Exposing some important barriers to health care access in the rural USA

Douthit, Nathan T; Kiv, Sakal; Dwolatzky, Tzvi; Biswas, SK

doi:10.1016/j.puhe.2015.04.001

Cited by 766 publications

(650 citation statements)

References 41 publications

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“…Previous work indicates that rural residents tend to be more often uninsured than those living in metropolitan areas and more likely to report that health care costs limit their medical care [29][30][31]; however, this study indicates that these factors may be magnified among immigrant populations [32][33][34]. Although the ACA holds the promise of making health insurance accessible for millions of people including 756,000 uninsured non-elderly Marylanders, it will not change the restrictions instituted for recently arrived legal immigrants and those who are undocumented [17,35].…”

Section: Discussionmentioning

confidence: 99%

Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access

Sangaramoorthy

Guevara

2016

J Immigrant Minority Health

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Immigration to rural areas in new receiving communities like Maryland's Eastern Shore is growing. Despite a rapid rise in immigration and diminishing health system resources, little attention has been focused on barriers to health care access in this region for immigrants. A total of 33 in-depth key informant interviews with providers and immigrants were conducted. Qualitative analysis employing a constant comparison approach was used to explore emergent themes related to barriers to health care access for a growing immigrant population. Participants perceived limited health care resources, lack of health insurance coverage, high health expenditures, language barriers, and non-citizenship status as barriers to immigrants' access of health care. Findings imply that immigrants living and working on the rural Eastern Shore face serious barriers to health care access. Additional work on immigrant health in rural areas and the impacts of immigration to rural health systems are needed.

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Section: Discussionmentioning

confidence: 99%

Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access

Sangaramoorthy

Guevara

2016

J Immigrant Minority Health

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“…Such ruralurban differences may be driven by social cultural differences in health-seeking behaviour, where the most remote rural patients may be displaying stoicism when seeking help. 3,4,8,26 This may be supported by studies from northern Scotland that found rural patients were more likely to present later, had lower expectations of health care, and may pursue their care less tenaciously.…”

mentioning

confidence: 91%

“…3 First, rural populations may be impacted disproportionately by financial constraints and poor accessibility, compounded by the long distances travelled to obtain primary and secondary health care. 4 For example, longer distance to health services has been associated with fewer in-patient admissions, 5 with poorer uptake of cancer diagnosis and treatment, 1,6,7 and with lower survival. 2 Second, sociocultural factors could manifest as different attitudes or stoicism in rural dwellers, with correspondingly lower rates of primary care consultation and, as a consequence, lower likelihood of GPs being enabled to detect early cancer symptoms.…”

Section: Introductionmentioning

confidence: 99%

Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care

et al. 2017

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Background: Several studies have reported a survival disadvantage for rural dwellers who develop colorectal cancer, but the underlying mechanisms remain obscure. Delayed presentation to GPs may be a contributory factor, but evidence is lacking. Aim: To examine the association between rurality and travel time on diagnosis and survival of colorectal cancer in a cohort from northeast Scotland. Design and setting: The authors used a database linking GP records to routine data for patients diagnosed between 1997 and 1998, and followed up to 2011. Method: Primary outcomes were alarm symptoms, emergency admissions, stage, and survival. Travel time in minutes from patients to GP was estimated. Logistic and Cox regression were used to model outcomes. Interaction terms were used to determine if travelling time impacted differently on urban versus rural patients. Results: Rural patients and patients travelling farther to the GP had better 3-year survival. When the travel outcome associations were explored using interaction terms, the associations differed between rural and urban areas. Longer travel in urban areas significantly reduced the odds of emergency admissions (odds ratio [OR] 0.62, P<0.05), and increased survival (hazard ratio 0.75, P<0.05). Longer travel also increased the odds of presenting with alarm symptoms in urban areas; this was nearly significant (OR 1.34, P = 0.06). Presence of alarm symptoms reduced the likelihood of emergency admissions (OR 0.36, P<0.01). Conclusion: Living in a rural area, and travelling farther to a GP in urban areas, may reduce the likelihood of emergency admissions and poor survival. This may be related to how patients present with alarm symptoms

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“…Furthermore, although quantitative analyses found no statistically significant differentiation between urban and rural providers, the results suggested that rural respondents may be less likely than their urban peers to indicate that they have colleagues to informally call on for help (11.1% vs. 31.4%, p=.10), reiterating that rural areas, generally, have limitations around health care infrastructure and availability of providers [19][20][21], which could have particularly negative effects for care of unique minority populations such as transgender individuals [22,24]. Further research is needed to construct a better understanding of transgender health from both providers and patients, specifically in rural contexts.…”

Section: Discussionmentioning

confidence: 89%

Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study (Preprint)

Blosnich¹,

Rodriguez²,

Hruska³

et al. 2018

Preprint

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communication-related problems with e-consult, impractical recommendations for underresourced sites, and misunderstanding e-consult purpose. Improvement suggestions included adding concise/sectioned responses, expanding provider/patient program awareness, designating a follow-up contact person, and increasing provider education about transgender Veterans and related care. Quantitative analysis found common reasons for not using the program were: not knowing about it, not needing to use it yet, and getting help from a colleague outside of econsult. Common suggestions to improve program use were: more information about where to find e-consult in the chart, guidance on talking with patients about the program, and e-mail announcements to improve provider awareness of the program. Post hoc exploratory analyses showed no differences between urban and rural providers. Conclusions:The VA transgender e-consult program is useful to providers, but there are several barriers to implementing recommendations, some of which are especially challenging for rural providers. Addressing noted barriers and enhancing the facilitators may improve program use and improve quality care for transgender Veterans.

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Exposing some important barriers to health care access in the rural USA

Cited by 766 publications

References 41 publications

Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access

Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access

Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care

Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study (Preprint)

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