bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of a Rural Primary Care Clerkship on Medical Students' Intentions to Practice in a Rural Community
Authors: Jones Alma R. , Oster Robert A. , Pederson Linda I. , Davis Mary Kidd , Blumenthal Daniel S.
Published: April 2008

Abstract: The purpose of this study is to examine the relationship of a rural clerkship to medical students' interest in establishing careers in rural communities. The Association of American Medical Colleges Medical School Graduation Questionnaire (GQ) for years 1988 through 1997 was examined to compare the career plans of students graduating from Morehouse School of Medicine (MSM) with those of all students graduating from United States medical schools before the period 1988 through 1992 and after the period 1993 through 1997, after the inception of the rural clerkship at MSM. Select GQ data items examined include student demographics, medical school experiences, and career plans. Statistical analyses were used to compare pre‐ and post‐clerkship responses for MSM students and to compare their responses with the national trends. Results indicate that, following a transition period, MSM students showed an increased preference for a future career in a rural community. A smaller upward trend in the national data was observed. There appears to be an association between the rural clerkship experience at MSM and the stated preferred career choices of the students.
Using the American Medical Association Physician Masterfile to Measure Physician Supply in Small Towns
Authors: Konrad Thomas R. , Slifkin Rebecca T. , Stevens Catherine , Miller Jeremy
Published: April 2008

Abstract: The goal of this study was to describe the magnitude, direction and sources of error of the American Medical Association's (AMA) masterfile (MF) in estimating physician supply in small towns. A random sample of nonmetropolitan towns in the United States was selected, and physicians with AMA MF (MFMDs) addresses in these towns were listed. Local pharmacists were asked to confirm or disconfirm the identities and locations of practice for the listed physicians and to add any unlisted physicians who were there. We took pharmacist confirmed or identified local source physicians (LSMDs) to be the “gold standard.” The sample of 57 towns yielded 1,341 potential physician names. In these towns, there were 377 physician listings only from the MF, 188 only from local pharmacists, and 776 from both sources. About 80 percent of physicians identified by local informants were also listed on the MF; only 67 percent of physicians listed on the MF were identified by local informants as currently practicing in the town where they were listed. The error in these measures declined with increasing town size. The aggregate ratio of MFMDs to LSMDs was 1.20, ranging from 1.10 to 1.28 across size classes of towns. Given the persistence of local shortages of physicians, despite a national oversupply, accurate measurement of physician supply should be a priority of rural health care planners and advocates. Although the MF is the most comprehensive available national physician database, reliance on it alone to make local estimates of physician supply might lead one to believe that there are 20 percent more physicians in small rural communities than are actually there. Local pharmacists can be valuable informants about rural physician availability and their in‐ and out‐migration.
How Many Rural Doctors Do We Have?
Authors: Ricketts Thomas C. , Hart L. Gary , Pirani Michael
Published: April 2008

Abstract:The number of physicians practicing in the nonmetropolitan areas of the United States in relation to population has increased over the past two decades, but more slowly than the number of physicians in metropolitan counties. During the same period, there was a growing acceptance of the perception that the physician workforce in the United States exceeded the number necessary to meet the requirements of an efficient health care system. This has caused policy‐makers to consider reforming the incentives for training physicians and restricting the entry of physicians from other countries into the United States. The supply figures on which these assessments of oversupply were made are based on “head counts” of the number of licensed, active physicians. By using more detailed data describing the licensed practicing physicians in the states of North Carolina and Washington, and by using estimates of professional activity collected as part of the Socioeconomic Monitoring System of the American Medical Association, estimates of the number of full‐time equivalent physicians actually in practice in the two states and the comparative productivity of those physicians were made. Based on the state‐level data, the estimates of actively practicing physicians are approximately 14 percent lower than the head‐count number in North Carolina and, by using a more conservative estimation method, are approaching a 10 percent lower number than the head‐count number in Washington. Using national productivity data, the effective supply of nonmetropolitan physicians appears to have not grown significantly over the past 10 years, and for family physicians the supply has declined by 9 percent. These estimates of the effective physician supply support long‐held claims that rural communities continue to experience a severe undersupply of practitioners. These results suggest that the way in which physicians are counted needs to be re‐examined, especially in rural places where the ratios of providers to population are more sensitive to small changes in supply.
Changes and Challenges in Rural Graduate Medical Education: The Family Medicine Spokane Rural Training Track Experience in Colville, Wash.
Authors: Maudlin Robert K. , Newkirk Gary R. , Snook Michael D. , Cooper Gloria
Published: April 2008

Abstract: Rural community‐based graduate medical education programs in family practice are considered wise investments in America's future because they generate highly trained physicians who typically settle and practice in rural communities. In recent years, however, federal funding cutbacks and revised accreditation requirements have threatened the viability of these programs. In Colville, Wash., Mount Carmel Hospital has responded by agreeing to continue its collaboration with the Northeast Washington Medical Group to fully fund the cost of the Family Medicine Spokane Rural Training Track family practice residency program.
The Role of the Medical School in Rural Graduate Medical Education: Pipeline or Control Valve?
Authors: Rabinowitz Howard K. , Paynter Nina P.
Published: April 2008

Abstract: Although rural‐based graduate medical education is critically important in the training of competent rural family physicians, the number of physicians selecting these programs is highly dependent on what happens earlier in the pipeline, i.e, during medical school. Using the experience and outcomes research from Jefferson Medical Colleges Physician Shortage Area Program, as well as from published literature describing six other medical school programs with similar goals, this paper addresses the important role of these programs in substantially increasing the number of physicians interested in rural family practice. Although each of these programs differs in its structure, all contain three core features: a strong institutional mission; the targeted selection of students likely to practice in rural areas, predominantly those with rural backgrounds; and a focus on primary care, especially family practice. Outcomes show that all seven programs have been highly successful. Medical schools, therefore, can have a major impact on the number of rural physicians they produce by acting not only as a pipeline or conduit to residency programs, but also as a control valve, beginning as early as the admissions process. In order to maximize their impact on the supply and training of rural family physicians, rural residency programs should understand, support, collaborate with and help develop medical school programs whose mission is to provide rural physicians.
Impact of Rural Training on Physician Work Force: The Role of Postresidency Education
Authors: Acosta David A.
Published: April 2008

Abstract: Many innovative strategies have been developed over the years to improve the recruitment and retention of physicians in the shortage areas of rural America. These strategies have met with varying success. Postresidency education, or fellowship training, for family physicians is yet another strategy that has been developed for the same purpose. Most applicants have been interested in obstetrical and rural health fellowship programs as a means for preparing for rural practice. This paper describes these programs (demographics, funding, applicant pool, curriculum) and reviews their graduate outcomes (practice location after matriculation, clinical privileges). Twenty‐nine obstetrical and nine rural health fellowships are currently operational in the United States. Fellows who complete a rural health fellowship have a higher tendency to locate in rural settings. Almost all graduates from obstetrical and rural health programs attain general hospital privileges in family practice, including low‐risk obstetrics. A significant number of graduates from both types of programs attain privileges in high‐risk and operative obstetrics as well. Fellowship training can play an integral role in the preparation of family physicians for rural practice.
Graduate Medical Education for Rural Physicians: Curriculum and Retention
Authors: Stearns Jeffrey A. , Stearns Marjorie A.
Published: April 2008

Abstract: The chronic shortage of rural physicians prompts further consideration of the educational interventions that have been developed to address this issue. Despite rural admission strategies and a variety of undergraduate, graduate and postgraduate curricular innovations, the recruitment and retention of family physicians into many rural areas has not kept pace with the retirement of older general practice physicians. This paper reviews the 1994 American Academy of Family Physicians' rural training recommendations in the light of several recent educational needs assessments. These studies affirm the need for rural residency rotations and the need to maintain and better implement the established rural clinical training guidelines. However, although preparation for rural medical practice has been addressed and is being adequately accomplished in the clinical knowledge and procedural skills areas, instruction and experiences relating to the “realities of rural living” need to be enhanced to increase the retention duration of rural physicians. This can be accomplished with more curricular emphasis on developing community health competencies, including community‐oriented primary care (COPC). Physicians who know how to collaborate with community members on health improvement projects have skills that can also facilitate integration and, hence, retention.
A Primary Care Intervention for Depression
Authors: Smith Jeffrey I. , Rost Kathryn M. , Nutting Paul A. , Elliott Carl E. , Duan Naihua
Published: April 2008

Abstract: To assess a guideline‐based intervention's impact on depression care provided in rural vs. urban primary care settings, 12 community primary care practices (four rural, eight urban) were randomized to enhanced (i.e, intervention) and usual care study conditions. The study enrolled 479 depressed patients, with 432 (90.2 percent) completing telephone follow‐up at six months. Multilevel analytic models revealed that rural enhanced care patients had 2.70 times the odds (P=0.02) of rural usual care patients of taking a three‐month course of antidepressant medication at recommended dosages in the six months following baseline; urban enhanced care patients had 2.43 times the odds compared with their urban usual care counterparts (P=0.007). Rural enhanced care patients had 3.00 times the odds of rural usual care patients of making eight or more visits to a mental health specialist for counseling in the six months following baseline (P=0.03). Comparisons of patients in enhanced care practices showed that rural enhanced care patients had 2.00 times the odds (P=0.12) of urban enhanced care patients of making at least one visit to a mental health specialist for counseling in the six months following baseline and had comparable odds to urban enhanced care patients (odds ratio [OR] = 1.06, P=0.77) of making eight or more visits to such specialists during that interval. The study's intervention improved the care received by both rural and urban depressed primary care patients. Moreover, the interventions effect appears to have been greater in rural settings, particularly in terms of increasing depressed rural patients' use of mental health specialists for counseling.
Moving From Medical Student Placement to a Community‐Academic Partnership With a Rural Community
Authors: Maurana Cheryl A. , Beck Barbra , Beversdorf Sarah J. , Newton Gail L.
Published: April 2008

Abstract: This article explains a partnership‐based community education model, which uses as an example a partnership between the Center for Healthy Communities in the Department of Family and Community Medicine at the Medical College of Wisconsin (MCW) and the rural Marion area of central Wisconsin. MCW is similar to other medical schools in that it has a strong history and philosophy of placing students in communities for educational purposes. This article describes how the Center for Healthy Communities is moving beyond student placement to true partnership building. The center followed four stages of development as it built a partnership with this rural Wisconsin community: (1) establish and build relationships, (2) develop common goals, (3) develop and implement programs and (4) maintain and expand progress. The center also applied a set of principles in developing the partnership. By following the stages and applying the principles, the center found that two elements were key to building a partnership for medical student education and community health improvement: long‐term commitment and ability and willingness to spend time in the community. As a result, a meaningful, ongoing partnership developed that benefits both the community and MCW.
State HMO Accreditation and External Quality Review Requirements: Implications for HMOs Serving Rural Areas
Authors: Casey Michelle
Published: April 2008

The purpose of this article is to analyze state regulations regarding health maintenance organization (HMO) accreditation and external quality review; to briefly describe states’experiences implementing these regulations; and to discuss the implications of these regulations for HMOs serving rural areas. The incorporation of HMO accreditation and external quality review requirements into state HMO licensure processes and state employee contracting raises many policy issues, including several that are especially relevant to HMOs serving rural populations. A key issue is whether the linkage of accreditation and external quality review requirements to HMO licensure will be an additional deterrent to the development of new HMOs or the expansion of existing HMOs into rural areas. Other issues relate to the costs and benefits of accreditation for HMOs serving rural populations, and the potential impact of HMO accreditation requirements on efforts to expand managed care enrollment of rural Medicaid and Medicare beneficiaries and rural state employees. Nine states were identified that have regulations requiring HMOs to seek accreditation or to undergo an external quality review as a condition of licensure. Four states were identified as implementing requirements that an HMO be accredited in order to serve state employees. Many of these requirements are still in the early stages of implementation. Several states with the requirements have significant rural populations and will provide opportunities to evaluate their impact on HMOs serving rural areas, rural providers and rural consumers.
Rural Medicare Beneficiaries’Use of Rural and Urban Hospitals
Authors: Buczko William
Published: April 2008

This report examines the use of rural and urban hospitals by rural Medicare beneficiaries. Many rural Medicare beneficiaries are treated in urban hospitals, primarily for specialized care that is not available locally. This study examines Medicare inpatient hospital discharge data for rural beneficiaries from fiscal year 1990 to fiscal year 1998. Utilization patterns by diagnosis‐related group (DRG) are examined for fiscal year (FY) 1997. The percentage of rural beneficiaries treated in urban hospitals ranged from 30 percent to 36 percent during the study period. For the most frequently occurring DRGs among rural beneficiaries, which were those for routine conditions, treatment occurred predominantly in rural hospitals. The conditions most often responsible for rural beneficiaries’use of urban hospitals during this period reflected the need for coronary and other specialized surgical care. The stability of volume and case‐mix throughout the study period underscores the viability of rural hospitals during a period of substantial change in the organization of health care provision.
A Survey of General Surgeons in Rural Missouri: Potential for Rapid Decrease in Work Force
Authors: Stevermer James J. , Supattanasiri G. Julia , Williamson Harold
Published: April 2008

General surgeons have an essential role in the rural health care system. This telephone survey of 39 rural general surgeons in Missouri found that more than half were 55 or older. Most reported they practiced a broader scope of surgery than colleagues in urban areas, and half believed that current residency graduates are not prepared for surgical practice in rural areas. One‐fifth had sought special training experiences to prepare them for rural practice. On balance, 70 percent of the respondents’practices was general surgery, 13 percent “specialty surgery” and 17 percent primary care. Many reported feeling professionally isolated. One‐fourth had literally “returned home” to practice. The results suggest that if present trends continue, the next 10 years will see a substantial reduction in the number of general surgeons in rural Missouri.
Effects of Managed Mental Health Care on Service Use in Urban and Rural Maine
Authors: Hartley David
Published: April 2008

This study takes advantage of a “natural experiment” resulting from the reassignment of all Maine state employees to a managed behavioral health plan in December 1992. By comparing mental health claims before and after that date, the effects of a behavioral health carve‐out on mental health utilization by rural and urban beneficiaries were investigated. Following the implementation of the carve‐out, the penetration rate, defined as the proportion of beneficiaries who sought help for an affective disorder, increased significantly in both rural and urban areas (P<0.001). However, the rural penetration rate remained significantly lower than the urban rate (before implementation, 25.8 vs. 52.2 users per 1,000 enrollees, P<0.001; after implementation, 57.8 vs. 85.8 users per 1,000 enrollees, P<0.001). Similarly, rural utilization rates, defined as the average number of outpatient mental health visits per user, were significantly lower than urban rates both before and after implementation of the carve‐out (before, 9.2 vs. 12.9 visits per user, P<0.001; after, 9.8 vs. 13.3 visits per user, P<0.001). Before‐after differences were not significant. In addition, the proportion of mental health care provided in the primary care setting increased after implementation of the carve‐out (from 9.5 percent of all visits before to 12.6 percent of all visits after, P<0.001). The increase in penetration rates can be attributed, in part, to a member education initiative undertaken during the transition from fee‐for‐service to managed care. This type of carve‐out arrangement does not threaten to reduce access to mental health services, provided the managed behavioral health organization (MBHO) managing the carve‐out is willing to accept primary care practitioners as part of its provider network.
Rural, Urban and Suburban Comparisons of Preventive Services in Family Practice Clinics
Authors: Pol Louis G. , Rouse Jenine , Zyzanski Stephen , Rasmussen Donadea , Crabtree Benjamin
Published: April 2008

Numerous studies have compared health services provided in rural and urban areas, and overall they have found that utilization is lower in rural areas. A significant factor in lower utilization is that rural residents have less access to health services. Much less is known about rural and urban utilization differences once a patient has access to a service provider. This paper focuses on preventive services received when a patient is already in a clinic. Using data from an in‐depth qualitative study of 16 family practice clinics in Nebraska, comparisons of physician‐specific preventive service rates are made across three geographic categories: rural, urban and suburban. Results from a one‐way multivariate analysis of variance show that preventive services rates for nine services examined were as high or higher in rural areas, suggesting that rural health services do not lag for patients with access.
The Impact of Immunization Record Aggregation on Up‐to‐date Rates–Implications for Immunization Registries in Rural Areas
Authors: Renfrew Brenda L. , Kempe Allison , Lowery N. Elaine , Chandramouli Vijayalaxmi , Steiner John E , Berman Stephen
Published: April 2008

Problems with poorly documented immunization records may be especially important in rural areas. To evaluate the potential impact of a regional registry in a rural region, this study quantified the change in documented immunization rates for nine primary care sites in rural Colorado resulting from the addition of public health department immunization clinic records. Manual chart reviews of immunization data were conducted at both private primary care and public health department sites in two geographic areas in rural Colorado. Data from private primary care sites were matched to data from the public health department sites. Immunization up‐to‐date (UTD) rates at each primary care site were then recalculated for 12‐and 24‐month‐olds after including data from public health department sites. Of 1,533 children, 469 (31 percent) were given immunizations at both a private primary care and a public health department site. The UTD rate (3:2:3:2) of 12‐month‐olds using only data from primary care sites ranged from 32 to 79 percent. Including the public health department data increased the rates by 0 to 26 percent (mean =11 percent) for 12‐month‐old children. The UTD rate of 24‐month‐olds (4:3:1:3 and any Hib on/after 12 months) ranged from 6 to 54 percent at the primary care sites. These rates increased by 6 to 22 percent (mean =12 percent) when public health department data were added. This “virtual” registry combining primary care and public health department data increased calculated immunization rates at primary care sites substantially, with a range of 0 to 26 percent.
Urban and Rural Dimensions of Global Population Aging: An Overview
Authors: Kinsella Kevin
Published: April 2008

In keeping with the worldwide pattern of increased urbanization, the elderly population has become more concentrated in urban areas during the past 50 years. In developed countries as a whole, an estimated 73 percent of people aged 65 or over lived in urban areas in 1990, a figure that is projected to reach 80 percent by the year 2015. In developing nations, which are still predominantly rural, just over one‐third of people aged 65 or over lived in urban areas in 1990, projected to exceed one‐half by 2015. This article provides an overview of global data on urban elders, examines extant data on gender balances and migration patterns, and considers the importance of subnational urban/rural differences and whether rural elderly are disadvantaged relative to their urban counterparts.
Demographic and Health Issues in Rural Aging: A Global Perspective
Authors: Andmvs Gary R
Published: April 2008

The world is witnessing unprecedented changes in population structure, so that both the absolute number and proportion of older people are increasing worldwide. For many developing countries, rapid population aging and the phenomenon of a “double burden” of both infectious disease and emerging chronic diseases represent a major challenge. Many of those who will contribute to these extraordinary transitions will live in rural areas. Many countries, especially the poorest, still have a huge burden of infectious diseases, including increasing rates of HIV/AIDS along with a graving problem of chronic diseases. A number of critical policy considerations come to the fore in examining issues associated with rural aging, including: the need for rural development policies that take account of population aging and the needs of older people; improved coordination and integration of public health and care services in rural areas; support for nongovernmental organizations and community group efforts; and greater use of new technologies for communication. The year 1999 was pivotal for aging in terms of perceptions, attitudes, public action, better research and knowledge, and improved policy decisions that will benefit all of society into this new century. The Second United Nations World Assembly to be held in Madrid in April 2002 will provide further opportunity to build upon this progress and in the formulation of a new International Plan of Action on Aging to point the way for decisive action on positive policy and program initiatives for the future.
Health Status of the Rural Elderly
Authors: Kumar Vinod , Acanfora Miguel
Published: April 2008

An enormous proportion of the world's elderly live in rural areas and show wide variations in health status. Many, particularly those in the developing countries, are vulnerable to greater socioeconomic and health marginalization mainly due to inadequate provision of services and economic deprivation. As with the urban elderly, locomotor, visual and hearing disabilities, as well as life‐threatening conditions of coronary heart disease, diabetes and hypertension are common among rural elders also. Infections continue to take a heavy toll in many parts of the world. Higher prevalence of health and functioning impairments and of risk factors like sedentarism and current smoking have been reported for the rural elderly in developed countries like the United States, where less frequent use of certain preventive services also has been observed among the rural elderly. The positive association of well‐being and health with variables such as living with family, having children, and community involvement, which has been reported from developing countries like Ghana and India, supports the usefulness of the time‐honored value of joint family systems and lifelong social and physical activity–all known to foster healthy aging. Such traditional virtues therefore need to be preserved and strengthened. Effective geriatric health care services need to stress a community approach to primary health care, with provision of support and training for both family caregivers and professionals. In addition, emphasis on health promotion, cost‐effective indigenous systems of medicine and gender‐sensitive programs is needed.
Training to Provide for Healthy Rural Aging
Authors: Troisi Joseph
Published: April 2008

More than 60 percent of the world's aged population is in developing countries, the majority living in rural and remote areas. Resources in these areas are scarce and there is a lack of services and programs, especially in the areas of health, housing and social welfare. The most serious deficiency faced by many countries in meeting the challenges of population aging is the pronounced scarcity of trained caregivers. Little attention has been given to developing effective training policies and programs. Most of the people providing a service to older people lack basic training and this is more so in rural and remote areas. The processes for extending liealthy aging and postponing the onset of chronic diseases and disabling conditions exist already. Unfortunately, these processes are not disseminated in appropriate ways. It is therefore imperative to disseminate this information by training people at the grass roots level to reach the most vulnerable and isolated older people. Primary care workers should have the necessary skills, knowledge and techniques to facilitate good care of older people in their environment. This article reviews and analyzes attempts being made by a number of countries to meet this need. Though the basic issues dealt with are often the same, the approach used differs.
Community‐based Rehabilitation: Better Quality of Life for Older Rural People With Disabilities
Authors: Eldar Reuben
Published: April 2008

This article describes various categories of disability occurring in old age and goals that rehabilitation aims to achieve. It suggests that in rural areas these goals could be attained through application of rehabilitation care on a community level, provision of appropriate assistive technology and adaptation of the immediate environment.
Long‐term Care in Rural West Virginia: Managed Care and Future Roles for the Aging Network
Authors: Brown David K. , Goins R. Turner , Briggs Rick
Published: April 2008

The managed care movement emphasizes the rationalization of health care delivery through fixed price or capitation of service and the utilization of a preferred physician or health gatekeeper. These features are advanced as measures of cost control in health care delivery. This approach presents the aging network, established under the Older Americans Act, with a number of daunting challenges which are particularly acute to service providers in rural areas. How this network responds will determine its future efficacy in the delivery of health and long‐term care services. This article examines these concerns among eight rurally based senior centers and two Area Agencies on Aging in Southern West Virginia. Issues of management capacity, present and future positioning, and receptivity to managed care are emphasized. These providers stand on the strengths of a long tradition of serving clients, knowledge of their needs and face‐to‐face interactions with them–capabilities managed care organizations do not have. However, little outreach to managed care in these areas has occurred.
Vision, Visual Needs, and Quality of Life of Older People in Rural Environments: A Report and Synthesis of a Meeting
Authors: Odom J. Vernon
Published: April 2008

Vision as an aspect of rural aging was a major portion of the First International Conference on Rural Aging. Various perspectives on the relationship of vision to rural aging were presented in two symposia, two paper sessions, one workshop and the poster session (a total of 28 presentations). In summarizing this rich and varied material, the author emphasizes that: (a) vision is important to maintaining a healthy, active life as one ages; (b) impaired vision is generally preventable or treatable; (c) well‐designed community programs can assist in prevention and treatment; and (d) assessing the effects of these programs requires evaluation of patients’quality of life. More research is needed to refine strategies for creating, maintaining and evaluating community‐based eye care programs and integrating them with existing public health or other community programs.
The Public Health Perspective in Health Promotion and Disability Prevention for Older Adults: The Role of the Centers for Disease Control and Prevention
Authors: Hennessy Catherine Hagan , Buchner David M. , Jordan Joanne M. , Leveille Suzanne G. , Shefer Abigail M. , Stevens Judy A.
Published: April 2008

As the United States federal public health agency, the role of the Centers for Disease Control and Prevention (CDC) in health promotion and disability prevention with older adults encompasses research, surveillance and program activities in aging. This article characterizes the objectives and context of prevention in later life and summarizes CDC's functions, collaborative partnerships with public health agencies and other organizations, and range of activities in older adult health. As a major focus of these efforts, chronic disease risk reduction is examined through CDC's efforts in the area of physical activity; a longitudinal investigation of osteoarthritis in an older biracial rural population; and chronic illness self‐management programs as a prototype for secondary prevention. Other CDC activities highlighted include addressing the burden of vaccine‐preventable diseases through CDC‐funded programs to improve immunization coverage in older adults, and falls prevention interventions and resources. Future directions in aging at CDC are also outlined.
Telepsychiatry: Challenges in Rural Aging
Authors: Sumner Calvin R.
Published: April 2008

A significant health care dilemma for older individuals living in rural areas is that at a time in life when there is, predictably, a greater need for medical services, the ability to access those limited services is markedly reduced. Telepsychiatry presents an innovative and cost‐effective strategy for the provision of improved local access to quality mental health services for the underserved rural elderly. Telepsychiatry has demonstrated the potential to improve access to mental health services, provide those services in an affordable and cost‐effective manner and deliver those services at a quality nearly equal to traditional face‐to‐face services. Advances in telepsychiatry technology allow a core group of skilled mental health providers in a central location to provide timely local access to quality services for the rural elderly over a broad geographic area.
Conclusions and Recommendations for Policies on Rural Aging in the First Decades of the 21st Century
Authors: Hermanova Hana M. , Richardson Sally K.
Published: April 2008

The 2000 Forum on Rural Aging: Policy Debates was one of the main tracks of the first International Conference on Rural Aging held in Charleston, W.Va., in June 2000. The 2000 Forum was a follow‐up to the Expert Group Meeting on Rural Aging, which met at Shepherdstown, W.Va., in May 1999. That group considered policy implications of the 1999 International Year of Older Persons for rural aging in four key areas: the situation of older people, multigenerational relationships, lifelong development, and the development and aging of rural populations. As a direct follow‐up of the Shepherdstown Expert Group Meeting, the 2000 Forum on Rural Aging formulated the Conclusions and Recommendations for Policies on Rural Aging through a series of working groups. The Conclusions and Recommendations were endorsed by the Conference Plenary Session on June 11, 2000. The Draft Recommendations for Policies on Rural Aging were available for comments on the Internet in the remaining part of the year 2000. Many comments were received. Hana Hermanova and Sally Richardson incorporated the comments into the finalized version.
Augustus E. Jordan, Ph.D.
Authors: Brachlow Allison , Tervo Raymond
Published: April 2008

ABSTRACT: Screening results for the Child Development Review (CDR) and the Denver II Developmental Screening Test (Denver II) were compared in two locations: the Cheyenne River Reservation in South Dakota and Sioux Falls, S.D. Seventy‐three white, Native American and other minority children, half originating from the reservation and half from Sioux Falls, were randomly assigned to take one developmental screening test. A chi‐square analysis indicated a significant difference in results across tests. Specifically, more CDR than Denver II subjects passed the screening and more Denver II than CDR subjects failed the screening. This pattern held for subjects living on, but not off, the reservation. Thus, for Native American, white and other minority children living on the Cheyenne River Reservation, the CDR may be undersen‐sitive and/or the Denver II oversensitive to suspect presentations. Medical practitioners are advised to use these instruments with caution in rural settings.
The Kentucky Homeplace Project: Family Health Care Advisers in Underserved Rural Communities
Authors: Schoenberg Nancy E. , Campbell Karen A. , Garrity John E. , Snider Lyle B. , Main Karen
Published: April 2008

ABSTRACT:The Kentucky Homeplace Project (KHP) is a state‐legislated program designed to address well‐documented deficits in the health status of and health resources available to many of Kentucky's rural residents. Since its inception in 1994, the KHP has served approximately 80,000 clients, primarily through home visits by trained, locally residing paraprofes‐sionals known as family health care advisers. These family health care advisers employ culturally appropriate strategies to meet immediate needs as well as to foster long‐term client empowerment and the adoption of health prevention strategies. This descriptive examination of KHP provides information regarding (a) the advantages of the program, with specific attention to its orientation toward provision of culturally appropriate health services; (b) the disadvantages of KHP, including competing budgetary priorities and its vulnerability to local economic and political trends; and (c) the potential application of similar programs for other rural, difficult‐to‐reach populations.
Rural Hospitals and the Adoption of Managed Care Strategies
Authors: Saleh Shadi S. , Vaughn Thomas , Rohrer James E.
Published: April 2008

ABSTRACT: This research examined the performance of rural hospitals engaged in different levels of managed care activities and identified factors related to performance and competition that affected rural hospitals' likelihood of pursuing managed care as a strategy. The sample studied consisted of 139 rural hospitals in Iowa and Nebraska. Results showed that a relatively high percentage of hospitals were engaged in managed care activities, mainly through contractual arrangements. The study found that high competition in the marketplace increased the likelihood of hospitals pursuing managed care strategies, while high demand markets had a negative association with the likelihood of pursuing a managed care strategy. No significant relationship was detected between poor performance and pursuing a managed care strategy.
Functional Disability at Nursing Home Admission: A Comparison of Urban and Rural Admission Cohorts
Authors: Penrod Joan D.
Published: April 2008

ABSTRACT: This study's objective was to examine the relationships between rural residence and availability of nursing home and home liealth care to functional disability at the time of nursing home admission. Secondary data were obtained from tlte Minimum Data Set (MDS) 2.0 for Nebraska for 3,443 rural and 1,296 urban older people admitted to nursing facilities. Data from the MDS were merged with county‐level data on home health agencies and nursing homes in Nebraska. The relationship of rurality of nursing home residents' prior residence and availability of nursing home and home health care to functional status at admission, controlling for demographic and health characteristics of older people, was estimated using multiple linear regression with robust variance estimates. After taking account of demographic and health status characteristics, rural residence and availability of home health and nursing home care had nonsignificant effects on functional status at admission. The findings indicate that functional disability at admission is associated with specific diseases and medical conditions, cognitive status, gender, living arrangements and marital arrangements. Rural older people are not at higher risk of admission at lower levels of functional disability compared to their urban counterparts.
Productive Efficiency of Rural Health Clinics: The Midwest Experience
Authors: Sinay Tony
Published: April 2008

ABSTRACT: This article identifies the characteristics of efficient and inefficient rural clinics in the Midwest, using 1994 Medicare cost reports. Rural health clinics are compared on the basis of productive efficiency by estimating a nonparametric frontier. Six inputs and five output categories were employed to estimate an efficient frontier. The results show that an efficient clinic, on average, employs approximately 1.5 more physicians than an inefficient clinic and incurs capital expenses more than twice those of the inefficient clinic. Future rural clinics are expected to be larger, employing more capital and labor to take advantage of scale economies. However, given the steady (or decreasing) population of rural communities, the expansion of relatively small rural clinics could involve forming rural health care systems and/or networks in close proximity to create synergies from scale economies, staff recruitment, easier access to capital, shared information systems, improved mobility of physicians among several clinics and savings from management costs.
Strategy to Increase Agricultural Medicine Practice: An Exploratory Study to Predict Interest Among Generalists
Authors: Wheat John R. , Hartman Julia A. , Carter Tracy M. , McKnight Jerry T. , Leeper James D.
Published: April 2008

Abstract: Across the nation, farmers, farmworkers and their families experience an increased risk of death, illness and disability. A major concern is to determine how medical education and the medical profession can realize their potential to benefit the agricultural community. This exploratory study was completed to identify factors that might predict interest in practice of agricultural medicine among primary care physicians. Two hundred seventy‐eight Alabama primary care physicians, almost equally distributed as urban and rural, completed a questionnaire that surveyed interest in agromedicine practice, experience regarding 13 agromedicine topics, and other physician characteristics. Through a logistic regression model, interest in agromedicine practice was predicted by a high proportion of practice experience in smaller communities, agromedicine experience through personal hobby or avocation, and through professional literature. These three significant variables correctly predicted a moderate to high leoel of interest in agromedicine practice in 65% of the physicians in the study. If these results hold up with confirmatory study, the authors recommend that targeted efforts to produce physicians for agricultural medicine should prepare physicians whose backgrounds are rural and whose interests include agricultural and family medicine, thus predicting location and practice relevant to the needs of the agricultural community.
Veterinarian Perception of the Intentional Misuse of Veterinary Medications in Humans: A Preliminary Survey of Idaho‐Licensed Practitioners
Authors: Erramouspe John , Adamcik Barbara A. , Carlson Rena K.
Published: April 2008

The intentional administration of veterinary medications to humans is a form of medication misuse that has not been systematically studied Veterinarians are the health practitioner group most likely to haw knowledge about this problem and to be approached by the public for advice For this preliminary study, questionnaires were mailed to 1,077 veterinarians registered with the Idaho Board of Veterinary Medicine regarding their knowledge and perceptions of this type of misuse; 392 (36 4%) completed surveys were returned The most frequently reported veterinary medications misused in humans were analgesic, anti‐inflammatory medications, anti‐arthritis medications, or both; systemic antibiotics, topical anti‐infectives; and topical corticosteroids People involved with rodeo, horse racing, and health care; rural area residents; and those lacking health insurance were perceived to be the groups most likely to misuse veterinary drugs Veterinarians rated the following as likely reasons for misuse having an independent self‐sufficient attitude, convenient availability of veterinary medications, lower cost, and belief that veterinary medications are stronger than comparable human medications Human misuse of veterinary drugs may be more common than many health practitioners realize Limitations of this study include the response rate, sampling of veterinarians licensed in only one rural state, and reliance on veterinarians' recall of relevant instances of misuse and their perceptions of groups most likely to misuse these drugs and why These limitations make it difficult to determine if the problem is being under‐ or over‐represented relative to the general population However, regardless of the magnitude of the problem in the rural population, the general population, or both, the potential for harm is great Patients with risk factors for this form of misuse should be questioned by their physician in a nonthreatening manner to detect use of veterinary medications and to provide an opportunity to inform them of the risks.
The Health Effects of Rural‐Urban Residence and Concentrated Poverty
Authors: Auchincloss Amy H. , Hadden Wilbur
Published: April 2008

This research quantifies the extent to which excess morbidity in rural areas is associated with individual characteristics, county income, and neighborhood party Census geographic codes were assigned to people 25 to 64 years old (n = 176,930) from the National Health Interview Survey, 1989 to 1991, in order to link individuals to the US Department of Agriculture county urban‐rural classification scheme and to 1990 county per capita income and poverty concentration in Census tracts General health status and limitation of activity were analyzed in logistic and multinomial logit models Residents of rural counties were at greater risk for health problems compared to residents of metropolitan and central core counties In adjusted models, the health disadvantage of rural areas was partly explained by differences in population composition The residual rural disadvantage was concentrated in people with less than a high school education Tract poverty and county per capita income were also important independent predictors of morbidity The results of this study suggest that special attention should be paid to improving education in disadvantaged places and to better understanding the ways in which economic growth and its benefits are distributed.
Rural‐Urban Home Health Care Differences Before the Balanced Budget Act of 1997
Authors: Schlenker Robert E. , Powell Martha C. , Goodrich Glenn K.
Published: April 2008

This study arose from concerns that home health care may be more difficult to provide to rural than urban elderly patients (because of geographic barriers, personnel shortages, and other factors) and may therefore be less effective in terms of patient outcomes Case mix, home health care service use, and outcomes (primarily discharge status) were analyzed for a national random sample of 3,869 rural and urban elderly home health patients Longitudinal data covered the period from home health admission to discharge or 120 days (whichever occurred first) Primary data collection instruments were designed to obtain longitudinal patient‐level health status data; agency records and Medicare data provided service use information (The study did not address access but focused on services and outcomes after admission to home health care) Tim‐group statistical tests and multivariate analyses were employed to assess rural‐urban differences The major findings were that, after adjustment for rural‐urban case mix and agency differences, rural compared to urban patients received fm home health services and attained less favorable discharge outcomes For example, the rural patients had a high case mix adjusted hospitalization rate Because the study data pertain to 1995 through 1996, the results provide a baseline for future analyses of possibly different rural compared to urban effects of the Balanced Budget Act of 1997, which resulted in major changes in Medicare payment for home health care.
A National Call to Action: CDC's 2001 Urban and Rural Health Chartbook
Authors: Morgan Alan
Published: April 2008

It remains to be seen i f Congress will recognize the CDC report as a national call to action, or whether future CDC reports will simply record the ongoing health disparities of rural America. Regardless of the Congressional outcome in 2002, the CDC report clearly succeeds in moving the national debate on rural concerns beyond the political rhetoric and into a datadriven debate.