bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician Recruitment in Rural Canada: Programs in New Brunswick, Newfoundland, and Nova Scotia
Authors: Reamy Jack 
Published: April 2008

ABSTRACT:This paper examines programs used in the Atlantic provinces of New Brunswick, Newfoundland, and Nova Scotia to recruit and retain physicians in rural areas. The provinces have many similarities but have unique characteristics that have shaped recruitment methods. The total number of physicians in each province has grown at a faster rate than the population. Each has problems attracting physicians to underserved areas, although the magnitude of the problems vary. The data for this paper were gathered from documents available from various agencies in each province and a series of personal interviews conducted in the spring of 1993. The provinces have chosen different avenues in attempting to solve the maldistribution of physician resources, ranging from regulatory methods in New Brunswick to moves in Newfoundland to encourage graduates of the province's medical school to locate in the rural areas and lessen the dependence on foreign medical graduates. Nova Scotia, with fewer areas needing physicians, has been able to focus its efforts on selected locations. Reviewing the methods used in the three provinces provides an insight into the attempts to solve the shortage of physicians in rural areas.
Strategic Activity and Financial Performance of U.S. Rural Hospitals: A National Study, 1983 to 1988
Authors: Mick Stephen S. , Morlock Laura L. , Salkever David , de Lissovoy Gregory , Malitz Faye , Wise Christopher G. , Jones Alison 
Published: April 2008

ABSTRACT:This study examines the effect of 13 strategic management activities on the financial performance of a national sample of 797 U.S. rural hospitals during the period of 1983‐1988. Controlled for environment‐market, geographic‐region, and hospital‐related variables, the results show almost no measurable effect of strategic adoption on rural hospital profitability and liquidity. Where statistically significant relationships existed, they were more often negative than positive. These findings were not expected; it was hypothesized that positive effects across a broad range of strategies would emerge, other things being equal. Discussed are possible explanations for these findings as well as their implication for a rural health policy relying on individual rural hospital strategic adaptation to environmental change.
Rurality and Tuberculosis Incidence Trends in North and South Carolina, 1980 to 1992
Authors: Millard Peter S. , Cegielski J. Peter , Wing Steve , Silver Andrew 
Published: April 2008

ABSTRACT:U.S. tuberculosis incidence rates increased steadily from 1985 through the end of 1992. Many factors have been implicated as contributors to the reversal in the historic decline of tuberculosis: the HIV epidemic, poverty and homelessness, immigration from less developed countries, and a deteriorating public health infrastructure. The purposes of this study were to demonstrate the extent of geographic variation in tuberculosis incidence rate trends in North and South Carolina and to quantify the association between aggregate‐level characteristics of state economic areas and incidence rate trends. Data were obtained from the U.S. 1980 and 1990 decennial census and from the North and South Carolina health departments. In North Carolina, tuberculosis trends declined rapidly in the early 1980s, but declined much less rapidly from 1986 to 1992. In South Carolina, tuberculosis trends were nearly static during the early 1980s, but declined rapidly from 1986 to 1992. Rural and high‐*poverty state economic areas in South Carolina experienced especially favorable changes in tuberculosis incidence trends. South Carolina has a unique tuberculosis control program that makes widespread use of enablers, incentives, and directly observed therapy. This study demonstrates the distinct tuberculosis incidence trends that existed in two contiguous states and suggests that approaches to tuberculosis control that improve access to care may be effective in improving tuberculosis incidence trends, particularly in poor and rural areas. Strengthening tuberculosis programs may be an important strategy for controlling the current resurgence of tuberculosis in the United States.
The Impact of Informal Care Giving on Labor Force Participation by Rural Farming and Nonfarming Families
Authors: Horwitz Mary E. , Rosenthal Thomas C. 
Published: April 2008

ABSTRACT:Using data from the National Survey of Families and Households, 1987, this study contrasts urban versus rural, and farm versus rural nonfarm informal care givers of the elderly and disabled to illustrate the conflicts that each group experiences when combining work and care giving. Women are the primary care givers in both rural and urban areas. Rural care givers spent more time providing care than urban caregivers, whether the dependent resided in the care giver's home or elsewhere in the community. A moderate difference existed in the number of hours care givers spent at work, although the rural care giver's spouses worked significantly more hours than urban spouses. Rural nonfarm care givers spent more hours caring for individuals residing in their communities, while farm caregivers spent the most time in household‐related activities when caring for someone in their homes. In‐home activity decreased the number of hours spent at work, while community care giving did not.
Universal Precautions Compliance and Exposure Frequency to Patient Body Fluids in Nurses Employed By Urban and Rural Health Care Agencies
Authors: Glenn L. Lee , Ramsey Priscilla W. 
Published: April 2008

Abstract: Previous studies have suggested that health care workers may differ with respect to universal precautions knowledge, compliance, practice setting barriers, or exposure to patient body fluids in rural and urban areas. The purpose of this study was to determine whether or not there are rural/urban differences in the degree of precaution taken by health care workers to prevent the spread of blood borne pathogens, specifically human immunodefiency virus (HIV) and hepatitis B virus (HBV). A random sample of rural and urban registered and licensed practical nurses in Tennessee was surveyed. The respondents completed two instruments that assessed self‐reported universal precautions knowledge, precautions, and practice barriers.No measurable differences in universal precautions knowledge, compliance, or barrier scores between the two groups were found; yet rural nurses were 2.7 times as likely to be exposed to patient body fluids than urban nurses (P<0.005). The conclusion was that rural nurses were as experienced and as knowledgeable about universal precaution techniques as their urban peers, but their knowledge was not translated into practice to the same degree. Two possible explanations offered are (1) rural nurses are more likely to be acquainted with, and thus trusting of, their patients, and (2) the lower seroprevalence of human immunodefiency virus and hepatitis B virus in rural areas may lead to complacency.
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.
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 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 hospitalsData 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
Potential Effects of Managed Care Organizations in Rural Communities: A Framework
Authors: Christianson Jon 
Published: April 2008

SummaryThis 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

SummaryRocky 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 RockyMountain 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

SummaryRegence 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.
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.
Rural‐Urban Differences in End‐of‐life Care: The Use of Feeding Tubes
Authors: Gessert Charles E. , Calkins David R. 
Published: April 2008

ABSTRACT:Efforts to improve end‐of‐life care have increased during the past decade. The goals of these efforts include increasing patient autonomy and reducing or more selectively using intensive medical interventions near the end of life. In this light, examination of community‐to‐community variations in end‐of‐life practices may serve to clarify the values and goals of different populations, as well as the roles of patients, families and professionals in bringing about specific patterns of medical care. This study examined the use of feeding tubes among Kansas nursing home residents between Jan. 1, 1994, and June 30, 1998 (n=78,895), using the Minimum Data Set. Residents with very severe, persistent and irreversible cognitive impairment (n =4,847) were included in the study population. The location of nursing homes in urban, midsize and rural counties was an independent variable. Feeding tubes were used in 19.3 percent of the urban nursing home residents, 8.0 percent of the residents in midsize counties and 6.4 percent of the rural residents. The rate of feeding tube use was significantly higher in urban counties for most subpopulations, including men, women, whites, nonwhites, and those eligible and ineligible for Medicaid. The observed rural‐urban differences in feeding tube use near the end of life may be associated with differences in access to surgical or nursing services, differences in the relationships between providers and consumers of care in different communities or differences in rural and urban cultures. Qualitative research may be useful in clarifying the roles of each of these factors.
Screening for Diabetic Retinopathy in Rural Areas: The Potential of Telemedicine
Authors: Cummings Doyle M. , Morrissey Susan , Barondes Michael J. , Rogers Lance , Gustke Susan 
Published: April 2008

ABSTRACT:Diabetic retinopathy is a common cause of blindness, and screening can identify the disease at an earlier, more treatable stage. However, rural individuals with diabetes may have limited access to needed eye care. The objective of this project was to demonstrate the feasibility of a diabetic retinopathy screening program using a state‐of‐the‐art nonmydriatic digital fundus imaging system. The study involved a series of patients screened in primary care and public health locations throughout seven predominantly rural counties in eastern North Carolina. Images of each fundus were obtained and sent to a retinal specialist. The retinal specialist reviewed each image, recorded image quality, diagnosed eye disease and made recommendations for subsequent care. Of193 volunteers with a history of diabetes mellitus, 96.3 percent reported that they were very comfortable or comfortable with the camera. Eighty‐five percent of images were rated as good or fair by the retinal specialist. The retinal specialist also reported being very certain or certain of the diagnosis in 84 percent of cases. Image quality correlated highly with the certainty of diagnosis (Spearman's rank order correlation coefficient =0.79; P<0.001). The average time since the previous examination by an eye care specialist for diabetic subjects was two years. Approximately 62 percent of diabetic patients had diagnosable eye conditions, the most common of which was diabetic retinopathy (40.9 percent). In this convenience sample, African Americans, despite similar age and disease duration, were more likely to have retinopathy. Digital imaging is a feasible screening modality in rural areas, may improve access to eye care, and may improve compliance with care guidelines for individuals with diabetes mellitus.
The Economic Realities of Rural Pharmacy Practice
Authors: Stratton Timothy P. 
Published: April 2008

TOPIC EDITOR'S NOTE:The issue of availability of pharmacists is gaining importance in rural health care. In 1999, for example, Congress responded to growing concern over a potential pharmacist shortage by directing the secretary of Health and Human Services to conduct a study of the pharmacist workforce. The agency was to determine the extent of any shortage and was also directed to seek comments regarding the issue. The report, delivered to Congress in fall 2000 with evidence indicating an emerging shortage of these professionals, has important implications for health care in rural areas. This Crossroads feature by pharmacist Timothy P. Stratton, Ph.D., offers additional insight by combining a brief review, personal experience and findings of a preliminary study to help tire journal focus attention on this issue.