Patient-Perceived Barriers to Preventive Health Care Among Indigent, Rural Appalachian Patients

Dm, Elnicki; Dk, Morris; Wt, Shockcor

doi:10.1001/archinte.1995.00430040097012

Cited by 56 publications

(8 citation statements)

References 16 publications

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“…Similar to many rural populations in the United States, patients from Appalachian communities have demonstrated numerous barriers to healthcare. 38 , 39 Of note, these obstacles exist within an otolaryngology setting and have previously been demonstrated to impede access to care. 3 , 40 In this study, Appalachian populations demonstrated decreased odds of developing TS on both univariate analysis ( p = .005) and multivariate analysis ( p = .003) in addition to decreased odds of developing VFI on univariate analysis ( p = .03).…”

Section: Discussionmentioning

confidence: 99%

Healthcare disparities for the development of airway stenosis from the medical intensive care unit

Burruss

Pappal

Witt

et al. 2022

Laryngoscope Investig Oto

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Objectives/hypothesis To identify sociodemographic factors associated with the development of airway stenosis (AS) among intubated medical intensive care unit (MICU) patients. Study design Retrospective cohort study. Methods A retrospective review of adult MICU intubated patients from 2013 to 2019 at a single academic institution was performed. Univariate and multivariate analysis with logistic regression examined associations between the development of AS and subsite abnormalities such as posterior glottic stenosis (PGS), subglottic stenosis (SGS), tracheal stenosis (TS), vocal fold immobility (VFI), and posterior glottic granuloma (PGG) with age, body mass index (BMI), height, weight, race, ethnicity, sex, rurality, Appalachian status, length of admission, distance to hospital, and median household income. Results Of an overall sample of 6603 MICU patients, 449 intubated patients were included in the study, and 204 patients were found to have AS. AS was statistically associated with decreased driving distance to the hospital and increases in BMI. PGS was statistically associated with increases in age. TS was statistically associated with increases in admission duration and not having residence status in Appalachia. VFI was statistically associated with decreases in driving distance to the hospital and not having residence status in Appalachia. Additionally, black patients had a higher odds of developing VFI compared to Caucasian patients. Conclusion AS is associated with sociodemographic factors such as age, BMI, shorter distance to hospital, admission duration, and no Appalachian status. These data demonstrate the need to further investigate the impact of social determinants of health on airway pathology and outcomes. Level of evidence 4.

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Section: Discussionmentioning

confidence: 99%

Healthcare disparities for the development of airway stenosis from the medical intensive care unit

Burruss

Pappal

Witt

et al. 2022

Laryngoscope Investig Oto

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“…Access to primary care can be challenging in rural areas and preventive care in these regions is often underutilized [30, 31]. Lower socioeconomic status, health literacy, and religiosity/conservatism are prevalent in rural areas [32] and may contribute to challenges with HPV vaccination. A study of communication disparities [33] found that rural parents are less likely than urban parents to engage in communication with their children’s healthcare clinicians, with lower rates of mutual information exchange, deliberation, and shared decision-making.…”

Section: Discussionmentioning

confidence: 99%

A stepped-wedge cluster randomized trial designed to improve completion of HPV vaccine series and reduce missed opportunities to vaccinate in rural primary care practices

et al. 2019

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ObjectivesTo test the effectiveness of a comprehensive team-based intervention to improve human papillomavirus (HPV) vaccination completion rates and reduce missed opportunities to vaccinate in rural Oregon.DesignStepped-wedge cluster randomized trial.ParticipantsForty family physicians and pediatricians who are members of the Oregon Rural Practice-based Research Network.InterventionTailored to individual practice needs, components will include (1) practice facilitation with clinicians, nurses, front office staff, and others who have patient contact to redesign patient care and communication strategies to optimize HPV vaccine series completion; (2) workflow mapping adapted to practice context to support HPV vaccine delivery; (3) a practice improvement model designed to firmly establish reminder and recall systems and then standing orders; (4) education for patients and parents that underscores HPV vaccination is safe, effective, and an important approach for reducing cancer risk; and (5) partnering with community organizations to plan and implement a social marketing campaign on HPV vaccination.Main outcome measuresInitiation and completion of the HPV vaccine series as well as reduction in rates of missed opportunities to vaccinate derived from Oregon Immunization Program data.Trial registrationClinicalTrials.govPRS, NCT03604393: .Trial was registered on July 11, 2018. The first participant was enrolled on September 11, 2018.

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“…Researchers have shown that level of disease knowledge is associated with rates of screening in rural populations for other chronic diseases, such as diabetes, 51 cervical cancer, 38,52 breast cancer, 53,54 hypertension, 55 and colorectal cancer. 39,[56][57] It would be helpful to know whether culturally based education regarding dementia and cognitive screening would increase knowledge, perceptions of risk, and screening behaviors.…”

Section: Implications For Researchmentioning

confidence: 99%

Analysis of Barriers to Cognitive Screening in Rural Populations in the United States

Wiese

Williams²,

Tappen³

2014

Advances in Nursing Science

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There is scant research regarding barriers to cognitive screening in rural US populations. This is surprising when there is evidence of the importance of preventative health behaviors such as memory screening that can lead to earlier diagnosis and treatment of Alzheimer's disease and decrease in associated costs. A systematic review of published research revealed modifiable barriers to screening such as lack of knowledge and lack of knowledgeable providers to screen. Recommendations for diminishing barriers include the use of storytellers to provide culturally relevant education and informing practitioners of new Medicare coverage for cognitive screening.

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Patient-Perceived Barriers to Preventive Health Care Among Indigent, Rural Appalachian Patients

Cited by 56 publications

References 16 publications

Healthcare disparities for the development of airway stenosis from the medical intensive care unit

Healthcare disparities for the development of airway stenosis from the medical intensive care unit

A stepped-wedge cluster randomized trial designed to improve completion of HPV vaccine series and reduce missed opportunities to vaccinate in rural primary care practices

Analysis of Barriers to Cognitive Screening in Rural Populations in the United States

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