bluuebunny/crossref_metadata_2025_split huggingface dataset:
Children with Special Health Care Needs Program: Urban/Rural Comparisons
Authors: Jr. Robert M. Saywell , Zollinger Terrell W. , Schafer Mark E. , Schmit Troy M. , Ladd James K. 
Published: April 2008

Abstract: The purposes of this study were to: (1) describe both the urban and rural clients who received services from the Indiana Children with Special Health Care Needs program (CSHCN) including both demographic and clinical characteristics; (2) conduct a health care needs assessment of the CSHCN program clients in both urban and rural areas; and (3) measure the perceived quality and adequacy of the CSHCN program services.A survey instrument was developed and mailed to all 6,459 families who participated in the Indiana CSHCN program from July 1,1990 to June 30,1992. Of the 2,722 questionnaires used in the analysis, 1,624 clients (59.7%) resided in urban counties and 2,098 (40.3%) resided in rural counties.The most frequently noted conditions for program eligibility were asthma, ear infections, hearing impairments, heart defects, and convulsions and seizures. Asthma had greater prevalence among the urban clients while cleft lip/palate, epilepsy, and heart defects were more common among the rural clients.The majority of program clients perceived their medical needs as being met. However, significant numbers of clients perceived unmet needs for mental health services, support groups, information about community services, resources to pay for uncovered medical expenses, and respite care. Of the 23 listed services, five were reported at significantly lower rates by rural clients as not being met: regular medical care, recreation, child care/day care, parent support group services, and speech therapy.Quality of medical services was generally perceived as being “excellent or good,” while services related to information about community programs, child's rights in school, resources available to pay for uncovered medical expenses, as well as communication between the treatment center and the child's school were more often rated as “fair or poor.” A smaller proportion of rural clients rated physician care and availability of staff nurses as fair or poor. A larger percentage of the rural group reported that access to treatment center location was fair or poor, compared to the urban group.Overall, the evaluation of the Indiana CSHCN program has shown that the non‐medical care component seems to be in need of change, especially in the area of information and communication. Attention needs to be focused on providing more family support such as respite or child care and support groups, better information and communications, and improved availability of mental health services to better enable the CSHCN program to meet its objectives.
Rural Hospital Inpatient Surgical Volume: Cutting‐edge Service or Operating on the Margin?
Authors: Williamson Harold A. , Hart L. Gary , Pirani Michael J. , Rosenblatt Roger A. 
Published: April 2008

ABSTRACTSurgical services are an important part of modern health care, but providing them to isolated rural citizens is especially difficult. Public policy initiatives could influence the supply, training, and distribution of surgeons, much as they have for rural primary care providers. However, so little is known about the proper distribution of surgeons, their contribution to rural health care, and the safety of rural surgery that policy cannot be shaped with confidence. This study examined the volume and complexity of inpatient surgery in rural Washington state as a first step toward a better understanding of the current status of rural surgical services.Information about rural surgical providers was obtained through telephone interviews with administrators at Washington's 42 rural hospitals. The Washington State Department of Health's Commission Hospital Abstract Recording System (CHARS) data provided a count of the annual surgical admissions at rural hospitals. Diagnosis‐related group (DRG) weights were used to measure complexity of rural surgical cases.Surgical volume varied greatly among hospitals, even among those with a similar mix of surgical providers. Many hospitals provided a limited set of basic surgical services, while some performed more complex procedures. None of these rural hospitals could be considered high volume when compared to volumes at Seattle hospitals or to research reference criteria that have assessed volume‐outcome relationships for surgical procedures. Several hospitals had very low volumes for some complex procedures, raising a question about the safety of performing them.The leaders of small rural hospitals must recognize not only the fiscal and service benefits of surgical services–and these are considerable–but also the potentially adverse effect of low surgical volume on patient outcomes. Policies that encourage the proper training and distribution of surgeons, the retention of basic rural surgical services, and the rational regionalization of complex surgery are likely to enhance the convenience and safety of surgery for rural citizens.
Urban/Rural Differences in Prosthetic Dental Service Rates
Authors: Bader James D. , Scurria Mark S. , Shugars Daniel A. 
Published: April 2008

ABSTRACT:There have been few reports of relative rates of provision of dental health services in rural and urban settings, a comparative measure of access to care in these populations. One part of a statewide survey of active North Carolina general dentists (n=959, response rate=47%) was designed to quantify provision of prosthetic services. To determine contrasting rural and urban rates, responses were analyzed according to dentists’self‐report of practice city size using analysis of covariance with percent of insured patients in the practice as the covariate. Mean per‐patient‐visit rates for crowns, fixed partial dentures, removable partial dentures, and extractions, as well as the distributions of treatment following tooth extraction, differed by city size, with practitioners in the smallest cities reporting treatment distributions reflecting more frequent loss of teeth and less frequent replacement. These differences in patterns of prosthetic care echo the limited existing information describing oral health status, provider supply, and receipt of care, all of which suggest that differential levels of access to care exist and lead to differences in oral health outcomes.
Contracting for Emergency Room Coverage by Rural Hospitals
Authors: Wakefield Douglas S. , Tracy Roger , Myer Mark , Wallace Robert 
Published: April 2008

ABSTRACT:Obtaining adequate physician availability remains a challenge to many rural communities. To ensure 24‐hour emergency room physician coverage, many rural hospitals contracted for emergency room services from out‐of‐area and/or local physician. Survey findings for 99 rural and rural referral Iowa hospitals addressing the nature, extent, and cost of contracting physician coverage of the emergency room are presented. While nearly two‐thirds of the hospitals reported contracting for at least some emergency room coverage, the extent and costs of contracts vary widely. Advantages and disadvantages of contracting for emergency room services are discussed.
The Health of Rural Homeless Women with Young Children
Authors: Wagner Janet D. , Menke Edna M. , Ciccone Janet K. 
Published: April 2008

ABSTRACTMore than 30 percent of the homeless are families with children; however, little is known about these families, particularly rural homeless mothers with children. The purpose of this study was to describe the characteristics of rural homeless mothers, their physical and mental health, and their health care practices. A descriptive cross‐sectional design was used to study a sample of 76 rural mothers with children younger than age 13. An interview schedule and the SCL‐90‐R were used to collect data about these families. The majority of the families had been homeless for more than four months, 46 percent were woman‐headed, 17 percent of the mothers reported having a physical health problem, and only 3 percent had scores on the SCL‐90‐R that were indicative of needing additional evaluation for possible mental health problems. The use of drugs was higher than expected, which puts both the mothers and their children at risk for health problems.
A Strategy to Increase the Number of Urban Family Practice Resident Physicians Who Enter Rural Practice
Authors: Foley Anthony E. 
Published: April 2008

ABSTRACT:Physician geographic maldistribution is a problem in the United States health care system. Innovative strategies are needed to entice resident family physicians training in the larger, more numerous suburban and urban training programs to practice in rural areas upon completing their training. This paper describes a strategy used at St. Elizabeth Medical Center Family Practice Residency Program, Dayton, OH, to encourage rural practice. In the St. Elizabeth plan, the interested family practice resident moonlights in a rural practice provided by the local county hospital. The county medical staff covers the resident physician's practice during the frequent absences. The residency program faculty provide on‐site supervision, telephone back‐up coverage, and practice consultation. The county hospital provides billing services; the resident physician retains 100 percent of collections. The resident physician gains exposure to the knowledge, skills, and attitudes needed in rural practice. Upon completion of residency training, the physician remains in practice and is not required to pay back any expenses incurred by the hospital. Two resident physicians participate currently; three others have expressed interest in practicing in the community. A similar plan might work in parts of the United States where, like Ohio, training programs and rural communities are not far apart.
Impact of New Information Technologies on Training and Continuing Education for Rural Health Professionals
Authors: Crandall Lee A. , Coggan Janet M. 
Published: April 2008

ABSTRACT:Recently developed and emerging information and communications technologies offer the potential to move the clinical training of physicians and other health professionals away from the resource intensive urban academic health center, with its emphasis on tertiary care, and into rural settings that may be better able to place emphasis on the production of badly needed primary care providers. These same technologies also offer myriad opportunities to enhance the continuing education of health professionals in rural settings. This article explores the effect of new technologies for rural tele‐education by briefly reviewing the effect of technology on health professionals’education, describing ongoing applications of tele‐education, and discussing the likely effect of new technological developments on the future of tele‐education. Tele‐education has tremendous potential for improving the health care of rural Americans, and policy‐makers must direct resources to its priority development in rural communities.
Bypassing of Local Hospitals by Rural Medicare Beneficiaries
Authors: Buczko William 
Published: April 2008

ABSTRACT:Several previous studies of hospital utilization by nonelderly rural residents suggest that local rural hospitals have been increasingly bypassed, often for care in urban hospitals. This resulted in lost volume for rural hospitals, detracting from their financial viability. It is not clear to what extent elderly rural residents also bypass local hospitals and whether this reflects regionalization of treatment for some conditions or avoidance of local hospitals assumed to provide inadequate care.This study examines hospital use by aged rural Delaware Medicare beneficiaries living in a ZIP code area that has a local hospital during Fiscal Year (FY) 1987 (N=670). Most of these Medicare beneficiaries were hospitalized locally. Those beneficiaries who bypassed local rural hospitals usually did so because cardiovascular surgical procedures were required and were often only performed in large urban teaching hospitals. Beneficiaries using nonlocal hospitals were similar to users of local hospitals with respect to age and sex and traveled an average of nearly 42 miles for treatment. “Bypassing” here appears to be due primarily to regional specialization of care rather than abandonment of local rural hospitals by rural residents.
To Stay or Not to Stay: Issues in Rural Primary Care Physician Retention in Eastern Kentucky
Authors: Cutchin Malcolm P. , Norton James C. , Quan Mae Marie , Bolt David , Hughes Sarah , Lindeman Barry 
Published: April 2008

ABSTRACT:An important aspect of primary care physician availability is the retention of physicians once they have located. While retention has been under‐researched compared to recruitment, it is especially important in rural areas where physician shortages already exist. This study reports the results of a retention survey completed by 132 primary care physicians in rural eastern Kentucky. The survey sets up an objective, hypothetical retention scenario and asks physicians to respond to structured questions and to an open‐ended question about factors not appearing in the survey. In response to the structured portion of the survey, physicians indicate that relief coverage is the most important factor in rural physician retention. A content analysis of 75 open‐ended responses reveals that besides the other factors in the survey, “socio‐cultural integration” is the pre‐eminent retention issue for rural practitioners. This article concludes that the role of the local rural community may be more important in retention than in recruitment. Finally, it is suggested that additional in‐depth qualitative research be conducted within the local contexts to enhance the understanding of rural physician retention processes.
Graduates' Reflections on Their Rural Medical Education: The Upper Peninsula Campus Experience
Authors: Sesney John W. , Kreher Nancy E. , Potts Michael J. 
Published: April 2008

ABSTRACT:A comprehensive graduate evaluation study was conducted by the Upper Peninsula campus of Michigan State University's College of Human Medicine in 1990. The purpose of this qualitative study was to describe the effects of the program's philosophy, curriculum, and general operational features on the 56 physician graduates from the program during 1978‐1989. All practicing graduates were interviewed in their practice locations and residents were interviewed by telephone. Forty‐six percent of the upper peninsula graduates are practicing in primary care specialities (family practice, general pediatrics, general internal medicine) and 41 percent are living in cities of less than 50,000 population. The overall findings identify several factors that were significant to the graduates, such as excellent role models, problem‐focused curriculum, and early applied clinical work in an ambulatory, primary care, rural setting. Based on the data, the program attracts students who are satisfied with its innovative medical education.
Two Decades of Experience in the University of Washington Family Medicine Residency Network: Practice Differences Between Graduates in Rural and Urban Locations
Authors: Baldwin Laura‐Mae , Hart L. Gary , West Peter A. , Norris Tom E. , Gore Edmond , Schneeweiss Ronald 
Published: April 2008

Abstract: This study describes how graduates of the University of Washington Family Medicine Residency Network who practice in rural locations differ from their urban counterparts in demographic characteristics, practice organization, practice content and scope of services, and satisfaction. Five hundred and three civilian medical graduates who completed their residencies between 1973 and 1990 responded to a 27‐item questionnaire sent in 1992 (84% response rate). Graduates practicing outside the United States in a specialty other than family medicine or for fewer than 20 hours per week in direct patient care were excluded from the main study, leaving 116 rural and 278 urban graduates in the study. Thirty percent of graduates reported practicing in rural counties at the time of the survey. Rural graduates were more likely to be in private and solo practices than urban graduates. Rural graduates spent more time in patient care and on call, performed a broader range of procedures, and were more likely to practice obstetrics than urban graduates. Fewer graduates in rural practice were women. A greater proportion of rural graduates had been defendants in medical malpractice suits.The more independent and isolated private and solo practice settings of rural graduates require more practice management skills and support. Rural graduates' broader scope of practice requires training in a full range of procedures and inpatient care, as well as ambulatory care. Rural communities and hospitals also need to develop more flexible practice opportunities, including salaried and part‐time positions, to facilitate recruitment and retention of physicians, especially women.
Availability of Rural Minnesota Obstetric Services: Is It a Problem?
Authors: Yawn Barbara , Wellever Anthony , Hartley David , Casey Michelle , Krein Sarah , Moscovice Ira 
Published: April 2008

Abstract: In the late 1980s several published articles predicted a crisis in the availability of obstetric care due to declining numbers of rural obstetrical providers. Several state and national studies documented the adverse impact of malpractice and time demands on both urban and rural physicians. But only limited information is available to document current trends in rural obstetrical practice and assess whether or not the predicted crisis occurred. This study sought to provide that updated information for rural Minnesota.A telephone survey of all rural Minnesota obstetrical providers was used to document the number, location, and specialty of rural obstetrical providers, their practice limitations, and plans for future practice. This data was combined with state perinatal statistics for each county to further assess obstetrical care availability and perinatal outcomes.All rural Minnesota obstetricians and certified nurse midwives provide obstetrical care as did 69 percent of all rural family physicians. Only 27 percent of rural obstetrical providers put any type of restrictions on their obstetrical practices. During the past year, 67 currently practicing rural physicians have stopped providing obstetrical care while 55 new obstetrical providers have begun rural practice. Two to 3 percent of current rural providers plan to retire or discontinue obstetrical services during the next five years. The provider demographics from the survey identified eight counties with no prenatal providers, and 22 additional communities of decreased provider availability. However, only two of the counties with no prenatal providers and five of the counties with areas of limited providers had increased percentages of adverse prenatal outcomes such as low birthweight or late prenatal care. This study concluded that Minnesota does not have a serious statewide problem with availability of rural obstetrical providers. However, a few isolated regions of the state have limited provider availability, including limited availability of local high‐risk services and consultants.
Access to Primary Health Care Among Persons With Disabilities in Rural Areas: A Summary of the Literature
Authors: Lishner Denise M. , PhD Mary Richardson , Levine Phyllis , Patrick Donald 
Published: April 2008

Abstract:Despite the prevalence of disabilities among persons living in rural areas, scarce data exist on their health care needs. While rural residents generally experience barriers to access to primary health care, these problems are further exacerbated for people with disabilities. This article summarizes findings from the published literature on access to primary health care among people with disabilities living in rural locations. A comprehensive computerized literature search turned up 86 articles meeting the study criteria, focused on the following rural populations affected by disabilities: children and adolescents, working‐age adults, the elderly, the mentally ill, and people with AIDS.For each of these populations, substantial problems in accessing appropriate health care have been documented. The literature consistently emphasizes the failure of local health care systems in nonmetropolitan areas to adequately address the complex medical and related needs of individuals with disabilities. In the absence of specialized expertise, facilities, and primary care providers trained specifically to care for disabled persons, local programs rely heavily on the use of indigenous paraprofessionals and alternative models of care. Further research is needed to identify and test the efficacy of innovative service delivery strategies to improve health care access for this population.
Knowledge, Attitudes, and Patterns of Cancer Screening: A Self‐report Among Foreign Born Hispanic Women Utilizing Rural Migrant Health Clinics
Authors: Skaer Tracy L. , Robison Linda M. , Sclar David A. , Harding Gary H. 
Published: April 2008

Abstract: Hispanics are the fastest growing minority in the United States and are currently Washington state's largest minority, with the highest growth rates found in the rural agricultural areas of eastern Washington state. Because breast and cervical cancer mortality rates are higher in Hispanics than other U.S. women, subgroups of Hispanic women with the lowest cancer screening utilization rates need to be identified and targeted for cancer control intervention to most effectively reduce late‐stage cancer diagnoses and mortality. A study was conducted at six migrant health clinics located throughout eastern Washington state to discern age‐specific proportions for utilization of mammography, breast self‐examination, and Pap smears among Hispanic migrants to the United States. Knowledge and attitudes regarding these procedures also were assessed and face‐to‐face interviews were completed with 512 women.Among women 20 years or older, 15 percent had never heard of a Pap smear, only 78 percent had ever received a Pap smear, and only 44 percent had received a Pap smear within the prior year. In all, 73 percent of the women had been taught breast self‐examination, 62 percent performed breast self‐examination, and 41 percent had performed a breast self‐examination in the prior month. Among women 40 years or older, only 38 percent had never heard of a mammogram, 38 percent had ever received a mammogram, and only 30 percent had received a mammogram in the prior two years. Cost was reported as a major barrier for screening in this population. Additionalzy, a substantial proportion of the women perceived Pap smears and mammography as unnecessary or diagnostic procedures, rather than preventive health measures.The above breast and cervical cancer screening rates fall well below those documented in national studies of US. women and Hispanic women, as well as below the recommended guidelines of the American Cancer Society and the National Cancer Institute. Culturally sensitive in tmentions to increase cancer screening knowledge and rates are urgently needed for high‐risk groups of Hispanic women, especially those 50 years or older.