Objective: Despite studies suggesting that there is a higher prevalence of overweight or obese children in rural areas in the U.S., there are no national studies comparing the prevalence levels of overweight or obese rural to metropolitan children. The objective of this research was to examine the hypothesis that living in a rural area is a risk factor for children being overweight or obese. Research Methods and Procedures:Using the National Survey of Children's Heath, the prevalence of overweight and/or obese rural children was compared with that of children in metropolitan settings. Multivariate analyses were performed on the data to detect if differences varied by health services use factors or demographic factors, such as household income, gender, and race. Results: Multivariate analysis revealed that overweight or obese children Ն5 years of age were more likely to live in rural rather than metropolitan areas (odds ratio ϭ 1.252; 95% confidence interval, 1.248, 1.256). Rural overweight U.S. children Ն5 years of age of age were more likely than their metropolitan counterparts to: be white, live in households Յ200% of the federal poverty level, have no health insurance, have not received preventive health care in the past 12 months, be female, use a computer for non-school work Ͼ3 hours a day, and watch television for Ͼ3 hours a day. In addition, they were more likely to have comorbidities. Discussion: Living in rural areas is a risk factor for children being overweight or obese.

The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of better healthcare services that would eventually lead to improved health outcomes. This review of the interprofessional education (IPE) and collaborative practice empirical literature from 2008 to 2013 focused on the impact of this area of inquiry on the outcomes identified in the Triple Aim. The preferred reporting items for systematic reviews and meta-analyses methodology were employed including: a clearly formulated question, clear inclusion criteria to identify relevant studies based on the question, an appraisal of the studies or a subset of the studies, a summary of the evidence using an explicit methodology and an interpretation of the findings of the review. The initial search yielded 1176 published manuscripts that were reduced to 496 when the inclusion criteria were applied to refine the selection of published manuscripts. Despite a four-decade history of inquiry into IPE and/or collaborative practice, scholars have not yet demonstrated the impact of IPE and/or collaborative practice on simultaneously improving population health, reducing healthcare costs or improving the quality of delivered care and patients’ experiences of care received. We propose moving this area of inquiry beyond theoretical assumptions to systematic research that will strengthen the evidence base for the effectiveness of IPE and collaborative practice within the context of the evolving imperative of the Triple Aim.

BackgroundBy examining 2013 County Health Rankings and Roadmaps data from the University of Wisconsin and the Robert Wood Johnson Foundation, this paper seeks to add to the available literature on health variances between United States residents living in rural and non-rural areas. We believe this is the first study to use the Rankings data to measure rural and urban health differences across the United States and therefore highlights the national need to address shortfalls in rural healthcare and overall health. The data indicates that U.S. residents living in rural counties are generally in poorer health than their urban counterparts.MethodsWe used 2013 County Health Rankings data to evaluate differences across the six domains of interest (mortality, morbidity, health behaviors, clinical care, social and economic factors, and physical environment) for rural and non-rural U.S. counties. This is a cross-sectional study employing chi-square analysis and logit regression.ResultsWe found that residents living in rural U.S. counties are more likely to have poorer health outcomes along a variety of measurements that comprise the County Health Rankings’ indexed domains of health quality. These populations have statistically significantly (p ≤ 0.05) lower scores in such areas as health behavior, morbidity factors, clinical care, and the physical environment. We attribute the differences to a variety of factors including limitations in infrastructure, socioeconomic differences, insurance coverage deficiencies, and higher rates of traffic fatalities and accidents.DiscussionsThe largest differences between rural and non-rural counties were in the indexed domains of mortality and clinical care.ConclusionsOur analysis revealed differences in health outcomes in the County Health Rankings’ indexed domains between rural and non-rural U.S. counties. We also describe limitations and offer commentary on the need for more uniform measurements in the classification of the terms rural and non-rural. These results can influence practitioners and policy makers in guiding future research and when deciding on funding allocation.

BackgroundRural residents are increasingly identified as being at greater risk for health disparities. These inequities may be related to health behaviors such as adequate fruits and vegetable consumption. There is little national-level population-based research about the prevalence of fruit and vegetable consumption by US rural population adults. The objective of this study was to examine the prevalence differences between US rural and non-rural adults in consuming at least five daily servings of combined fruits and vegetables.MethodsCross-sectional analysis of weighted 2009 Behavioral Risk Factor Surveillance Survey (BRFSS) data using bivariate and multivariate techniques. 52,259,789 US adults were identified as consuming at least five daily servings of fruits and vegetables of which 8,983,840 were identified as living in rural locales.ResultsBivariate analysis revealed that in comparison to non-rural US adults, rural adults were less likely to consume five or more daily servings of fruits and vegetables (OR = 1.161, 95% CI 1.160-1.162). Logistic regression analysis revealed that US rural adults consuming at least five daily servings of fruits and vegetables were more likely to be female, non-Caucasian, married or living with a partner, living in a household without children, living in a household whose annual income was > $35,000, and getting at least moderate physical activity. They were also more likely to have a BMI of <30, have a personal physician, have had a routine medical exam in the past 12 months, self-defined their health as good to excellent and to have deferred medical care because of cost. When comparing the prevalence differences between rural and non-rural US adults within a state, 37 States had a lower prevalence of rural adults consuming at least five daily servings of fruits and vegetables and 11 States a higher prevalence of the same.ConclusionsThis enhanced understanding of fruit and vegetable consumption should prove useful to those seeking to lessen the disparity or inequity between rural and non-rural adults. Additionally, those responsible for health-related planning could benefit from the knowledge of how their state ranks in comparison to others vis-à-vis the consumption of fruits and vegetables by rural adults---a population increasingly being identified as one at risk for health disparities.

This review shows that placement in rural settings is a positive learning experience that students and preceptors value. Although the evidence supports that these rotations influence practice site and career choice, it is not clear whether they reinforce preexisting interest or have the ability to motivate previously uninterested students to consider careers in primary care or rural medicine.

BackgroundNon-malignant chronic pain (NMCP) is one of the most common reasons for primary care visits. Pain management health care disparities have been documented in relation to patient gender, race, and socioeconomic status. Although not studied in relation to chronic pain management, studies have found that living in a rural community in the US is associated with health care disparities. Rurality as a social determinant of health may influence opioid prescribing. We examined rural and non-rural differences in opioid prescribing patterns for NMCP management, hypothesizing that distinct from education, income, racial or gender differences, rural residency is a significant and independent factor in opioid prescribing patterns.Methods2010 National Ambulatory Medical Care Survey (NAMCS) data were examined using bivariate and multivariate techniques. NAMCS data were collected using a multi-stage sampling strategy. For the multivariate analysis performed the SPSS complex samples algorithm for logistic regression was used.ResultsIn 2010 an estimated 9,325,603 US adults (weighted from a sample of 2745) seen in primary care clinics had a diagnosis of NMCP; 36.4% were prescribed an opioid. For US adults with a NMCP diagnosis bivariate analysis revealed rural residents had higher odds of having an opioid prescription than similar non-rural adults (OR = 1.515, 95% CI 1.513-1.518). Complex samples logistic regression analysis confirmed the importance of rurality and yielded that US adults with NMCP who were prescribed an opioid had higher odds of: being non-Caucasian (AOR =2.459, 95% CI 1.194-5.066), and living in a rural area (AOR =2.935, 95% CI 1.416-6.083).ConclusionsOur results clearly indicated that rurality is an important factor in opioid prescribing patterns that cannot be ignored and bears further investigation. Further research on the growing concern about the over-prescribing of opioids in the US should now include rurality as a variable in data generation and analysis. Future research should also attempt to document the ecological, sociological and political factors impacting opioid prescribing and care in rural communities. Prescribers and health care policy makers need to critically evaluate the implications of our findings and their relationship to patient needs, best practices in a rural setting, and the overall consequences of increased opioid prescribing on rural communities.

Background: A growing literature supports the contention that closing the divide between dental and medical care can improve access to and coordination of patient care. Health service deficits (HSDs) entail: no routine medical exam, no personal healthcare provider (HCP), no health insurance, and/or delaying medical care because of cost all within the last 12 months. Examining the associations between HSDs and dental care utilization could inform strategies and interventions aimed at narrowing the gap between the medical and dental professions. This study explored whether HSDs are associated with not having a dental care visit within the last 12 months. In addition, the study sought to provide an updated analysis of the characteristics and factors associated with dental care utilization. Methods: Two thousand sixteen Behavioral Risk Factor Surveillance System survey data were analyzed using bivariate and multivariable techniques. The outcome variable for this study was: last dental visit was longer than 12 months ago.

Although this study focused on only three disease states, these are among the most common clinical conditions encountered in inpatient settings. The findings suggested that there may be differences in quality in rural critical access hospitals and urban acute care hospitals and support the need for future studies addressing disparities between urban acute care and rural critical access hospitals.