bluuebunny/crossref_metadata_2025 huggingface dataset:
Unmet Need Among Rural Medicaid Beneficiaries in Minnesota
Authors: Long Sharon K. , Coughlin Teresa A. , Kendall Stephanie J.
Published: April 2008

Given the vulnerabilities of rural residents and the health care issues faced by the Medicaid population generally, the combined effects of being on Medicaid and living in a rural area raise important questions about access to health care services. This study looks at a key dimension of health care access: unmet need for health care services. The study relies on data from a 1998 survey of rural Minnesota Medicaid beneficiaries. An overall response rate of 70% was obtained. For this study, the sample is limited to women who were on Medicaid for the full 12 months prior to the survey, resulting in 900 respondents. The study finds that the rural Medicaid beneficiaries face high levels of unmet need: more than 1 in 3 reported either delaying or not getting doctor, hospital, or specialist care that they felt they needed. Although the study lacks direct measures of the consequences of the high levels of unmet need, there is evidence that greater emergency room use is associated with unmet need. The survey data cannot necessarily be generalized to other rural areas, and like all surveys, this one is subject to nonresponse bias as well as potential biases because of respondent recall and self‐assessment of medical needs. Nevertheless, these findings are suggestive of negative consequences of unmet need for both Medicaid beneficiaries and program costs.
Food Security and Perceptions of Health Status: A Preliminary Study in Rural Appalachia
Authors: Pheley Alfred M. , Holben David H. , Graham Annette S. , Simpson Chris
Published: April 2008

Food insecurity is estimated to affect about 10% of the United States population. Rural areas experience even higher rates and intensity of food security problems related to party, food access, and higher food costs. Reports of the relationship between household food security and health status, however, are limited. This report examines the relationship between household food security and measures of functional health status in a rural Appalachian sample. A comprehensive health status survey was completed by 1,006 individuals seen either in a clinical (n = 605) or nonclinical (n = 401) community setting. The survey included the USDA Food Security Core Module, the SF‐36, and demographic and health care access questions. Household food insecurity wds reported by 23% of respondents. Food insecure respondents reported significantly poorer functional status on all SF‐36 scales compared to food secure respondents (all p > 0.05). After adjusting for demographic and access variables in a multiple regression analysis, food insecurity remained a significant independent predictor of responses for each SF‐36 scale. Generalizability of results are limited by the convenience sampling methods and geographic region in which the study was conducted. In this preliminary study, even minimal levels of food insecurity are related to self‐reported levels of health status as measured by the SF‐36 spectrum. Health professionals must be able to identify individuals at risk for food insufficiency; policy makers must develop more effective programs for alleviating the basic causes of food insecurity.
Pharmacy Services in Rural Areas: Is the Problem Geographic Access or Financial Access?
Authors: Casey Michelle M. , Klingner Jill , Moscovice Ira
Published: April 2008

Access to pharmacy services is an important rural health policy issue but limited research has been conducted on it. This article describes rural retail pharmacies in Minnesota, North Dakota, and South Dakota, including their organizational characteristics, staffing, services provided, and planned future changes; examines the availability of pharmacy services and pharmacy closures in rural areas of these three states; and briefly discusses policy issues that affect the delivery of pharmacy services in rural areas. Study data came from a phone survey of 537 rural pharmacies, an analysis of pharmacy licensure data, and phone interviews with clinic, public health, and social services staff in rural communities with potential pharmacy access problems. Using a standard of 20 miles to the nearest pharmacy, most rural residents of these three states currently have adequate geographic access to pharmacy services. However, rural pharmacists and clinic, public health, and social services staff rate financial access to pharmacy services for the elderly and the uninsured as a major problem. Key policy issues that will affect future access to pharmacy services in rural areas include pharmacy staffing and relief coverage; alternative methods of providing pharmacy services; the financial viability of rural pharmacies; and the potential impact of a Medicare prescription benefit on rural consumers and rural pharmacies.
Access to Dental Care Services for Medicaid Children: Variations by Urban/Rural Categories in Illinois
Authors: Byck Gayle R. , Walton Surrey M. , Cooksey Judith A.
Published: April 2008

Poor oral health status and limited access to dental care have been recognized as problems for children from Medicaid and low‐income families. Families. little is known about dental access for Medicaid‐enrolled children in rural areas. This study examines differences between rural and urban counties in dental utilization rates of Illinois children enrolled in either Medicaid or the Children Health Insurance Program. How the overall dentist supply, the dentist Medicaid participation rate, and county level sociodemographic factors relate to Medicaid daztal utilization are examined. Illinois counties were aggregated into four urban/ rural categories. Descriptive analysis showed lower utilization rates in the rural categories (25 and 27%) compared with the metropolitan categories (35 and 31%). Rural areas had a substantially lower supply of dentists, and consequently a lower supply of dentists participating in Medicaid, despite the substantially higher Medicaid participation rate of dentists in the rural categories (45 and 51%) than in the metropolitan categories (22 and 32%). However regression results indicated no significant relationship between the rate of utilization of Medicaid‐enrolled children and rural status after controlling for several dental supply and population factors. The most important factors relating to Medicaid‐enrolled children's dental utilization, regardless of urban or rural status, were the proportion of children enrolled in Medicaid and the participating dentist to population ratio. Without the high participation rate of dentists in rural areas, access to oral health care for rural children enrolled in Medicaid would have been worse. Policy makers should focus on maintaining high rural dentist participation rates as well as addressing future supply problems that may exacerbate difficulties with access in rural areas.
Depression Treatment in Rural California:Preliminary Survey of Nonpsychiatric Physicians
Authors: Ng Bernardo , Bardwell Wayne A. , Carnacho Alvaro
Published: April 2008

Depressive disorders have been recognized as disabling conditions of public health proportions. However, in areas underserved by mental health professionals, the treatment of depressed patients becomes challenging. Furthermore, patients living in rural areas and communities underserwd by health professionals are at risk for high levels of depressive symptoms and low access to care. Physicians (N = 58)of multiple nonpsychiatric specialties in Imperial County, a rural underserved area in California, were surveyed to ascertain their preferred strategies in the management of depressed patients. More than half (57%) of the respondents preferred to either refer patients to a mental health specialist(p > .01) as the only strategy, or in combination with counseling, prescribing medication, or both. The most commonly reported form of counseling was of a supportive nature. The most commonly prescribed drugs were selective serotonin reuptake inhibitors (in order of frequency: fluoxetine, sertraline, and paroxetine). Tricyclic antidepressants and benzodiazepines were identified as first‐line drugs by some pediatricians and surgeons. The results of this study support the need for enhanced postgraduate training in the treatment of depression for nonpsychiatric physicians, and greater exposure of psychiatric residents to rural psychiatry.
Quality of Care in the Rural Context: A Proposed Research Agenda
Authors: Rosenblatt Roger A.
Published: April 2008

The quality of health care provided in rural areas is critical to rural patients and providers and will shape the future evolution of the rural health care system. Past research has focused almost exclusively on disease‐specific comparisons of the quality of care rendered in rural as compared with urban areas, which ignores the fact that it is the functioning of the entire system of care that determines whether or not rural residents receive high quality care. Future research should focus on the functioning of the entire rural system of care. To accomplish this objective, we suggest investments in the following areas: the creation of a national database that collects information on the process and outcome of care delivered to rural populations, the incorporation of human factors research into our research agenda, greater emphasis on the importance of sociodemographic and cultural issues to the quality of care, and a shift to a focus on populations as opposed to individuals.
Initial and Repeat Mammography Screening: Different Behaviors/Different Predictors
Authors: Mayne Linda , Earp JoAnne
Published: April 2008

Abstract: Despite evidence of the efficacy of mammography in early detection of breast cancer, many women choose not to have a mammogram. Some women who have an initial mammogram do not return for a second one. Many others, especially minority women, and those who live in rural areas or in a low socioeconomic class, are not being screened according to recommended guidelines. The full benefits of early detection are available only if women receive regular screening. This study of 830 randomly selected women over age 50 from rural, eastern North Carolina included women who had never had a mammogram (213), women who had had a mammogram but not in the prior 2 years (89), and women who reported having had a mammogram in the previous 2 years (528). Logistic regression was used to identify significant mammography predictor variables. The results support the robust role that provider recommendation plays in encouraging mammography behavior; they also demonstrate that past behavior is also a strong predictor of future screening participation. Only 13% of the women who had never had a mammogram reported obtaining a referral from their provider compared with 79% of the women who had a mammogram in the previous 2 years. Likewise, 75% of the women who had engaged in mammography behavior in the prior 2 years expressed a positive intention to be screened in the next year compared with only 14% of those women who had never had a mammogram. Initial and repeat mammography screenings are different behaviors and are influenced by different factors. For provider counseling to be effective, the strategies employed need to consider past behavior as well as current recommendations, and they must incorporate a discussion of beliefs as well as reinforcement of regular screening behavior.
Realized Access to Physician Services Among the Elderly in West Texas
Authors: Rohrer James E. , Kruse Gina , Borders Tyrone , Kupersmith Joel
Published: April 2008

Abstract: The purpose of this study is to identify populations in a sparsely populated region that are less likely to obtain medical care. We conducted a cross‐sectional survey of more than 5,000 elderly persons who participated in telephone interviews after being identified through more than 65,000 calls to residential listings. Subjects were persons aged 65 years and older who resided in 108 counties in western Texas. The response rate was 72%. The probability of seeing a physician in the last 6 months for urban and rural residents was modeled using multiple logistic regression analysis. Among rural residents, characteristics that were significantly (p < 0.05) associated with not recently visiting a physician when health status is held constant included belief in home remedies, having less than a high school education, lack of health insurance, and low income. Among urban residents, Hispanic ethnicity and skepticism about medical care were negatively associated with having a recent visit, whereas being religious was positively associated. Despite the availability of Medicare coverage, several subgroups of the elderly population have impaired access to medical care in this sparsely populated region. Intensified outreach efforts are indicated.
Ancillary Community Pharmacy Services Provided to Older People in A Largely Rural and Ethnically Diverse Region: A Survey of Consumers in West Texas
Authors: Xu K Tom , Rojas‐Fernandez Carlos H.
Published: April 2008

Abstract: Little is known about the quality of pharmacy services provided to the rural elderly population. This exploratory study examines rural/urban and ethnic differences in perceived access to ancillary pharmacy services among elderly people. Two telephone surveys were conducted using directory listings in West Texas to generate a longitudinal sample. Persons aged 65 years and older who were not cognitively impaired were asked to complete the survey. The number of participants in both rounds of the survey was 3,689. Seven ancillary pharmacy services were examined: delivery of medications, medication counseling, written medication information, blood pressure monitoring, blood glucose monitoring, osteoporosis screening, and immunization. The sample was stratified by county of residence (urban, rural, or frontier) and racial/ethnic background. Chi‐square tests were performed to detect rural/urban and racial/ethnic differences in access to the seven ancillary services. The association between proficiency in English and access to the services was also examined. Rural residents were more likely than urban residents to report that their pharmacies provide delivery of medications, medication counseling, and immunization services, but they were less likely than their urban counterparts to report that their pharmacies provide blood pressure monitoring. Access to ancillary pharmacy services was reported as poorer by older Hispanic people compared with non‐Hispanics. Deficiency in English was significantly related to inequality in reported access to ancillary pharmacy services. It is essential to consider the special needs of rural and Hispanic elderly people to ensure equitable access to ancillary pharmacy services.
Tetanus Seroprevalence Among Farmers: A Preliminary Study
Authors: Hayney Mary S. , Love Gayle Dienberg , Carlberg Beth M. , Buck Jessica M. , Muller Daniel
Published: April 2008

Abstract: Background: Farmers are at increased risk of contracting tetanus. However, no difference in immunity to tetanus has been reported between rural and urban dwellers in large epidemiological studies. We hypothesized that tetanus antibody concentrations would be lower in farmers than in nonfarmers within the rural population. Methods: We recruited 102 adult subjects attending an agribusiness trade show who identified themselves as farmers in Wisconsin. The nonfarmer group (n = 120) was composed of adults attending the agribusiness show who were not engaged in farming or were participating in another research study.1 Concentrations of antibody to tetanus toxin (antiTT) in sera were measured by an enzyme‐linked immunosorbent assay (IBL, Hamburg). AntiTT levels of >0.15 IU/mL were considered protective. Results: The antiTT concentrations for the farmer population (median = 2.74 IU/mL) were much higher than those for the nonfarmer group (median = 1.82 lU/mL) (P<008). As in other studies, being male, being younger, and having a history of military service were positively correlated with protective antiTT concentrations. However, only farming, age, and the farming‐sex interaction term were significantly associated with antiTT concentrations in the multiple‐regression model. Conclusions: The farmers we studied had high antiTT concentrations and a high tetanus seroprevalence rate. Occupation may be an important consideration in the development of immunization policies. A broader seroepidemiological study of farmers must be undertaken before any such considerations can be made.
Variations in Nursing Home Discharge Rates for Urban and Rural Nursing Facility Residents With Hip Fracture
Authors: Coburn Andrew F. , Bolda Elise J. , Keith Robert C.
Published: April 2008

Abstract:Context:The more limited availability and use of community‐based long‐term care services in rural areas may be a factor in higher rates of nursing home use among rural residents.Purpose:This study examined differences in the rates of nursing home discharge for older adults receiving posthospital care in a nursing facility.Methods:The study sample was comprised of a cohort of rural and urban residents newly admitted to nursing home care in Maine following surgery for hip fracture.Findings:The results indicated that rural residents who were hospitalized for hip fracture and subsequently admitted to a nursing facility for rehabilitation were significantly less likely than urban residents to be discharged within the first 30 days of their admission. Rural residents who stayed in the nursing facility beyond 30 days were also less likely to be discharged in the first 6 months. These geographic differences were not explained by service use and resident characteristics such as age, health, or functional status.Conclusions:The finding of lower discharge rates among rural nursing facility residents appears to be consistent with previous studies demonstrating higher rates of nursing home use among rural residents. There continues to be a need for a better understanding of the role that service supply and accessibility and other factors play in the patterns and outcomes of rural long‐term care.
Premedical Education: The Contribution of Small Local Colleges
Authors: Wheat John R. , Brandon John E. , Carter Lee R. , Leeper James D. , Jackson James R.
Published: April 2008

Abstract: Context: Small local colleges may be sources of medical students with the gender, ethnicity, and background that promote identity with and empathy for underserved populations. Purpose: This study examined the impact of attendance at these premedical colleges on outcomes of medical education. Methods: Data for 2508 matriculates to the University of Alabama School of Medicine, a state‐supported medical school, were examined according to premedical colleges attended. Findings: Medical students who had graduated from small local colleges were more diverse in gender, race, and rural background than other students. They had slightly lower academic performance in medical school, were more likely to drop out (10.6% versus 5.3% overall), and were more likely to locate in rural areas of the host state. Conclusions: Small local colleges may be rich sources of student diversity and medical students who choose rural practice, outcomes that are gained at a cost in terms of drop‐out rate. Compared with other students, minor differences in performance and larger differences in the drop‐out rate raise the question of cultural context and social support during medical school as points for intervention.
The Utah Rural Residency Study: A Blueprint for Evaluating Potential Sites for Development of a 4‐4‐4 Family Practice Residency Program in a Rural Community
Authors: Catinella A. Peter , Magill Michael K. , Thiese Steven M. , Turner Deborah , Elison Gar T. , Baden Daniel J.
Published: April 2008

Abstract: Context: Most graduates of rural residencies enter rural practice. Rural residencies therefore have emerged over the past 2 decades to increase the supply of rural physicians. However, researchers have published few descriptions of strategies to evaluate and select communities in which to locate rural residencies. Purpose: This report describes the development and application of such a strategy to assess 7 rural communities in Utah as potential sites for family practice residency training. Methods: Criteria were developed on the basis of an examination of the literature, residency accreditation requirements, and characteristics of existing rural residency programs. Ten rural or frontier communities with hospitals were selected as study candidates, and 7 agreed to participate. Data were collected through hospital surveys, state hospital discharge records, and community site visits. Findings: Specific evaluation criteria that were developed included the presence of a medical practice of the appropriate specialty and size, a sufficient number of medical subspecialty physicians, an adequate number and mix of hospitalized patients, an adequate number of ambulatory patients, adequate outpatient facility space to accommodate learners, and a commitment by the practicing physician and hospital to lead the program and teach residents. Two communities were found to be potentially capable of supporting a residency if physicians and hospital leaders in the communities were to become motivated to lead program development. Conclusions: These criteria may be useful in other states, but they have not been tested for validity or reliability and are subject to limitations such as exclusion of alternate rural residency models. Future research should address data needs and the relationship of the evaluation criteria to the quality of resident learning.
Public Health Rural Health Priorities in America: Where You Stand Depends on Where You Sit
Authors: Gamm Larry , Hutchison Linnae
Published: April 2008

Abstract: Purpose: To assess levels of agreement on priority areas among state and local rural health leaders nationwide

Methods: Analysis of responses to a mail survey sent to 999 rural health leaders, with 501 responses. Respondents were asked to rank importance to rural health of focus areas named in Healthy People 2010

Findings: There was substantial agreement on top rural health priorities among state and local rural health leaders across the 50 states. “Access to quality health services” was the top priority among leaders of state‐level rural agencies and health associations, local rural public health agencies, rural health clinics and community health centers, and rural hospitals. It was the top priority across all 4 major census regions of the nation as well. The next 4 top‐ranking rural priorities–“heart disease and stroke,”“diabetes,”“mental health and mental disorders,” and “oral health”–were selected as 1 of the top 5 rural priorities by one third or more of respondents across most groups and regions. At the same time, some observed differences in rural health priorities suggest opportunities for community partnership strategies or for regional multistate policy initiatives by states sharing similar rural health priorities.
A Framework and Action Agenda for Quality Improvement in Rural Health Care
Authors: Calico Forrest W. , Dillard Carole D. , Moscovice Ira , Wakefield Mary K.
Published: April 2008

Abstract: Purpose: The Agency for Healthcare Research and Quality and the federal Office of Rural Health Policy collaborated to convene an expert group to address issues of quality improvement in the rural health care environment

Outcomes: The group identified issues, barriers, and opportunities related to bringing rural health care into the mainstream of the national quality “revolution.” A framework for rural quality and specific action steps was proposed. Recommendations were made in the areas of workforce, organizational performance, measurement, dissemination of innovation, and external factors impacting quality. Specific recommendations included fostering development of rural consortia, relevant quality measures for the rural environment, technical assistance capacity, appropriate financial incentives, leadership capacity, and databases
Predictive Accuracy of Rural Physicians' Stated Retention Plans
Authors: Pathman Donald E. , Konrad Thomas R. , Agnew Christopher R.
Published: April 2008

Abstract: Context: The retention of rural physicians is a difficult phenomenon to study because job changes–the outcome of interest–take years to unfold. One common way to study retention is to ask rural practitioners through surveys how much longer they expect to remain in their current positions and use these statements of “anticipated retention” as an expedient proxy measure of actual retention

Purpose: To test the predictive accuracy of rural physicians' stated retention plans and test the hypotheses that predictions are more accurate for certain physicians, such as those with more experience, more control of their work situations, and at less risk for job burnout

Methods: A 1991 mail survey (national stratified random sample) prospectively queried rural physicians' retention plans, and a follow‐up survey 5 to 6 years later determined if and when respondents (N = 405, 67.5% combined response rate) had moved

Findings: Retention predictions for the entire cohort corresponded remarkably well to the group's actual retention, with the proportion remaining each year deviating by only a few percentage points from what the group collectively expected. Predictions for individuals were also moderately accurate: 4 of 5 physicians who predicted remaining at least 5 years did so; 2 of 3 who predicted remaining less than 5 years indeed left before 5 years. Predictions of job changes in less than 2 years tended to be more accurate than predictions of 2 to 5 years. Physicians' predictions were more accurate when they worked in practices they owned (greater control) and were on‐call 2 or fewer times each week (lower burnout risk). Accuracy was not greater with any of 5 measures of experience

Conclusions: Rural generalist physicians are moderately accurate when reporting how much longer they will remain in their jobs, validating the use of anticipated retention in rural health workforce studies
Oral Health Status of Children and Adolescents by Rural Residence, United States
Authors: Vargas Clemencia M. , Ronzio Cynthia R. , Hayes Kathy L.
Published: April 2008

Abstract: Context: The limited information available on the oral health status of rural children in the United States makes it difficult to devise policy strategies to address perceived problems

Purpose: To document the oral health status and dental care utilization of US children by place of residence.

Methods: Data from National Health Interview Surveys for 1995, 1997, and 1998, and from the third National Health and Nutrition Examination Survey (1988–1994) were analyzed

Findings: Children residing in rural areas were more likely to be uninsured for dental care than were children from urban areas (41.1% versus 34.7%). A greater percentage of rural than urban children reported unmet dental needs (7.5% versus 5.6%); there was no difference in selfreported poor dental status. Urban children were more likely than rural children to have visited the dentist in the past year (73.6% versus 69.9%) and were also more likely to be regular users of dental care (61.7% versus 51.4%). Differences in percentage of rural and urban children with caries lesions and caries experience were not significant

Conclusions: Children residing in rural areas have less access to and utilization of dental care compared to children residing in urban areas. Moreover, poor rural children display less utilization of dental services than poor urban children. Differences in the sum of decayed and filled primary teeth and the sum of decayed, missing, and filled permanent teeth were not significant
Diagnosed Mental and Physical Health Conditions in the united States Nursing Home Population: Differences Between Urban and Rural Facilities
Authors: Dobalian Aram , Tsao Jennie C. I. , Radcliff Tiffany A.
Published: April 2008

Abstract: Context: There has been limited examination of the differences in health characteristics of the rural long‐term care population. Recognizing these differences will allow policymakers to improve access to long‐term care services in rural communities. Purpose: To determine whether differences in likelihood of diagnosis exist between urban and rural nursing home residents for 8 common medical conditions: 4 mental health conditions (depression, anxiety, Alzheimer's, and non‐Alzheimer's dementia) and 4 physical health conditions (cancer, emphysema/chronic obstructive pulmonary disease, heart disease, and stroke/ transient ischemic attack). Methods: We used multivariate logistic regression to examine data derived from the 1996 Nursing Home Component of the Medical Expenditure Panel Survey, a multistage stratified probability sample of 815 nursing homes and 5899 residents, representing 3.1 million individuals in the United States who spent 1 or more nights in nursing homes during 1996. Findings: Residents in rural homes were less likely to be diagnosed with depression compared to those in homes in large metropolitan areas, and residents in homes in small metropolitan areas were less likely to have cancer than those in large metropolitan areas. Diagnostic status between urban and rural residents was comparable for the other 6 conditions. Conclusions: Further research is necessary to determine whether and why depression is inadequately diagnosed in rural nursing homes and to ascertain which types of cancer are responsible for the observed differential. Such research is particularly important for elderly nursing home residents who are more likely to suffer from chronic conditions that require significant medical supervision.
Children's Health Insurance Status, Access to and Utilization of Health Services, and Unmet Health Needs in a Rural Alabama School System
Authors: Carter Tracy M. , Adams Marsha Howell , Judd Alesa Hicks , Leeper James D. , Wang Lei , Yu Jing
Published: April 2008

Abstract: Purpose: This study examines the relationship between children's health insurance status and utilization of health services, establishment of a medical home, and unmet health needs over a 3‐year period (1996–1998) in a rural Alabama K–12 school system. Methods: As part of a children's health insurance outreach program, questionnaires were administered to parents of 754 children regarding health and health care access. In addition, noninvasive head‐to‐toe physical assessments of children were conducted on‐site at 4 schools. Findings: A relationship between health care utilization and insurance status was observed. Results found that insured children had 1.183 (P<0115) times the number of medical visits as uninsured children. Among uninsured children, the time since last dental visit was 1.6 (P<001) times longer than that of insured children. Also, insured children were 5.21 times more likely than uninsured (P<0001) to report having a medical home. No significant differences between insured and uninsured children were found regarding unmet health needs as measured by referrals made after the children's physical assessments. Conclusions: Child health coverage is an important determining factor in the ability of families to access and utilize health care services. These findings have implications for populations in similar rural communities across the nation.
Southern Rural Access Program: An Overview
Authors: Beachler Michael , Holloman Curtis , Herman James
Published: April 2008

Abstract: Rural residents experience significant disparities in health status and access to care. These disparities and access barriers are particularly prevalent in rural communities in the South. The Southern Rural Access Program, a national program of the Robert Wood Johnson Foundation, was designed as a long‐term effort to improve access to basic health care in 8 of the most underserved states in the country. The program was launched in 1998 with 3 goals: (1) to increase the supply of providers in underserved areas, (2) to strengthen the health care infrastructure, and (3) to build capacity at the state and community level to solve problems. The first 3‐year phase of the program made £13.8 million available to communities in the 8 target states, and a January 2002 reauthorization of the program will make an additional £18.9 million available in the next 4 years. This article will provide an overview of the Southern Rural Access Program, focusing on the development and evolution of the program during its first 3‐year phase. The article will also highlight some of the refinements that the foundation has made during the 2002–2006 second phase of the program
A Description of the Southern Rural Access Program's Practice Management Strategies
Authors: Adams Graham L. , Holloman Curtis E. , Nye Jeannie M. , Salain Rita , Glenn Kelli G. , Harrison Sally , Patterson Mary M.
Published: April 2008

Abstract: Context: Many state, federal, and foundation resources have been invested in improving the recruitment of primary care providers to rural communities. The Southern Rural Access Program of the Robert Wood Johnson Foundation (RWJF) has provided varying levels of support to several southern states to assist with retention of those providers

Purpose: This study describes the strategies that 6 states used to develop and implement practice management technical assistance services for rural health care providers

Methods: Practice managers in each of the 6 states were surveyed regarding how their service was structured, what types of entities were eligible, and the nature of the technical assistance offered. Information regarding what types of entities used the service, characteristics of the practices, and the number of practices served was also collected

Findings: The survey results showed that almost half (46%) of all practices assisted were private stand‐alone physician practices, with overall practice assessments being the practice management service rendered most often. Although the type of organizational home for the technical assistance services varied by state, overall states employed an average of 1.67 full‐time equivalent practice managers (0.81 full‐time equivalent supported by RWJF) and received an average of $136 055 per state from the RWJF for the 2‐year period beginning April 2002 for practice management support

Conclusions: Overall, the study found that the type of organizational home did not appear to affect the type of technical assistance services offered. However, the type of organizational home did appear to affect what types of providers used the service, with trade associations assisting their members or constituents at least half the time
Rural and Urban Physicians' Perceptions Regarding the Role and Practice of the Nurse Practitioner, Physician Assistant, and Certified Nurse Midwife
Authors: Burgess Stephanie E. , Pruitt Rosanne H. , Maybee Patricia , Metz Arnold E. , Leuner Jean
Published: April 2008

Abstract: Context: There is a dearth of literature citing the differences in rural and urban physicians' perceptions of the role and practice of nurse practitioners, physician assistants, and certified nurse midwives (nonphysician providers)

Purpose: The purpose of this study was to investigate and compare differences, if any, between rural and urban primary care physicians' perceptions of the role and practice of nonphysician providers

Results: Despite a 15.55% response rate using a mail‐out survey in South Carolina, data from 681 rural and urban primary care physicians indicated that they perceived that non‐physician providers possess the necessary skills and knowledge to provide primary care to patients, are an asset to a physician's practice, free the physician's time to handle more critically ill patients, and increase revenue for the practice, but increase the risk of patient care mistakes and a physician's time in administrative duties. Urban physicians' mean scores were higher for perceiving that nonphysician providers are able to see as many patients in a given day as a physician but experience impediments in the delivery of patient care

Conclusions: Results will be used to clarify physicians' perceptions regarding the role and practice of nonphysician providers to reduce impediments to patient care access
A Comparative Assessment of West Virginia's Financial Incentive Programs for Rural Physicians
Authors: Jackson Jodie , Shannon C. Ken , Pathman Donald E. , Mason Elaine , Nemitz James W.
Published: April 2008

Abstract: Context:Financial incentive programs are increasingly being used as a strategy to recruit physicians to underserved rural areas. Critical evaluation of state‐supported programs is often lacking but is necessary to determine their efficacy and to improve outcomes

Purpose: The purpose of this study was to assess 4 service‐contingent programs in West Virginia, a state with critical physician shortages

Methods: Survey instruments were developed to evaluate the effectiveness of these programs and to document the practice environments and career paths of obligated allopathic and osteopathic physicians compared with a control group of nonobligated rural practitioners. Data were also collected from physicians who were recipients of multiple incentive programs and from obligated physicians who had defaulted

Findings: Responses from more than 60% of surveyed physicians indicated that the typical respondent was a married white male who was a midcareer family practice physician. Obligated physicians were more likely than nonobligated physicians to have graduated from a West Virginia medical school and residency program, to be influenced by financial factors in their career decisions, to provide care to uninsured patients, and to work in offices that offered sliding fee scales. Both groups of physicians demonstrated similar retention patterns, reported a high degree of job satisfaction, and expressed a need for more practice management training

Conclusions: Although these financial incentive programs were found to be effective in recruiting primary care physicians to medically under‐served areas of the state, the financial support of these programs was found to be too modest, and improved marketing of the programs was indicated
Recruitment of Rural Health Care Providers: A Regional Recruiter Strategy
Authors: Felix Holly , Shepherd Joy , Stewart M. Kathryn
Published: April 2008

Abstract:Context:Access to care in rural areas is a major problem. Despite more than 20% of the US population residing in these areas, only 9% of physicians practice there. Extensive research has documented multiple issues that affect where physicians decide to locate and maintain practices. Creative strategies have been used to influence these recruitment and retention decisions. An emerging strategy, borne out of the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), effectively uses a targeted regional approach to assist rural communities and health care facilities in assessing health care needs and recruiting primary care providers

Purpose:This article examines the issues surrounding recruitment and retention of primary care providers to rural areas and describes the experiences of the regional recruitment strategy in several states and in particular in the Mississippi Delta region of Arkansas

Methods:A case study approach is used to examine the targeted regional recruiter strategy in the Mississippi Delta region of Arkansas

Findings:The regional recruiter strategy, which combines traditional recruitment efforts with community development activities, has been successful in recruiting health care providers to rural communities. The cost‐effective strategy can be easily replicated in other rural states

Conclusions:Community factors affect provider decisions on practice locations. Addressing community factors in recruitment efforts through community development activities may increase their success
The Southern Rural Access Program and Alabama's Rural Health Leaders Pipeline: A Partnership to Develop Needed Minority Health Care Professionals
Authors: Rackley Benjamin P. , Wheat John R. , Moore Cynthia E. , Garner Robert G. , Harrell Barbara W.
Published: April 2008

Abstract: Rural Health Leaders Pipeline programs are intended to increase the number of youth interested in and pursuing health professions in rural communities. This paper presents 2 complementary approaches to Rural Health Leaders Pipeline programs. Two different organizations in Alabama recruit students from 18 specified counties. One organization is a rural, community‐based program with college freshmen and upperclassmen from rural communities. Students shadow health professionals for 6 weeks, attend classes, visit medical schools, complete and present health projects, and receive support from online tutors. The second organization is a universitybased program that supplements an existing 11th grademedical school rural medicine pipeline with 10 minority students from rural communities who have graduated from high school and plan to enter college as premedical students in the following academic year. Students participate in classes, tutorials, seminars, and other activities. Students earn college credits during the 7‐week program, maintain contact with program staff during the school year, and by performance and interest can continue in this pipeline program for a total of 4 consecutive summers, culminating in application to medical school. Each organization provides stipends for students. Early experiences have been positive, although Rural Health Leaders Pipeline programs are expensive and require long‐term commitments
Connecting Our Resources: Louisiana's Approach to Community Health Network Development
Authors: Broussard Marsha , Blackwell Robyn , Caillouet L. Philip , Nichols Kristy Holloway , Shipman Margaret
Published: April 2008

Abstract: Louisiana's rural community health systems are in crisis because of pressures fueled by the rising costs of health care, sustained poor health status, state budget shortfalls and changes in priorities, and a sliding rural economy. The development of community health networks is providing new infrastructure and capacity for communities to reprioritize, formulate innovative partnerships, and leverage new resources. Successful elements of Louisiana's network development experience include community commitment to engage in study and action; the availability of capable and motivated technical assistance; an approach that involves open‐engagement, community‐driven decision‐making; and data‐driven problem definition, prioritization, and solutions. Louisiana's experiences illustrate the benefits of developing networks along with, or as a result of, a community health plan. When a community owns its health improvement plan, it is more likely to support the new network as a structure for implementation. Broad‐scale participation is also a principle of success. When social service agencies are included along with health agencies, more comprehensive strategies result, and they bring additional resources, resulting in more holistic solutions. The cases of 2 networks are presented as illustrations. One involves the facilitation of a community planning process for an existing network. The plan helped to expand the network's community connections and support and provided the content for a successful application for a Health Resources and Services Administration Community Access Program grant. In the second case, a new network was developed, and it leveraged federal funds from the federal Office of Rural Health Policy's Network Development Grant Program
The Arkansas River Valley Rural Health Cooperative: Building a Three‐pronged Approach to Improved Health and Health Care
Authors: Stewart M. Kathryn , Redford Robert “Bob” , Poe Kendall , Veach Debble , Hines Rebecca , Beachler Michael
Published: April 2008

Abstract: This paper describes the Arkansas River Valley Rural Health Cooperative (ARVRHC), one of the Arkansas networks jump‐started with support from the Southern Rural Access Program (SRAP). The initial goal of the network was to develop a subsidized health insurance program to provide affordable medical services for the uninsured population (23%) in the 3‐county service area. When planning efforts called for the network to address broader needs, the ARVRHC crafted a more comprehensive 3‐pronged program model consisting of 3 interrelated programs: (1) the Health Care Access Program (HCAP), (2) the Health Education and Disease Management Program (HE&DMP), and 3) the Information and Assistance Program (I&AP). The HCAP is designed to address the financial barriers to access through a community‐based health plan. The HE&DMP focuses on improving the health of individuals through education, counseling, and preventive care. The I&AP links low‐income families to existing public assistance programs (eg, Medicaid) and social support services. The Prescription Drug Assistance Program is one of the I&AP programs that helps individuals without prescription coverage obtain drugs at no cost. A key lesson learned is the importance of combining technical assistance with funding. The ARVRHC has been successful in leveraging funding, having received over $1.7 million in grant funds since 1999. A critical challenge facing the network today is the need for ongoing subsidy funding. Proposed legislation for a federal demonstration of the HCAP and similar programs would enable full implementation and evaluation of this model
Improving Access to Capital for Health Care Infrastructure: The Experience of the Southern Rural Access Program's Revolving Loan Fund
Authors: Stewart M. Kathryn , Beachler Michael , Slayton Deborah
Published: April 2008

Abstract: Lack of access to affordable capital is a formidable barrier that compromises rural health care infrastructure development in poor rural areas. Commercial lending institutions are often limited in their ability to respond to those needs due to traditional lending criteria: creditworthiness, equity, management ability, experiences, and cash flow or profits. In the Southern Rural Access Program, a development model more frequently used in other sectors has been successfully applied to health care to help clear these hurdles. This paper describes the 5 operational loan funds in Arkansas, Louisiana, Mississippi, South Carolina, and West Virginia receiving support from the Southern Rural Access Program. Two models of loan funds have evolved: those led by health agencies and those led by community development finance institutions whose mission is rural economic development. This paper outlines major distinctive features of these 2 approaches and describes major implementation challenges these loan funds face. Key accomplishments are highlighted, including the ability to leverage additional resources from state, federal, philanthropic, and private sources through these funds. These loan fund programs provide models for other states interested in improving access to capital to help build the rural health care infrastructure while making health care more economically viable through integration with other community development initiatives