continued to resist retrofitting tractors with ROPS. Recommendations are offered for designers of community‐based interventions beyond the ROPS project described here.
Rural Bioethical Issues of the Elderly: How Do They Differ From Urban Ones?
Authors: Glover Jacqueline J.
Published: April 2008

Typical ethical issues in health care for the elderly include decision making for elderly patients with and without capacity, advance directives, the use of life‐sustaining technologies, and questions of access to services and justice. Obviously the same issues are relevant for elderly patients in rural settings. But the unique features of rural living add another dimension to ethical discourse and the care of patients, namely the primary importance of relationships. Rural bioethics is based on an ethic of familiarity, which alters our attention to such issues as confidentiality, multiple relationships, scope of practice, and access issues. The following article briefly outlines the unique features of rural bioethics and provides a case analysis.
Finding and Using Rural Aging Data: An International Perspective
Authors: Havens Betty , Stloukal Libor , Racher Fran , Norris Doug , Keefe Janice , Coppin Antonia
Published: April 2008

This article reports on a workshop in which participants identified sources of data on rural aging. Such sources are typically part of larger data collection efforts or special aging studies with large rural components. Finding and using data on rural aging are not only two different processes but they also face somewhat different obstacles and the solutions are likewise different. The workshop addressed both of these issues. Participants shared many innovative and creative means for collecting, finding and adapting more general data sources, and analyzing and using these data, to further our understanding of rural aging phenomena.
Social Services for the Elderly Based on the New Rurality: The Japanese Experience
Authors: Ogawa Takeo
Published: April 2008

Since the 1920s, Japan has changed from being a relatively youthful society, with an average age of about 26, to an elderly society with an average age of over 40 (Fordyce, 1999). The number of elderly is rising and the number of births is falling. Concurrently, the health and infrastructure needs of many of the retired elderly are increasing while, for the same retirees, their contribution to productivity and revenue is diminishing (Fordyce, 1999). As the population ages, inevitably the burdens of taxes, pensions, public medical insurance and social services have been rapidly increasing. To meet the challenges of these changes in population structure, Japan has established policies such as the Gold Plan and the Public Long‐term Care Insurance Program and it has expanded social services into rural agricultural areas. This article examines those policies and the care services and productive aging programs that have developed due to population aging and new rural patterns in Japan.
How Much Do Rural Hispanics Know About the Adverse Health Risks of Smoking?
Authors: Butkovic Tania , Hegde Ramanujan S. , Hughes Susan , Lourie Andrea , Schafer Sean
Published: April 2008

ABSTRACT: The object of this study was to measure knowledge in a rural Hispanic community about the adverse health effects of smoking and to compare knowledge between current smokers and nonsmokers. A survey was administered to waiting room patients (n=137) over 16 years old at three predominantly Hispanic rural community health centers in the central San Joaquin Valley of California. Proportions of respondents who believed that smoking caused a specific consequence were calculated and compared between smokers and nonsmokers by chi‐square tests. Likelihood of attributing negative health consequences to smoking was determined and compared between smokers and nonsmokers. A majority of all participants (smokers and nonsmokers) knew that smoking causes lung cancer (93 percent) and emphysema (91 percent). Many fewer participants knew that smoking contributes to problems such as osteoporosis (39 percent) or sexual dysfunction (33 percent). Current smokers were less likely than nonsmokers (P=0.01) to say that smoking causes any adverse health outcome, including those not known to be related to smoking. Although this is a culturally, ethnically and geographically unique group, knowledge of smoking risks among smoking and nonsmoking rural Hispanics is similar to that found in the general population. When compared with nonsmokers, current smokers underestimate the risk that smoking poses to health.
The Effects of Payback and Loan Repayment Programs on Medical Student Career Plans
Authors: Miller John Bernard , Crittenden Robert A.
Published: April 2008

ABSTRACT: Many states have considered implementing payback programs on state‐subsidized medical education to increase the rate of graduates returning to those states to practice. An alternative is for states to offer and expand loan repayment programs to entice medical school graduates from rural states to return to their home states. The goal of this study is to determine and contrast the impact these two types of programs might have on medical school choice and students' intentions to return to their home states. Two hundred twenty‐nine medical students were surveyed (response rate 80 percent). The questionnaire collected background information on the students and addressed the possible impact of payback and loan repayment policy proposals on student plans. Forty‐seven percent of students reported that they would attend a different medical school if a required payback program were in place. Students who were more competitive at the time of admission to medical school were significantly more likely to say they would attend another medical school than ivere less competitive students. In contrast, 48 percent of students reported that they would be more likely to return to their home states if expanded loan repayment programs were available for service in areas of need. The findings suggest that payback programs may dissuade more competitive students from entering medical schools with such requirements, compromising tlie pool of students most likely to return to rural areas. Conversely, medical students appear willing to consider loan repayment programs upon completion of their training.
Rural Highpoints from Other Journals
Authors: Vail Robin
Published: April 2008

AIDS Care: HIV/AIDS‐Related Services for Women and the Rural Community Context by Castaneda, D.

Teaching and Learning in Medicine: Interim Evaluation of the Rural Health Scholars Program by Lynch, DC, Teplin, SE, Willis, SE, Pathman, DE, Larsen, LC, Steiner, BD, & Bernstein, ID.

Telemedicine Journal and e‐Health: Improved Rural Provider Access to Continuing Medical Education Through Interactive Videoconferencing by Callas, PW, Ricci, MA, & Caputo, MI.

Journal of Air Waste Management Association: A Comparison of Measured and Simulated Ozone Concentrations in the Rural Areas of the Eastern United States during Summer 1995 by Sistla, G, Civerolo, K, Hao, W, & Rao, ST.
The Contributions of Business and Civil Society Sectors to Rural Capacity to Solve Local Health Issues
Authors: Morton Lois Wright
Published: April 2008

ABSTRACT: The new health movement, which has emerged over the last decade, focuses decision making for program designs, interventions and health policies at the local level. This movement assumes that rural communities have the capacity to deal with local health issues. Local problem‐solving capacity is based in local leadership patterns, relationships among different community sectors and the ability to select critical but feasible goals. In this research, 159 community leaders in 16 rural counties were interviewed regarding local health priorities, organizational interactions, and leadership roles in county health issues. Analysis of variance was used to identify differences among community sectors. The business and industry sector was found to interact with other organizations around health issues significantly less than all other sectors. Further, 69 percent of the business and industry sector compared with 32 percent of all other sectors thought that the business sector was a source of local leadership. The civil society sector, when compared with all other sectors, was significantly more likely to give priority to health services such as primary, specialty and auxiliary care goals. These findings suggest that rural communities need to find ways to more actively involve the business and industry sector in local health problem solving. In addition, the civil society sector brings to community problem solving a set of priorities that are often different from other sectors of the community.
The Effect of Medicaid Managed Care on Rural Public Health Departments
Authors: Slifkin Rebecca T. , Silberman Pam , Reif Susan
Published: April 2008

ABSTRACT: Medicaid managed care programs are now operating in more than half of all rural counties in the United States. This study examines how rural health departments that have historically provided clinical services have responded to and been affected by the implementation of Medicaid managed care. To the extent that rural health departments have changed, the effect of this change on the health department and the rural populations that these providers serve is assessed. Site visits were made to four rural public health departments in each of five study states, for a total of 20 case studies. At each site, in‐person interviews of county public health department directors were conducted using semistructured interview protocols. In recent years, the majority of health departments decreased or discontinued provision of well‐child services, causing many to lose Medicaid revenue. None of the health departments appeared to be in danger of closing, but most lost income security. Medicaid managed care appeared to have increased the number of children with medical homes in the private sector, but adequacy and continuity of care remains an issue. Privatizing Medicaid managed care has not decreased fragmentation, as public health functions such as tracking and screening represent an important facet of comprehensive health services for poor rural populations.
Consumer Perspectives on Medicaid Managed Care: A Comparison Between Rural and Urban Enrollees in One Selected Health Plan
Authors: Riportdla‐Muller Roberta
Published: April 2008

ABSTRACT: This report presents the findings from a telephone survey of 313 respondents who have family members enrolled in Medicaid managed care in a multicounty region that encompasses both rural and urban counties in Wisconsin. Some demographic differences were noted between the rural and urban families that might affect their impressions of the health care system, their needs for services and their abilities to use those services appropriately. Families in the urban counties had poorer access to health care, as they were more likely to report at least one child not being assigned to a primary care provider. Inadequate preventive health behaviors were found among both rural and urban families, as evidenced by children being overdue for immunizations or health checkups. Yet respondents reported being happy with the care they received. Rural families in particular seemed to fare well in this managed care system.
Perceptions of Important Retention and Recruitment Factors by Therapists in Northwestern Ontario
Authors: Solomon Patricia , Salvatori Penny , Berry Sue
Published: April 2008

ABSTRACT: Recruitment and retention of health professionals in rural and remote communities are well‐knoivn challenges. Although the literature states that lifestyle factors and being from a rural background influence recruitment and retention, much of the research is dated and of limited relevance to rehabilitation professionals. This study reports on a survey of physical therapists (PTs) and occupational therapists (OTs) in northwestern Ontario. Seventy‐four percent of the OTs and PTs from this geographically isolated region of Canada responded to a mail survey examining factors that influenced their job recruitment and retention decisions. Availability of leisure and recreation activities, proximity of family of origin, need for OTs and PTs and influence of spouse or partner frequently contributed to recruitment decisions and were also important in retention decisions. Although professional autonomy was an important source of job satisfaction for the respondents, almost one‐third reported a feeling of professional isolation. Professional development initiatives appeared to influence job satisfaction but were unlikely to influence working life decisions. TIk findings suggest that recruitment and retention strategies should be multifaceted to reflect tlie complexity of therapists' decision‐making.
A Pilot Study of Oncology Staff Perceptions of Palliative Care and Psycho‐oncology Services in Rural and Community Settings in Indiana
Authors: Passik Steven D. , Whitcomb Laurie A. , Kirsh Kenneth L. , Donaghy Kathleen , Theobald Dale , Holtsclaw Elizabeth , Edgerton Sara , Dugan William
Published: April 2008

Abstract: Although there has been an increased interest in health care delivery for rural community populations, concerns remain regarding the lack of access to primary health care and specialty services (such as palliative care), particularly in rural areas that are medically underserved (MU). This survey was conducted to examine the perceptions of palliative care services in rural communities and toward identifying perceived barriers that interfere with accessing palliative care services. In conducting the study, personnel from various disciplines throughout the Community Cancer Care (CCC) network (the largest private provider of oncology services in Indiana) completed a survey that assessed their perceptions of the strengths and weaknesses of the available palliative care services in their communities. These responses, which indicate discrepancies in perceptions among staff within sites, suggest problems of integration of palliative care in given locations. Results revealed three particularly problematic areas: accessing pain control, accessing psychological or psychiatric services or both, and overcoming barriers to hospice care. Although no significant differences were found for any variables between MU and adequately medically served (AMS) areas, in general palliative care is limited and unintegrated into oncology care. Confusion among staff at a particular oncology program likely contributes to the haphazard delivery and poor integration of palliative care. Conclusions are tempered by important study limitations but the results suggest the need for programs that improve delivery of palliative care in rural Indiana.
Quality of Diets Consumed by Older Rural Adults
Authors: Vitolins Mara Z. , Quandt Sara A. , Bell Ronny A. , Arcury Thomas A. , Case L. Douglas
Published: April 2008

Older adults residing in rural communities are at risk for low dietary quality because of a variety of social, physical and environmental circumstances. Minority elders are at additional risk because of poorer health status and lower socioeconomic status. This study evaluated the food group intake of 130 older (>70 years) African American (34%), European American (36%), and Native American (30%) residents of two rural communities in central North Carolina. An interviewer‐administered food frequency questionnaire was used to measure dietary intake. Food items were classified into food groups similar to the United States Department of Agriculture (USDA) Food Guide Pyramid and the National Cancer Institutés 5 A Day for Better Health program. None of the survey participants met minimum intake recommendations and most over‐consumed fats, oils, sweets and snacks. African Americans and Native Americans consumed fewer servings of meats, fruits and vegetables, and fats, oils, sweets and snacks than European Americans. African American men consumed the fewest servings of fruits and vegetables of all gender/ethnic groups. Consumption of fats, oils and sweets was greatest among those 85 years and older and was more common among denture users. National strategies to educate the public about the importance of consuming a varied diet based on the recommendations presented in national nutrition education campaigns may not be reaching older adults in rural communities, particularly minority group members.
Why Do Rural Primary Care Physicians Sell Their Practices?
Authors: Stensland Jeffrey , Brasure Michelle , Moscovice Ira
Published: April 2008

This study evaluates why rural primary care physicians sell their practices. A random sample of rural primary care practices in California, Utah, Ohio, Texas, and Virginia were surveyed to investigate changes in ownership of the practices during the period 1995–1998. These five states were selected because they represent areas with different experiences with physician‐hospital integration and varied rates of managed care penetration. A series of logistic regressions were conducted to examine the factors that led independent physicians to sell their practices to either nonlocal buyers, local hospitals, or local physicians. Findings suggest that sales to nonlocal buyers represent the majority of practice ownership changes. The motivations for ceding control to nonlocal buyers center on managed care concerns, recruitment concerns, and administrative burdens. Sellers were also concerned about their level of net income prior to being acquired. However, the preacquisition financial concerns of sellers were not significantly stronger than the financial concerns of practices that remained independent. The environmental conditions that motivate rural physicians to sell their practices are not expected to improve. Therefore, additional sales of rural primary care practices to nonlocal buyers are expected. Further research is necessary to determine whether this shift in control will lead to changes in the quality or accessibility of care.
Community Entry in Conducting Rural Focus Groups: Process, Legitimacy, and Lessons Learned
Authors: Smith Shannon L. , Blake Kelly , Olson Carol R. , Tessaro Irene
Published: April 2008

This article explores the value of community collaboration in a qualitative study of diabetes. In 1999, the Appalachian Diabetes Coalition of West Virginia University's Prmntion Research Center employed a statewide effort to conduct focus groups in West Virginia to elicit cultural perspectives on diabetes and its management. The success of this research depended on community participation at many levels, particularly because of the rural, often geographically isolated community structure of the state. The researchers' entry into small communities and the involvement of local residents in focus groups was possible with the collaboration of the West Virginia Rural Health Education Partnerships program and the West Virginia University Extension Service, both of which played primary roles as community gatekeepers in helping the research team access and involve rural areas. This collaboration reinforced the value of a two‐tiered approach in enlisting local resources. These relationships resulted in beneficial outcomes to all partners. Researchers benefited by gaining entry to communities, and the community organizations benefited by gaining a better understanding of the diabetic population to assist in planning programs. Working with well‐established community groups with strong community ties is crucial when gaining entry for research and interventions. The identification and involvement of trusted, accessible members of rural communities gives research local legitimacy, ensures adequate participation and effective data collection, and permits entry into remote communities.
Health Risk Factors Among Iowa Farmers
Authors: Park Hyesook , Sprince Nancy L. , Jensen Christine , Whitten Paul S. , Zwerling Craig
Published: April 2008

This study compares the prevalence of the health risk factors for chronic disease and injury among farmers with their prevalence among other workers, using data from the lowa Behavioral Risk Factor Surveillance System From January 1999 to December 1999, there were 3,620 adults who participated in the survey This report focuses on the 2,140 subjects who reported they were working We calculated the percentage with each health risk factor, the adjusted odds ratio (OR) and the associafed 95% confidence interval (Cl), comparing the prevalence of health risks among farmers and other workers Most health conditions and risk factors were similar among farmers and other workers However, ue found that farmers had some protective behaviors They had better oral health (OR = 0 34, 95% CI 0 20‐0 57) and were less likely to smoke (OR = 014, 95% CI 0 06‐0 29) than other workers In contrast, we found that farmers reported some high‐risk behauiors compared to other workers They were less likely to have smoke detectors at home (OR = 0 39, 95% CI 018‐0 82), or to have had stool blood screening fir colorectal cancer (OR = 041, 95% CI 017‐1 00) These results suggest areas for future research to define targeted preventive interventions in farm communities.
Developing, Implementing, and Evaluating a Treatment Protocol for Rural Substance Abusers
Authors: Clark James J. , Leukefeld Carl , Godlaski Theodore , Brown Cyndy , Garrity John , Hays Lon
Published: April 2008

Substance abuse is a significant social and public health problem facing rural Americans. Hawever, most treatment protocols ham been developed in urban areas. This article describes the development, implementation, and evaluation of an innovative substance abuse treatment designed with the collaboration of rural professionals and consumers specifically for rural clients and delivered by rural clinicians. Results of the process evaluation of Structured Behavioral Outpatient Rural Therapy (SBORT) produced findings about the experiences of participating clients, clinicians, and program directors. Most clients perceived SBORT as a helpful learning process that used multiple treatment strategies and presented an alternative to 12‐step programs. Clients also reported that treatment was stressful even when beneficial, and that clinician support was critical for remaining in treatment. Most clinicians found that SBORT challenged their “old” treatment frameworks, was demanding to learn and adopt, and that the training and supervision involved in the project implementation helped remedy rural isolation from the treatment community. Interestingly, agency approach to program implementation strongly influenced clinician responses to the innovation. Agency program directors' appraisals of SBORT included observations that the therapy was viable because of its rural‐specfic design and that most staff were able to adapt to the changes demanded by the manualized protocol. All three groups reported that they saw the emphasis and acceptance of motivation as an emergent process as important to the treatment. This project highlighted the challenge and importance of testing rural substance abuse treatment protocols in naturalistic settings.
An Outreach Intervention for Older Rural African Americans
Authors: Forti Esther M. , Koerber Marilynn
Published: April 2008

This article describes the process, approaches, and selected outcomes of a rural care management outreach intervention for older African Americans in South Carolina. The model is a community‐academic partnership between a federally qualified community health center, a rural health clinic, and the Medical University of South Carolina. Its aim is to improve access to and utilization of health care and social services to enhance the quality of life of older African Americans. This is being accomplished by using paid, trained outreach work‐ers (called geriatric coordinators), who function as advocates in linking clients to needed health and social services through activities such as arranging transportation to health care, rescheduling missed medical appointments, providing health promotion, and making referrals to public benefits and indigent drug programs. Outcomes demonstrated that the use of geriatric coordinators as care managers is a feasible way of increasing quality of life for older African Americans. The most notable outcome showed that 54% of clients who were eligible but not receiving benefits prior to this intermtion were signed on for programs such as Supplemental Security Income, Specified Low‐lncome Medicare Beneficiary (SLMB), Qualified Medicare Beneficiary (QMB), disability, railroad pensions, and Veterans Administration benefits. Health centers realized an increase in reimbursable services and new clients. Increased capacity for older adult services is being accomplished through geriatric‐coordinator‐directed collaborations with social service agencies and participation in community events and committees.
Variations in Rural AIDS Epidemiology and Service Delivery Models in the United States
Authors: McKinney Martha M.
Published: April 2008

This article reviews AIDS surveillance data and the rural health literature to summarize what is known about the rural AIDS epidemic, characteristics of rural environments that affect HIV service delivery, and approaches that rural areas are using to address the health and support service needs of HIV‐positive residents. During 1999, nonmetropolitan (non‐MSA) adult/adolescent AIDS rates were highest in the South (11 per 100,000) and Northeast (9 per 100,000). The South had the highest non‐MSA proportion of adult/adolescent AIDS cases (12%), followed by the North Central region (9%), the West (4%), and the Northeast (3%). Variations in rural HIV/AIDS epidemiologic patterns and the demographic, socio‐economic, and cultural characteristics of rural environments are likely to require different levels of resource investment and different methods of organizing and delivering HIV services. Currently, many HIV‐positive rural residents are traveling to metropolitan areas for medical care because of concerns about confidentiality or a lack of confidence in the HIV management capabilities of local physicians. Rural communities are attempting to address these problems by developing the HIV care capacity of existing clinics, building local networks of physicians with HIV management experience, and cultivating “shared care” arrangements with urban‐based specialists.
Rural Nebraska Elementary School Educators Teach Nutrition Concepts
Authors: Pohlman H. Darlene , Driskell Judy A.
Published: April 2008

The purpose of this study was to determine if diferences exist in the teaching of nutrition to students in grades one to four in rural (less than 10,000 population); midsized (10,000 to 99,999); and urban (100,000 or more) counties in Nebrash. Surveys me sent to one‐fifty of educators teaching grades une to four (n=1,232); the response rate was 37.7%. Sixty eight percent of the teachers responded that the teaching of nutrition was of very high or high priority in the elementary curriculum. Nutrition was taught as part of a nutrition/health unit as well as being integrated into other subject areas. The resources the teachers used me not different by county population size. Significant diferences (p >.05) were observed among county groups as to the frequency of teaching the recommended intakes of grain products, vegetables, fruits, dairy, and meats, with urban teachers teaching these concepts least often. The majority of the teachers rarely, if ever, taught serving sizes and which food groups are in combination foods, with no diferences among county groups. The formal training that the respondents had in nutrition was not different among groups. A larger percentage of teachers in rural and midsized community groups taught food selection concepts me consistently or frequently than did their urban counterparts.