Confronting Disparities in Diabetes Care: The Clinical Effectiveness of Redesigning Care Management for Minority Patients in Rural Primary Care Practices

ObjectiveTo describe common strategies and practice-specific barriers, adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation (ACO).DesignThis study used a multiple case study design. Purposive sampling was used to identify a diverse group of practices within the ACO. Data were collected from focus group interviews and workflow mapping. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. Data were cross-analysed by clinic and CFIR domains to identify common themes and practice-specific determinants of cancer screening implementation.SettingThe study included eight rural primary care practices, defined as Rural-Urban Continuum Codes 5–9, in one ACO in the Midwestern United States.ParticipantsProviders, staff and administrators who worked in the primary care practices participated in focus groups. 28 individuals participated including 10 physicians; one doctor of osteopathic medicine; three advanced practice registered nurses; eight registered nurses, quality assurance and licensed practical nurses; one medical assistant; one care coordination manager; and four administrators.ResultsWith integration into the ACO, practices adopted four new strategies to support cancer screening: care gap lists, huddle sheets, screening via annual wellness visits and information spread. Cross-case analysis revealed that all practices used both visit-based and population-based cancer screening strategies, although workflows varied widely across practices. Each of the four strategies was adapted for fit to the local context of the practice. Participants shared that joining the ACO provided a strong external incentive for increasing cancer screening rates. Two predominant determinants of cancer screening success at the clinic level were use of the electronic health record (EHR) and fully engaging nurses in the screening process.ConclusionsJoining an ACO can be a positive driver for increasing cancer screening practices in rural primary care practices. Characteristics of the practice can impact the success of ACO-related cancer screening efforts; engaging nurses to the fullest extent of their education and training and integrating cancer screening into the EHR can optimise the cancer screening workflow.

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Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care

Medical Care Research and Review ◽

10.1177/1077558720945913 ◽

2020 ◽

pp. 107755872094591

Author(s):

Hannah T. Neprash ◽

Laura Barrie Smith ◽

Bethany Sheridan ◽

Ira Moscovice ◽

Shailendra Prasad ◽

...

Keyword(s):

Primary Care ◽

Nurse Practitioners ◽

Rural Areas ◽

Urban Areas ◽

The United States ◽

Rural Primary Care ◽

Rural And Urban ◽

Clinical Autonomy ◽

Care Practices ◽

Primary Care Practices

The growing ranks of nurse practitioners (NPs) in rural areas of the United States have the potential to help alleviate existing primary care shortages. This study uses a nationwide source of claims- and EHR-data from 2017 to construct measures of NP clinical autonomy and complexity of care. Comparisons between rural and urban primary care practices reveal greater clinical autonomy for rural NPs, who were more likely to have an independent patient panel, to practice with less physician supervision, and to prescribe Schedule II controlled substances. In contrast, rural and urban NPs provided care of similar complexity. These findings provide the first claims- and EHR-based evidence for the commonly held perception that NPs practice more autonomously in rural areas than in urban areas.

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Rural-urban differences in the pattern of referrals to an asynchronous teledermatology service

International Archives of Medicine ◽

10.3823/2571 ◽

2018 ◽

Vol 11 ◽

Cited By ~ 3

Author(s):

Josep Vidal-Alaball ◽

Jacobo Mendioroz Peña ◽

Glòria Sauch Valmaña

Keyword(s):

Primary Care ◽

Rural Areas ◽

Urban Areas ◽

Face To Face ◽

Rural Primary Care ◽

Primary Care Teams ◽

The Face ◽

Care Practices ◽

Urban And Rural Areas ◽

Primary Care Practices

Background Telemedicine is particularly useful in rural areas where can facilitate access to specialised care in regions far from urban hospitals and can prevent unnecessary travel. The purpose of this research was to evaluate the degree of resolution of an asynchronous teledermatology service in the Bages County, comparing urban and rural primary care centres. Methods and findings A longitudinal descriptive study of referrals from 14 Primary Care Teams to a hospital dermatology service as a result of a previous referral to a teledermatology program was performed, comparing years 2015 and 2016 and urban with rural practices. Both in urban and rural areas there was an increase in referrals to the teledermatology service in 2016 compared to the previous year (12.9% and 0.3% respectively). In the two years analysed, referral rates to the teledermatology service per thousand inhabitants from rural centres was statistically much higher than that of urban centres (p<0.001). The number of referrals to the face-to-face dermatology service after a teledermatology consultation decreased significantly in both urban [OR=0,81 (0,70-0,93) p=0,001] and rural centres [OR=0,64 (0,57-0,72) p<0,001]. Conclusions The asynchronous teledermatology service established in the Bages County increases the resolution of primary care teams as reduces referrals to the face-to-face dermatology service. This effect is more pronounced in rural than in urban areas. Such finding may indicate the need to prioritize telemedicine services in rural primary care practices.

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