bluuebunny/crossref_metadata_2025 huggingface dataset:
Breast Cancer Screening in Rural Populations: A Pilot Study
Authors: Sparks Barbara T. , Ragheb Nawal E. , Given Barbara A. , Swanson G. Marie
Published: April 2008

Abstract: This report describes the development and implementation of a pilot intervention project designed to determine the economic, logistic, behavioral, and attitudinal variables that influence rural women's participation in a community‐based breast cancer screening program. The intervention targeted rural female residents age 40 and older in four Michigan counties. This paper reports on survey responses of women who registered for this pilot breast cancer screening program. It includes information on all women who registered for the project—both those who received breast cancer screening and those who did not.

The study is a pilot intervention project, the overall goal of which was to develop a network of community providers, organizations, and volunteers to facilitate breast cancer screening among rural women. Of the 159 women registered for this pilot program, 101 (63.5%) were screened (receiving both a clinical breast examination and mammogram). The attitudes of women surveyed through the project confirm the importance of a physican recommendation for breast cancer screening. More than 90 percent of both the screened and unscreened groups of women stated that a doctor's recommendation to have breast cancer screening is important. Further, nearly 42 percent of the unscreened group had never had a physician recommend breast cancer screening. Despite existing barriers to screening, this pilot study demonstrated that health care professionals and regional organizations that have not traditionally been associated with delivering health care in this particular community setting can successfully work together to implement breast cancer screening programs.
Selected Comparisons and Implications of a National Rural and Urban Survey on Health Care Access, Demographics, and Policy Issues
Authors: Edelman Mark A. , Menz Brian L.
Published: April 2008

Abstract: As the national health debate evolved over the past two years, a need to better understand the differential constraints of rural health delivery and popular attitudes toward policy initiatives became apparent. Selected 1994 and 1995 results of two national surveys designed to compare rural and urban household responses are reported. The average distance those living in rural households must travel to access medical providers and emergency care is nearly double that of urban household residents. Rural household resident responses show a higher level of acceptance of nonphysician health care providers such as physicians assistants and registered nurses. Means testing of Medicare programs and use of special indicators for providing more Medicaid funds to states with medically underserved and sparsely populated areas are examples of two policy initiatives that receive favorable responses from both urban and rural household residents, but would disproportionately benefit rural areas.
International Medical Graduates in Rural America: The 1987 Distribution of Physicians Who Entered the U.S. Medical System Between 1969 and 1982
Authors: Mick Stephen S. , Sutnick Alton I.
Published: April 2008

Abstract: This study examines the differential location on Dec. 31, 1987, in nonmetropolitan U.S. counties of a cohort of international medical graduates (IMGs) (n=246,754) certified by the Educational Commission for Foreign Medical Graduates between 1969 and 1982, and a matched group of U.S. medical graduates (USMGs). Analysis of counties grouped into categories of population size revealed disparities across certain U.S. census divisions. IMGs were distributed disproportionately in the West North Central and East South Central census divisions. The implications of the IMG presence in numerous rural counties is discussed from the perspective of recent policy proposals to reduce the number of IMGs in the United States.
Developing the National Institute for Occupational Safety and Health's Cancer Control Demonstration Projects for Farm Populations
Authors: Connally L. Barbara , Schulte Paul A. , Alderfer Raymond J. , Goldenhar Linda M. , Calvert Geoffrey M. , Davis‐King Karen E. , Sanderson Wayne T.
Published: April 2008

Abstract: Although farmers experience lower overall cancer rates than the U.S. population, they are at increased risk for cancers of certain sites, such as brain, stomach, lymphatic and hematopoietic, lip, prostate, and skin. Little research has been done to determine the extent to which farmers and their families use cancer control services or how their utilization behaviors and cancer survival rates compare to those of nonfarmers in the United States. In 1989, recognizing the occupational uniqueness of farm populations and the limited cancer‐related information about them, Congress mandated that the National Institute for Occupational Safety and Health (NIOSH) develop a program to promote cancer control among farming populations. Eight institutions were funded through cooperative agreements to collaborate with NIOSH and each other to develop the demonstration research and intervention projects. The projects are aimed at identifying barriers that prevent farmers, farmworkers, and their families from accessing the full range of cancer control services, and then implementing interventions to mitigate those barriers. This paper illustrates some of the conceptual and methodological issues NIOSH researchers and their collaborators faced while developing the cancer control program.
Wisconsin Farmer Cancer Mortality, 1981 to 1990: Selected Malignancies
Authors: Hanrahan Lawrence P. , Anderson Henry A. , Haskins Linda K. , Olson Joseph , Lappe Karen , Reding Douglas
Published: April 2008

Abstract: Cancer mortality risks for Wisconsin white male farmers were examined during the years 1981 to 1990. Four malignancies were studied: Non‐Hodgkin's lymphoma, melanoma, colon cancer, and rectal cancer. Occupation coded deaths were segmented into farmer and nonfarmer groups and population counts for the groups were estimated from 1980 and 1990 Bureau of the Census data. Standardized mortality ratios (SMRs) were constructed from the ratio of observed farmer deaths and the expected number of farmer deaths. Expected deaths were generated from the underlying statewide nonfarmer rate for the malignancy multiplied into the farmer population at risk. Farmers had significantly lower mortality risks for melanoma (SMR: 0.659; 95% CI: 0.993‐0.326) and colon cancer (SMR: 0.763; 95% CI: 0.928‐0.599). Farmers also exhibited a nonsignificant decrement for non‐Hodgkin's lymphoma (SMR 0.930; 95% CI: 1.214‐0.645). For rectal cancer, farmers experienced a slightly higher but essentially the same risk as nonfarmers (SMR: 1.013; 95%CI: 1.418‐0.608)—the SMR was not significant. This study corroborates a number of cancer incidence and mortality investigations demonstrating that farmers generally experience the same or lower mortality risks for these malignancies.
Mammogram Utilization Among Farm Women
Authors: Carr W. Peter , Maldonado George , Leonard Pamela R. , Halberg Julia U. , Church Timothy R. , Mandel Jeffrey H. , Dowd Bryan , Mandel Jack S.
Published: April 2008

Abstract: Utilization of preventive health care services is lower in rural populations than in urban populations, possibly as a result of barriers to preventive health care that are characteristic of rural settings. This study was conducted to identify factors associated with mammogram utilization among farm women. Mammogram utilization among farm women from six southern Minnesota counties was examined as part of a larger community‐based cancer intervention study. Farm women aged 40 and older were randomly selected from a list of farm households and interviewed by telephone to determine mammogram utilization and factors related to utilization. Of the 606 respondents, 78 percent reported ever having a mammogram and 49 percent reported a mammogram within the past year. Physician recommendation for a screening mammogram and family history of breast cancer were found to be associated with ever having a mammogram. Correct knowledge of mammogram screening guidelines was associated with a mammogram within the past 12 months. Overall, physician recommendation was the most influential determinant of utilization. As more emphasis is placed on prevention, patient education by physicians could have the greatest impact on mammogram utilization.
Georgia's Harvesting Healthy Habits: A Formative Evaluation
Authors: Parrott Roxanne , Steiner Carol , Goldenhar Linda
Published: April 2008

Abstract: Occupational safety and health researchers seek to conduct effective cancer awareness campaigns to increase agricultural workers' skin cancer prevention and detection behaviors. Georgia undertook such a project using a social cognitive theory (Bandura, 1986) conceptual model, with its objectives focusing on personal determinants of and environmental influences on farmers' behavior. One underused strategy to increase the success of health campaigns, formative evaluation, was undertaken during year one of the demonstration project, with four goals. These included an assessment of (1) the availability of societal resources to support farmers' practices, (2) the affordability for farmers to follow through with behaviors being promoted, (3) the social support for behaving in ways that reduce farmers' skin cancer risk, and (4) farmers' current knowledge, outcome expectations, and self‐efficacy in this regard. Formative evaluation revealed an absence of information, products, services, and social support for farmers' skin cancer prevention and detection. As a result, the Georgia project's plan was refined to include specific activities aimed at increasing the environmental support for health promotion activities relating to farmers' skin cancer prevention and detection. These include a seminar for rural primary care physicians and public health nurses to increase knowledge and skills relating to conducting clinical skin exams; programs for agricultural extension agents, cotton scouts, and 4‐H groups to provide opportunities to learn more about and practice sun safety; and a feed and seed store campaign.
Factors Associated with Safe Use of Agricultural Pesticides in Minnesota
Authors: Mandel Jeffrey H. , Carr W. Peter , Hillmer Teresa , Leonard Pamela R. , Halberg Julia U. , Sanderson Wayne T. , Mandel Jack S.
Published: April 2008

Abstract: How farmers protect themselves against pesticide exposure has important public health consequences. To obtain insights into pesticide self‐protection, this study obtained data on chemically resistant glove and other protective equipment use as they relate to the type of farming practice, demographic characteristics of farmers and their farming operations, farmers' preventive health beliefs and behaviors, and factors related to their health care. Data were obtained by telephone interviews conducted in six rural Minnesota counties. Survey respondents totaled 1,327 (82% response rate), with 502 reporting pesticide use. Ninety‐five percent of the latter respondents believed in the effectiveness of protective equipment and 88 percent believed that pesticide exposures are harmful. Fifty‐six percent of the subjects wore chemically resistant gloves and 22 percent wore other protective clothing 75 percent of the time or more when using pesticides. Glove use and certification to use restricted pesticides was less frequent for women. The use of protective equipment in this group of Minnesota farmers was weakly related to being certified to apply restricted pesticides, believing in the effectiveness of protective clothing, believing that smoking causes serious health problems, using crop insecticides, and distance to a health care facility.
Utilization of Cancer Early Detection Services Among Farm and Rural Nonfarm Adults in Iowa
Authors: Muldoon Joann T. , Schootman Mario , Morton Roscoe F.
Published: April 2008

Abstract: An increase in the proportion of advanced malignancies among rural residents has been noted and may be due to a combination of factors, including availability of screening services, demographic characteristics, and access to health care facilities. A cross‐sectional study was conducted in 33 nonmetropolitan Iowa counties among randomly selected middle‐aged farm and rural nonfarm adults to compare utilization of cancer early detection services. A total of 1,126 adults in 600 farm households and 1,092 adults in 589 rural nonfarm households provided information through a 155‐item in‐home interview.

Differences in income, age, and health insurance coverage (including preventive services) between the farm and nonfarm study populations were found. Although farm men were less likely to have had a checkup during the past year than men in the nonfarm population, no difference was found for women. Overall, differences in screening behaviors were small. Larger differences between both populations were observed for use of mammograms, prostate examinations among men age 50 and older, use of sigmoidoscopy among women age 50 and older, and skin cancer examinations among both sexes. When controlling for demographic characteristics and insurance coverage, members of the farm and rural nonfarm population were equally likely to use multiple screenings according to ACS guidelines. Because of the increased risk of breast cancer, interventions aimed at increasing utilization of mammography among women age 50 and older should be implemented. Although the farm population was more likely to use skin examinations, prevalence should be increased substantially to counteract the continuing rise in skin cancer.
The Criminalization of Persons with Serious Mental Illness Living in Rural Areas
Authors: Sullivan Greer , Spritzer Karen
Published: April 2008

Abstract: In the context of restrictive admissions policies at public inpatient facilities, rates of arrest and incarceration of persons with serious mental illness (SMI) have been increasing, leading to the perception that SMI persons are being unduly “criminalized.” This paper describes the characteristics of persons with SMI (N=177) in Mississippi who have been (1) jailed without charges while awaiting a hospital bed and (2) jailed for a criminal offense. Seventy‐five percent (N=132) of the 177 subjects had been held in local jails awaiting state hospital admission at least once in their lives, most for more than five days. Fifteen percent (N=26) had contact with the police for a criminal offense in the past year. Rural residence markedly increased the risk for waiting in jail (OR=4.24) but was not related to committing a criminal offense. Protective factors for any type of criminal justice contact were female gender, caucasian ethnicity, better compliance with medication regimes, and nonrural residence. The phenomenon of rural criminalization, i.e., waiting in jail without criminal charges, differs qualitatively from the criminalization that occurs in urban areas and may require a different solution. To avoid criminalization of SMI persons in rural areas, public mental health systems must develop effective crisis interventions in the community or work with local law enforcement officials and medical and mental health facilities to create more immediate access to acute inpatient care.
The Employment and Use of Nurse Practitioners and Physician Assistants by Rural Hospitals
Authors: Krein Sarah L.
Published: April 2008

Abstract: Nurse practitioners and physician assistants are both important resources for the delivery of health care services in rural areas. Nevertheless, little is known about the demand for their services by rural employers. The purpose of this study was: (1) to describe and compare the employment and use of nurse practitioners and physician assistants by rural hospitals in an eight‐state region in the northwestern United States (Minnesota, North Dakota, South Dakota, Iowa, Montana, Idaho, Oregon and Washington); and (2) to examine how different market and organizational factors influence the employment of nurse practitioners and physician assistants by rural hospitals

Data for the study were collected through telephone interviews of rural hospital administrators (N=407) and analyzed using both descriptive tables and logistic regression. Study results show that rural hospitals are important employers of both nurse practitioners and physician assistants, although there is a greater demand for than supply of both types of practitioners. Moreover, there are several differences in the characteristics of hospitals that employ the different types of practitioners. Rural hospitals use nurse practitioners and physician assistants to enhance their delivery of outpatient services, and a major factor related to the employment of nurse practitioners and physician assistants by rural hospitals is the Rural Health Clinic program. The majority of hospitals that use nurse practitioners, as well as those that use physician assistants, indicate that nurse practitioners and physician assistants can prescribe medications and order lab tests and X‐rays, but considerably fewer report that nurse practitioners and physician assistants have admitting or discharge privileges. Physician assistants appear to provide a more expanded scope of services in rural hospitals. Nonetheless, rural hospitals seem to employ nurse practitioners and physician assistants for similar reasons: (1) to extend care, assist physicians, or increase access to primary care; (2) because physicians are unavailable or too difficult to recruit; (3) because nurse practitioners or physician assistants are considered cost‐effective or more economical for rural areas; and, (4) for Rural Health Clinic certification
Rural Mental Health Leaders' Perceptions of Stigma and Community Issues
Authors: Johnsen Matthew C. , Morrissey Joseph P. , Calloway Michael O. , Fried Bruce J. , Blank Michael , Starrett Barbara E.
Published: April 2008

Abstract: This paper provides a description of the attitudes of rural leaders toward mental health issues using data collected in two rural counties (one in Virginia and one in North Carolina). Study participants (N=63) are individuals identified as leaders making a significant positive contribution to mental health issues in each county. While the counties were matched on a number of demographic characteristics, the counties had one difference believed important: one had a county mental health center located within the county boundary while the other had no in‐county mental health center. The study found that rural leaders believed that other community members held attitudes toward mentally ill persons that were more discriminatory than their own. In addition, rural leaders expressed that mental health was a more important concern to them than it was to the community as a whole. Finally, the importance placed on issues of importance to the community and the resulting issue of priority of relevance varied in response to the occupation of respondents. The study presents an approach to understanding how occupational structures affect community issue priorities among rural Ieaders.
Effects of Second Office and Hospital Consulting Practices of Physicians on Rural Communities
Authors: Hicks Lanis L. , Hassinger Edward , Taparanskas Wendy
Published: April 2008

Abstract: This research examined the prevalence of second offices and hospital consulting practices of physicians in Missouri, the characteristics of physicians participating in such practices, the change in availability of services through these practices, the characteristics of counties and hospitals involved, and the practice organization of participating physicians. The assessment of the factors was conducted within the conceptual framework of community and physician characteristics, practice form and organization, and health system resources. In 1993, 64 of the 93 nonmetropolitan counties in Missouri gained, on average, 1.3 full‐time equivalent physicians through second office and hospital consulting practices. Eighteen non‐metropolitan counties lost, on average, 0.4 full‐time equivalent physicians through these practices; 11 nonmetropolitan counties were not affected. The majority of physicians engaged in these two types of practices are nonprimary care specialists. Consequently, in addition to the net contribution to total physician service availability, many nonmetropolitan counties gained access locally to a wider variety of specialty services. This change in availability of physician services, not generally incorporated in decisions, needs to be considered when policy efforts are undertaken to change the spatial and specialty distribution of physicians
HMO Financial Arrangements With Rural Physicians
Authors: Christianson Jon B. , Hamer Richard , Knutson David
Published: April 2008

Abstract: The growth of managed care in general suggests that a substantially larger number of rural primary care physicians will be asked to enter into risk‐bearing contracts with Health Maintenance Organizations (HMOs) in the near future. This article describes the different types of payment and risk‐sharing arrangements that exist between HMOs and primary care physicians and presents survey data relating to their prevalence in rural areas. Also, it describes in detail the payment arrangements used by four HMOs that contract with rural primary care physicians. The concluding discussion highlights policy issues regarding risk‐sharing arrangements that are especially pertinent in rural settings.
Rural‐Urban Comparisons of Age and Health at the Time of Nursing Home Admission
Authors: Duncan R. Paul , Coward Raymond T. , Gilbert Gregg H.
Published: April 2008

ABSTRACT: This study re‐examines the contention that rural elders admitted to nursing homes are younger and healthier than their counterparts who enter urban facilities. The analysis uses interview data gathered in both urban and rural nursing homes. Residents were inter‐viewed at or near the time of admission regarding their health and circumstances immediately prior to entering the nursing home. The findings indicate few and modest differences between urban and rural residents. In those instances where differences are observed, there is ambiguity—some measures indicate lower health status in the case of rural residents, while others suggest that urban residents are more likely to report health impairments. The divergence of these findings from earlier research may be due to differences in the study populations, measurement differences, or, more likely, that policies and processes have changed over time
Rural Radiology: Who is Producing Images and Who is Reading Them?
Authors: Yawn Barbara , Krein Sarah , Christianson Jon , Hartley David , Moscovice Ira
Published: April 2008

ABSTRACT: The purpose of this study is to identify the local availability and trends in local availability of imaging technology and interpretation services in rural hospitals in the northwestern United States during the period between 1991 to 1994. Another objective is to describe hospital and community factors associated with the diffusion of image production and interpretation services. The information for this study was gathered through telephone surveys of rural hospital administrators in eight northwestern states in 1991 and 1994. The availability of magnetic resonance imaging (MRI) equipment, computed tomography (CT) scanners, ultrasonography equipment, and dedicated mammography equipment increased between 1991 and 1994. The increases in MRI units were primarily in mobile equipment, while ultrasonography and mammography equipment increases were primarily fixed hospital‐based units. In 1994, image interpretation in the rural hospitals was provided by both primary care and radiology physicians. Forty‐six (11.5%) of the rural hospitals had no on‐site radiology services and only 73 (18%) had daily radiology services. Between 1991 and 1994, 12 hospitals gained at least once‐a‐week radiology services, but 24 lost all radiology services. Teleradiology availability more than doubled during the three years. Radiologic technology has diffused widely into rural communities in this region of the United States at differing rates for large and small hospitals. Radiologists are available to these hospitals only 46 percent of the days each year, with more days of availability in the larger hospitals and fewer days in the smaller hospitals. Teleradiology capability is increasing more rapidly in the larger hospitals that have radiologists more readily available
Conditions Affecting Rural Hospital Specialization, Conversion, and Closure: A Case‐based Analysis of Threat and Change
Authors: Harmata Rita , Bogue Richard J.
Published: April 2008

ABSTRACT: The purpose of this analysis is to increase understanding of how and why rural hospitals change, with an eye toward the relevance of these questions to overall access and quality in the rural community. This study reports the threats that precipitated three major classes of organizational change (specialization, conversion, and closure) in 16 rural hospital cases. The authors identify the types and levels of threat faced by the case hospitals and examine how different threat situations may lead toward different classes of change. Conversions and closures typically seem to result from moderate‐ or high‐threat situations. Specializations seem fn result from lour nr moderate‐threat situatinns
Job Satisfaction Among Rural Physician Assistants
Authors: MUUS Kyle J. , Geller Jack M. , Williams John D. , Ludtke Richard L. , Knowlton Douglas D. , Hart L. Gary
Published: April 2008

Abstract: Because increasing numbers of physicians are being trained in specialized medicine, health professional shortage areas remain common in the United States, and the role of physician assistants (PAS) in health services provision is becoming increasingly important, especially in rural and underserved areas. By most accounts, there is a shortage of PAS in the United States, particularly in rural areas. A nationwide survey was conducted in 1994 to determine what attracted PAS to rural settings and what they found satisfying about their work and community. This study involved a random sample of 1,263 PAS who practiced in rural (nonmetropolitan) areas of the United States. A 15‐item scale was developed to measure job satisfaction. A statistical model was tested for its ability to predict levels of job satisfaction using multiple regression analysis. Independent variables included demographics, practice, and community factors. Findings indicated that rural PAS were generally satisfied with their work. The most significant predictors of satisfaction included practice factors (e.g., importance of autonomy and a good relationship with the supervising physician), extent of practice responsibilities (e.g., regular and on‐call hours and the percentage of PAS' patient load that was not discussed with the supervising physician), and community factors (e.g., community satisfaction).
Psychosocial Differences Between Urban and Rural People Living With HIV/AIDS
Authors: Heckman Timothy G. , Somlai Anton M. , Kalichman Seth C. , Franzoi Stephen L. , Kelly Jeffrey A.
Published: April 2008

Abstract: During the past decade, many investigations have examined the life circumstances of people living with HIV disease. Most of these studies, however, have focused on HIV‐infected people in large metropolitan areas. This study compares the psychosocial profiles of rural and urban people living with HIV disease. Anonymous, self‐administered surveys were completed by 276 people with HIV/AIDS in a Midwestern state. The assessment instrument measured respondents' quality of life, perceptions of loneliness, social support, experiences with AIDS‐related discrimination, access to services, and illness‐related coping strategies. Compared with their urban counterparts, rural people with HIV reported a significantly lower satisfaction with life, lower perceptions of social support from family members and friends, reduced access to medical and mental health care, elevated levels of loneliness, more community stigma, heightened personal fear that their HIV serostatus would be learned by others, and more maladaptive coping strategies. Programs that are designed to improve the life circumstances of people with HIV disease in rural areas—particularly those that facilitate access to adequate health care, increase perceptions of social support, and improve illness‐related coping—are urgently needed.
Potential Effects of Managed Care Organizations in Rural Communities: A Framework
Authors: Christianson Jon
Published: April 2008

This article has provided a conceptual framework regarding the implications of a growing MCO presence in rural areas. This framework addresses factors likely to influence the degree of MCO presence in any given rural community, as well as the possible effects of that presence on rural consumers, employers, providers, and the uninsured. These factors vary across communities and will result in variation in the nature and importance of MCOs among rural communities.

The arguments and considerations presented are based on analysis of MCO, employer, and consumer behavior, informed by research findings relating to MCOs in urban areas. The issues discussed raise a number of questions that deserve to be addressed through empirical research focused specifically on rural populations. The appendix contains a summary list of these questions. The next article reviews the results of existing research studies as they bear on these research questions and other issues raised in this article.
Rocky Mountain HMO
Authors: Wellever Anthony , Moscovice Ira
Published: April 2008

Rocky Mountain HMOs two‐decade history of success on the western slope of Colorado is due not only to the conscious decisions of its managers but also to the geography and demography of its primary market area. The managers of Rocky Mountain HMO sought to build a managed care plan that was physician friendly and that had a local face, explicitly recognizing that their success hinged on the ability to satisfy the needs of both providers and purchasers. Isolated by the Rocky Mountains from major population centers of the state and located beyond the pull of the Salt Lake City, Utah, market to the west, Rocky Mountain HMO had no real managed care competitors on the western slope during its formative years. This lack of competition, combined with the ability to defuse physician resistance to managed care and to provide a satisfactory array of benefits at a reasonably low price, gave Rocky Mountain HMO an impressive share of the western slope health insurance market.

Rocky Mountain HMOs expansion plans, in part, are a reaction to real and anticipated increases in managed care competition along the western slope. To maintain competitive premium rates, Rocky Mountain HMO executives perceive the need to spread the fixed costs of its infrastructure by increasing enrollment. As Rocky Mountain HMO expands its market to include all areas of the state, three issues relative to rural areas emerge. First, will Rocky Mountain HMO be able to import its successful rural HMO development strategies to other rural areas of the state at the same time it attempts to develop urban markets, or will rural expansion areas be treated in the same manner as urban expansion areas? Second, what are the consequences of the HMO's change in strategic focus for Rocky

Mountain HMO providers and consumers on the western slope? Third, how will increased competition on the western slope affect Rocky Mountain HMO's relationship with its providers and consumers?
Regence HMO Oregon
Authors: Casey Michelle , Moscovice Ira
Published: April 2008

Regence HMO Oregon is a large IPA‐model HMO based in Portland, Ore. It serves commercial, Medicaid, and Medicare cost enrollees throughout Oregon and southern Washington. An affiliate of Blue Cross and Blue Shield of Oregon, Regence HMO Oregon built its rural enrollment by acquiring Capitol Health Care, an HMO with rural enrollment; by encouraging rural employers with traditional Blue Cross and Blue Shield of Oregon indemnity and PPO coverage to switch to HMO coverage; and by aggressively contracting with providers statewide to serve Oregon Health Plan (Medicaid) enrollees.
Building a Research Agenda: Responding to the Needs of Community and Migrant Health Centers
Authors: Mueller Keith J. , Curtin Thomas , Hawkins Daniel , Williams Donna M. , Lefkowitz Bonnie
Published: April 2008

Abstract: This article summarizes the results of an invitational conference designed to establish a research agenda for collaborative projects involving university‐based health services researchers and staff (administrative and clinical) from Community and Migrant Health Centers (CIMHCs). More research related to CIMHCs needs to be developed, preferably by collaborative teams of researchers and CIMHC personnel. Specific research ideas are summarized, and five more detailed research proposals are presented. This is an especially important area that needs work, given the changes taking place in health care finance and the impacts of those changes on CIMHCs.
Clergy Perspectives and Practices Regarding Intimate Violence: A Rural View
Authors: Strickland George A. , Welshimer Kathleen J. , Sarvela Paul D.
Published: April 2008

Abstract: intimate violence has been recognized as a major problem in the United States. The financial and social hardships of declining rural economies, the social isolation of distance and poor transportation, inadequate social services for families in crisis, and limited options for women who might otherwise leave abusive partners are risk factors for intimate violence in rural areas. Church‐based prevention programs are considered particularly useful in rural communities. If preventive health programs engage them properly, rural church members' overlapping social structures and their especially interconnected social circles can spread and support new ideas and practices. This study was conducted in four rural, predominately white, southern Illinois counties. The survey instrument used consisted of four subscales, measuring knowledge about, attitudes toward, and practices to prevent intimate violence as well as religious ideology. Overall, clergy knowledge and attitudes about intimate violence in this study did not necessarily translate into actual prevention practices against intimate violence.

However, liberal clergy tend to employ prevention practices more often when compared with conservative clergy. Nevertheless, rural churches and their clergy seem to be promising sources for diffusion of intimate violence prevention information, attitudes and acceptable standards of behavior to rural communities.
Distance, Use of Resources, and Mortality Among Rural Missouri Residents With Acute Myocardial Infarction
Authors: Pierce Robert P. , Williamson Harold A. , Kruse Robin L.
Published: April 2008

Abstract: Prompt access to medical services is considered critical in managing acute myocardial infarction (AMI). Several socioeconomic and geographic factors affect access to such care in rural areas. This study measured the effect of geographic distance from care on utilization of cardiovascular technology and death after AMI. The records of 1,658 rural Missouri residents age 65 or older with a discharge diagnosis of AMI in 1991 were obtained from Medicare data. The rate of use of cardiovascular technology and rate of post‐AMI mortality for rural Missouri residents who live far from emergency departments and cardiac referral centers (CRC) were compared with those who live nearest such services. Those living 60 miles or more from a CRC were less likely to have cardiac catheterization (odds ratio [OR]=0.55; 95% confidence interval [CI]=0.40 to 0.75) or angioplasty (OR=0.68; 95% CI=0.47 to 0.98), compared with those living fewer than 30 miles from a CRC. There were no differences in 30‐day, 90‐day, or one‐year mortality rates. After adjusting for distance to a CRC, those living 20 miles or more from emergency services were more likely to have coronary artery bypass grafting (OR=1.92; 95% CI=1.18 to 3.15) than those living fewer than 10 miles from such services, but there was no difference in mortality. Distance from services strongly predicts utilization of cardiovascular resources, but it does not predict mortality among rural Missouri Medicare beneficiaries hospitalized with AMI.
Are There Need‐based Geographical Differences Between International Medical Graduates and U.S. Medical Graduates in Rural U.S. Counties?
Authors: Mick Stephen S. , Lee Shoou‐Yih Daniel
Published: April 2008

Abstract: The objectives of this study are to compare the rural location of international medical graduates (IMGs) and U.S. medical graduates (USMGs) by specialty (primary care vs. specialty care) according to geographical measures of need. This study utilized a cross‐sectional survey using the 1997 American Medical Association Physician Masterfile for all active post‐resident allopathic physicians and the Area Resource File (ARF) (Bureau of Health Professions, 1996) for all active post‐resident osteopathic physicians in 1995 in the rural U.S. physician workforce (N=69,065). Allopathic physician ZIP code location was matched to county data using the ARF. The key measure was the difference in proportions between USMGs and IMGs in each state's rural counties characterized by need: high infant mortality, low socioeconomic status, high proportion of nonwhite population, high proportion of population 65 years and older, and low physician‐to‐population ratio. Primary care and specialty care rural physicians were studied separately. A disproportion of IMGs were located in needy rural counties of more states than were USMGs. Further, IMG disproportions were generally larger than USMG disproportions when they existed. Disproportions of IMGs tended to be located more often in the central and south census regions. Disproportions of specialty care IMGs were more frequent and of greater magnitude than those of primary care IMGs. Variations in the relative and absolute numbers of IMGs and USMGs among the states was wide. Services delivered by active post‐resident primary care and specialty care IMGs appeared to be disproportionate to their overall number compared with USMGs in numerous needy rural counties. The extent of the IMG “safety net” presence differed, however, by the criteria used. Still, proposed limits on IMG entry into U.S. residency training may create long‐term problems of access to rural physician services absent policies to induce USMGs or midlevel practitioners to locate in such areas. State‐by‐state assessments of the potential impact of IMG restrictions are called for because of the wide state‐level variation that existed in comparative IMG‐USMG distributions.
Multi‐method Assessment of Access to Primary Medical Care in Rural Colorado
Authors: Fyer George E. , Drisko Jody , Krugman Richard D. , Vojir Carol P. , Prochazka Allan , Miyoshi Thomas J. , Miller Marie E.
Published: April 2008

Abstract: The objectives of this study include conducting an analysis of access to primary medical care in rural Colorado through simultaneous consideration of primary care physician‐to‐population and distance‐to‐nearest provider indices. Analyses examined the potential development and implications of excessively large, perhaps unmanageable patient caseloads that might result from every rural Coloradoan's exclusive use of the nearest generalist physician as a regular source of care. Using American Medical Association Physician Masterfile data for 1995 and coordinates for latitude and longitude from U.S. Census files (Census of Population and Housing, 1990), the authors calculated distance to the nearest primary care physician for residents of each of the 1,317 block groups in Colorado's 52 rural counties. Caseloads for each generalist physician were computed assuming the population used the nearest provider for care. Straight‐line mileage to primary medical care was modest for rural Coloradoans‐a median distance of 2.5 miles. Almost two‐thirds (65 percent) of the population resided within 5 miles, and virtually all residents (99 percent) were within 30 miles of a generalist physician. However, had everyone traveled the shortest possible distance to care, demand for service from many of the 343 primary care doctors in rural regions of the state would have been overwhelming. The results of simultaneous application of distance‐to‐care and provider‐to‐population techniques unrestricted by geographic boundaries depict access to primary medical care and corresponding consumer difftculty more furry than in previous studies. Further combination of methods of needs assessment such as those used in this analysis may better inform the future efforts of organizations mandated to address health care underservice in rural areas.
Rural Health Research Community Perceptions of the Effects of Rural Hospital Closure on Access to Care
Authors: Reif Susan Sullins , DesHarnais Susan , Bernard Shulamit
Published: April 2008

Abstract: The purpose of this case study was to ascertain the perceptions of health professionals who were located in six rural communities where hospital closure occurred, regarding the impact of closure on community residents. These health professionals were asked to respond to questions about effects of hospital closures on the availability of medical services such as emergency care, physician services, hospital services and nursing home care. To control for trends in medical services utilization that were unrelated to hospital closure, the study design included comparison areas where similar hospitals remained open. A standardized questionnaire was administered to three health professionals in each of the areas that experienced a hospital closure and also in the matched comparison areas. Interviews of the health professionals in closure areas provide evidence suggestive of some perceived negative effects of hospital closure on these communities. These negative effects include difficulty recruiting and retaining physicians, concern of residents about the loss of their local emergency room, and increased travel times to receive hospital services. The perceived effects of closure appeared to be mediated by the distance required for travel to the nearest hospital. Respondents perceived increased travel times to most significantly affect vulnerable populations, such as the elderly, the disabled and the economically disadvantaged. Respondents in the majority of comparison areas also reported access barriers for vulnerable populations. These barriers primarily center on problems of obtaining transportation and enduring the rigors of travel. Improvements in the availability of transportation to medical care may offer some stabilization to communities where hospitals closed; however, it also is the case that transportation improvements are needed to increase access to care in rural communities where hospitals remained open.
Rural Health Research: Demographic, Educational and Economic Factors Related to Recruitment and Retention of Physicians in Rural Pennsylvania
Authors: Rabinowitz Howard K. , Diamond James J. , Hojat Mohammedreza , Hazelwood Christina E.
Published: April 2008

Abstract: While prior studies have identified a number of factors individually related to physician practice in rural areas, little information is available regarding the relative importance of these factors or their relationship to rural retention. Extensive data previously collected from the Jefferson Longitudinal Study were analyzed for 1972 to 1991 graduates of Jefferson Medical College practicing in Pennsylvania in 1996, as were recent self‐reported perceptions of Jefferson Medical College graduates in rural practice. Rural background was overwhelmingly the most important independent predictor of rural practice, and freshman plans to enter family practice was the only other independent predictor. No other variable, including curriculum or debt, added significantly to the likelihood of rural practice. None of these variables, however, including rural background, was predictive of retention, which appeared to be more related to practice issues such as income and workload. These results suggest that increasing the number of physicians who grew up in rural areas is not only the most effective way to increase the number of rural physicians, but any policy that does not include this may be unsuccessful.
Rural Health Research: Factors Affecting Use of Chiropractic Services in Seven Midwestern States of the United States
Authors: Hawk Cheryl , Long Cynthia R.
Published: April 2008

Abstract: Although chiropractic is used by approximately 10 percent of the U.S. population, predictors of its use have not been definitively described. Previous studies have suggested that chiropractic users differ from nonusers in a number of socio demographic characteristics, but their findings are inconsistent, perhaps because of differences in populations sampled and dates of data collection, most of which are prior to 1990. Regional studies have been conducted in rural areas based on the premise that rural residents are more likely than non‐rural residents to use chiropractic; however, this premise has not been definitively documented. The purpose of this study was to provide clarification of these sociodemographic predictors of chiropractic use in Illinois, Iowa, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin by characterizing chiropractic users and nonusers in terms of sociodemographics, including rural or non‐rural residence, and presence of low back pain. Data from 1,511 respondents to a 1994 population‐based survey, conducted by the University of Iowa Social Science Institute, were analyzed. Unconditional logistic regression was used to derive odds ratios and 95 percent confidence intervals for univariate and multiple regression models. Overall, 15.1 percent of respondents had used chiropractic within the last year, most often for low back pain (57 percent). Chiropractic use was less likely in African Americans, Hispanics and Asians than whites, less likely by non‐rural than rural residents, and less likely in Catholics than Protestants in states other than Iowa and South Dakota. Overall, 42.7 percent of workers with low back pain reported using chiropractic, and use increased with age but remained significantly related to race, rural or non‐rural residence, state of residence and religious preference. Race, rural or non‐rural residence, state of residence and religious preference, independently of low back pain, affect use of chiropractic in seven Midwestern states.
A Rural Mental Health Research Agenda: Defining Context and Setting Priorities
Authors: Keller Peter A. , Murray J. Dennis , Hargrove David S.
Published: April 2008

Abstract: This article provides a brief overview of research perspectives on rural mental health services and suggests the importance of building an agenda to bring coherence to studies in this area. The need for sound theory and methodology to guide research is emphasized. The importance of better conceptualization of the rural context as a focus of research is addressed, and 14 propositions concerning issues the authors think will advance rural research are presented. This article is intended to stimulate discussion about a research agenda that will lead to better understanding of rural needs for mental health services as well as more responsive service models.