An Academic-Community Collaboration to Deliver Medication Therapy Management (MTM) Services to Patients Living in Rural Counties of a Southwestern State in the United States

2021 ◽  
pp. 089719002110002
Author(s):  
David Rhys Axon ◽  
Melissa Johnson ◽  
Brittany Abeln ◽  
Stephanie Forbes ◽  
Elizabeth J. Anderson ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Program Effectiveness ◽  
Small Town ◽  
The United States ◽  
Small Towns ◽  
Academic Community ◽  
Service Needs ◽  
Medication Therapy

Background: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. Objective: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. Methods: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). Results: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. Conclusion: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.

scholarly journals Urban-rural differences in COVID-19 exposures and outcomes in the South: A preliminary analysis of South Carolina

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246548
Author(s):  
Qian Huang ◽  
Sarah Jackson ◽  
Sahar Derakhshan ◽  
Logan Lee ◽  
Erika Pham ◽  
...  
Keyword(s):  
South Carolina ◽  
Rural Areas ◽  
Urban Areas ◽  
Temporal Patterns ◽  
The United States ◽  
Mortality Rates ◽  
Small Towns ◽  
Spatial And Temporal Patterns ◽  
Urban Rural ◽  
State And Local

As the COVID-19 pandemic moved beyond the initial heavily impacted and urbanized Northeast region of the United States, hotspots of cases in other urban areas ensued across the country in early 2020. In South Carolina, the spatial and temporal patterns were different, initially concentrating in small towns within metro counties, then diffusing to centralized urban areas and rural areas. When mitigation restrictions were relaxed, hotspots reappeared in the major cities. This paper examines the county-scale spatial and temporal patterns of confirmed cases of COVID-19 for South Carolina from March 1st—September 5th, 2020. We first describe the initial diffusion of the new confirmed cases per week across the state, which remained under 2,000 cases until Memorial Day weekend (epi week 23) then dramatically increased, peaking in mid-July (epi week 29), and slowly declining thereafter. Second, we found significant differences in cases and deaths between urban and rural counties, partially related to the timing of the number of confirmed cases and deaths and the implementation of state and local mitigations. Third, we found that the case rates and mortality rates positively correlated with pre-existing social vulnerability. There was also a negative correlation between mortality rates and county resilience patterns, as expected, suggesting that counties with higher levels of inherent resilience had fewer deaths per 100,000 population.

The Rural-Urban Continuum of Polarization: Understanding the Geography of the 2018 Midterms

The Forum ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kenneth M. Johnson ◽  
Dante J. Scala
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Metropolitan Areas ◽  
Political Attitudes ◽  
The United States ◽  
Rural America ◽  
Rural Regions ◽  
Urban America ◽  
Urban And Rural Areas ◽  
The Continuum

Abstract This study of the 2018 congressional midterms demonstrates how voting patterns and political attitudes vary across a spectrum of urban and rural areas in the United States. Rural America is no more a monolith than is urban America. The rural-urban gradient is better represented by a continuum than a dichotomy. This is evident in the voting results in 2018, just as it was in 2016. We found that the political tipping point lies beyond major metropolitan areas, in the suburban counties of smaller metropolitan areas. Democrats enjoyed even greater success in densely populated urban areas in 2018 than in 2016. Residents of these urban areas display distinctive and consistent social and political attitudes across a range of scales. At the other end of the continuum in remote rural areas, Republican candidates continued to command voter support despite the challenging national political environment. Voters in these rural regions expressed social and political attitudes diametrically opposed to their counterparts in large urban cores.

Housing Finance Reform: Should There Be a Government Guarantee?

2011 ◽  
Vol 01 (04) ◽  
pp. 811-822 ◽  
Author(s):  
Richard K. Green
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
The United States ◽  
Economic Stress ◽  
Mortgage Market ◽  
Best Interest ◽  
Finance Reform ◽  
Fixed Rate ◽  
The Great Depression ◽  
The Republic

In 2007 and 2008, the mortgage market failed. It failed in a number of dimensions: Default rates rose to their highest levels since the great depression, and mortgage liquidity ground to a halt. This failure has produced recriminations: Blame has been laid at the feet of borrowers, brokers, lenders, investment banks, investors and government and quasi-government entities that guaranteed mortgages. These recent events have produced an important debate: Whether the U.S. mortgage market requires a federal guarantee in order to best serve consumers, investors and markets. My view is that such a guarantee is necessary. I will divide my argument into four areas: (1) I will argue that the United States has had a history of providing guarantees, either implicit or explicit, regardless of its professed position on the matter. This phenomenon goes back to the origins of the republic. It is in the best interest of the country to acknowledge the existence of such guarantees, and to price them appropriately before, rather than after, they become necessary. (2) I will argue that in times of economic stress, such as now, the absence of government guarantees would lead to an absence of mortgages. (3) I will argue that a purely "private" market would likely not provide a 30 year fixed rate pre-payable mortgage. I think that this is no longer a particularly controversial statement; what is more controversial is whether such a mortgage is necessary — I will argue that it is. (4) I will argue that in the absence of a federal guarantee, the price and quantity of mortgages will vary across geography. In particular, rural areas will have less access to mortgage credit that urban areas, central cities will have less access than suburbs. Condominiums already are treated less favorably than detached houses, and this difference is likely to get larger in the absence of a guarantee.

Follow-up of Children With Trait in a Rural Setting

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 876-877
Author(s):  
Herman Harris
Keyword(s):  
Sickle Cell ◽  
Rural Areas ◽  
Urban Areas ◽  
Cost Effective ◽  
Rural Setting ◽  
Urban Centers ◽  
Hb S ◽  
The Individual ◽  
Limited Testing

The Comprehensive Sickle Cell Centers were established in 1972 to test, educate, counsel, and research sickle cell anemia and related hemoglobinopathies. Standards and protocols for testing, education, and research were readily established because similar procedures and methods were already in operation at the institutions where the centers were located. The most difficult and still the most controversial program to provide is counseling. It became evident, early, that there is no universally accepted method for informing carriers of abnormal Hb S about their results. Centers located in large urban areas with a limited testing radius do not face the same problems as centers located in rural areas where the testing radius may cover an entire state or several states. Individual, or one-on-one, counseling of persons with trait results appears to be successful for urban centers where the individual may be called to the center and given information. But, in a rural setting, it is not feasible for the center to ask a person to travel 350 miles to be told he or she has nothing to worry about. And it is not cost-effective to send a caseworker 350 miles to say the same thing. It must, therefore, be concluded that each agency or center must adopt counseling methods that meet its specific needs. Each program must be flexible, imaginative, and creative and must successfully and accurately deliver information about being a carrier for the sickle gene or other hemoglobinopathy and its implication and significance for patients and their future offspring. To do this, we must first look at the problems facing us.

Philomath Couplet

2005 ◽  
Vol 1931 (1) ◽  
pp. 49-57
Author(s):  
Marcy Schwartz ◽  
John Willis ◽  
Bruce Erickson
Keyword(s):  
Decision Process ◽  
Local Community ◽  
Small Town ◽  
Evaluation Criteria ◽  
The United States ◽  
Small Towns ◽  
Lessons Learned ◽  
Context Sensitive ◽  
Cost Constraints ◽  
Main Streets

Values associated with statewide freight and tourist mobility; traffic, pedestrian, and bicycle safety; and small-town livability create competing objectives that are difficult to balance when main streets of small towns are also state highways. Many communities opt for bypass solutions to these issues, but the Philomath Couplet Project represents a main street solution that is sensitive to both the demands of the state highway system and the character of the local community. The controversial 10-month decision process culminated in the selection of a preferred alternative. Final design is under way, and construction is scheduled for 2006. Although many projects are developed according to context-sensitive solution principles, the Philomath Couplet Project represents a class of projects with characteristics likely to be faced throughout the United States in relation to the management of state highways that are also main streets of small towns. The difficulties encountered in conducting this project provide important insights to guide context-sensitive solutions implementation in these circumstances. The lessons learned shared in this paper highlight the need to manage the “end game” of small-town politics, the value of time and cost constraints, the need for a structured decision process, and the usefulness of evaluation criteria based on interactions of land use and transportation.

scholarly journals Stroke Incidence and Case Fatality According to Rural or Urban Residence

Stroke ◽  
2019 ◽  
Vol 50 (10) ◽  
pp. 2661-2667 ◽  
Author(s):  
Olivier Grimaud ◽  
Yacine Lachkhem ◽  
Fei Gao ◽  
Cindy Padilla ◽  
Mélanie Bertin ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Healthcare Access ◽  
Case Fatality ◽  
The United States ◽  
Stroke Severity ◽  
Day Case ◽  
Stroke Incidence ◽  
Stroke Registry ◽  
Stroke Type

Background and Purpose— Recent findings suggest that in the United States, stroke incidence is higher in rural than in urban areas. Similar analyses in other high-income countries are scarce with conflicting results. In 2008, the Brest Stroke Registry was started in western France, an area that includes about 366 000 individuals living in various urban and rural settings. Methods— All new patients with stroke included in the Brest Stroke Registry from 2008 to 2013 were classified as residing in town centers, suburbs, isolated towns, or rural areas. Poisson regression was used to analyze stroke incidence and 30-day case fatality variations in the 4 different residence categories. Models with case fatality as outcome were adjusted for age, stroke type, and stroke severity. Results— In total, 3854 incident stroke cases (n=2039 women, 53%) were identified during the study period. Demographic and socio-economic characteristics and primary healthcare access indicators were significantly different among the 4 residence categories. Patterns of risk factors, stroke type, and severity were comparable among residence categories in both sexes. Age-standardized stroke rates varied from 2.90 per thousand (95% CI, 2.59–3.21) in suburbs to 3.35 (95% CI, 2.98–3.73) in rural areas for men, and from 2.14 (95% CI, 2.00–2.28) in town centers to 2.34 (95% CI, 2.12–2.57) in suburbs for women. Regression models suggested that among men, stroke incidence was significantly lower in suburbs than in town centers (incidence rate ratio =0.87; 95% CI, 0.77–0.99). Case fatality risk was comparable across urban categories but lower in rural patients (relative risk versus town centers: 0.76; 95% CI, 0.60–0.96). Conclusions— Stroke incidence was comparable, and the 30-day case fatality only slightly varied in the 4 residence categories despite widely different socio-demographic features covered by the Brest Stroke Registry.

Length-Based Vehicle Classification Schemes and Length Bin Boundaries

2013 ◽  
Vol 2339 (1) ◽  
pp. 19-29 ◽  
Author(s):  
Herbert Weinblatt ◽  
Erik Minge ◽  
Scott Petersen
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
The United States ◽  
Traffic Monitoring ◽  
Vehicle Classification ◽  
Pavement Performance ◽  
Department Of Transportation ◽  
Classification Schemes ◽  
Weigh In Motion

Vehicle classification data are an important component of traffic-monitoring programs. Although most vehicle classification conducted in the United States is axle based, some applications could be supplemented or replaced by length-based data. The typically higher deployment cost and reliability issues associated with collecting axle-based data as compared with length-based data present a challenge. This paper reports on analyses of alternative length-based vehicle classification schemes and appropriate length bin boundaries. The primary analyses use data from a set of 13 Long-Term Pavement Performance weigh-in-motion sites, all in rural areas; additional analyses are conducted with data from 11 Michigan Department of Transportation weigh-in-motion sites located in rural and small urban areas and one site located in an urbanized area. For most states, the recommended length-based vehicle classification scheme is a four-bin scheme (motorcycles, short, medium, and long) with an optional very long bin recommended for use by states in which significant numbers of longer combination vehicles operate.

scholarly journals Temporal Trends in Early Mortality in Acute Promyelocytic Leukemia in the United States

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 710-710
Author(s):  
Ana C. Xavier ◽  
Matthew A. Kutny ◽  
Omer Jamy ◽  
Luciano J Costa
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Rural Areas ◽  
Research Funding ◽  
Educational Achievement ◽  
Temporal Trends ◽  
Malignant Neoplasm ◽  
The United States ◽  
Promyelocytic Leukemia ◽  
Early Mortality

Abstract Background: Survival of patients with acute promyelocytic leukemia (APL) has dramatically improved with the use of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). Despite this, due to the complexity of initial management and the high risk of fatal thrombotic and hemorrhagic complications at presentation, early mortality (EM) remains the major contributor for treatment failure. It is less known whether advances in treatment, improvements in supportive measures, urgent access to specialized care and broad availability of ATRA and ATO have reduced EM in the last two decades. Methods: We used data from the National Cancer Institute's Surveillance Epidemiology and End Results program (SEER-13) to determine the rates of EM (death within the first 30 days from diagnosis) and overall survival (OS) in patients with APL. Inclusion criteria was the diagnosis of APL as first malignant neoplasm among patients of all ages between 1992 and 2015. Follow up was updated to the end of 2015. Cases were grouped and analyzed according to age, children, adolescent and young adults (< 40 years) and older adults (≥ 40 years), race/ethnicity, gender, county-level income and educational achievement, and residency in rural or urban county. Trends in EM and OS were analyzed across consecutive 4-year eras. Results: A total of 2,224 APL cases (895 <40 and 1,329 ≥ 40 years) were included in the analysis with median follow up of 41 months (range 0-287 months). Median age of patients was 45, and 1,090 (49%) were male. Most patients were White (1,228; 55.2%), 199 (9%) Black, 785 (35.3%) other ethnicity, and 12 (0.5%) unknown. Three-year OS for APL patients diagnosed in 1992-1995 was 49.2% ± 3.5% vs. 76.4 ± 2.1% for patients diagnosed in 2012-2015 (p < 0.001), Figure 1. Early mortality improved for patients < 40 years (27.4% in 1992-1995 vs. 5.4% in 2012-2015, p < 0.001), but not at the same extent for patients ≥ 40 years (35.2% in 1992-1995 vs. 22.2% in 2012-2015, p = 0.02), Figure 2. Improvements in EM are displayed in Table 1. Importantly, improvements in EM were not seen among patients of residents of rural counties. Conclusion: These findings confirm consistent improvements in EM and OS for APL patients in the US and point to the challenge of further extending these improvements in EM rates to older patients and for those living in rural areas. Disclosures Costa: Celgene: Honoraria, Research Funding; Sanofi: Honoraria; Karyopharm: Research Funding; Janssen: Research Funding; BMS: Research Funding; Abbvie: Research Funding; Amgen: Honoraria, Research Funding.

scholarly journals Okotoks: From Trading Post to Suburb

2013 ◽  
Vol 8 (2) ◽  
pp. 3-22 ◽  
Author(s):  
Lewis G. Thomas
Keyword(s):  
United States ◽  
Urban History ◽  
First Generation ◽  
Small Town ◽  
The United States ◽  
Small Towns ◽  
Southern Alberta ◽  
English Speaking ◽  
Complex Patterns

In spite of a growing interest in urban history, Canadian scholars have paid little attention to small towns. In this article a small town in southern Alberta is examined during the years 1890-1950, with particular attention paid to the decade of the 1920s. The author argues that a closer examination of such small centres might throw new light on the complex patterns of Canadian development. Small towns like Okotoks provided a means whereby the first generation of Alberta settlers, predominantly English-speaking, Protestant and British oriented, asserted their peculiar values in the life of the province in spite of the arrival after 1896 of new waves of settlers from the United States and continental Europe.

scholarly journals Comparison of the clinical effect of intra-articular injection of platelet-rich plasma and methylprednisolone in primary osteoarthritis of knee: a randomized controlled trial

2019 ◽  
Vol 6 (6) ◽  
pp. 1842
Author(s):  
Darendrajit S. Longjam ◽  
Joy S. Akoijam ◽  
Meina S. Ahongshangbam ◽  
Nilachandra S. Longjam
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Osteoarthritis Of The Knee ◽  
Womac Pain ◽  
Osteoarthritis Of Knee ◽  
Primary Osteoarthritis ◽  
Steroid Group

Background: Osteoarthritis of knee is one of the commonest musculoskeletal disorder causing mobility impairment affecting 3.3% in urban areas and 5.5% in rural areas. Intra-articular injection of Platelet-Rich Plasma (PRP) delivers activated platelets that may reduce inflammation, provide pain relief, improve function and stimulate possible cartilage regeneration at the site of worn cartilage area of the knee.Methods: Eighty patients with primary osteoarthritis of the knee fulfilling inclusion and exclusion criteria were recruited in the study conducted in the Department of Physical Medicine and Rehabilitation, RIMS, Imphal from October 2014 to September 2017. Six ml of PRP prepared by conventional bench top centrifugation system was injected intra-articularly, two weeks apart in the PRP group. Steroid group received 80mg of methylprednisolone, two weeks apart by the same technique. The outcome variables (VAS and WOMAC score) were measured before starting intervention (baseline) and at 8 and 24-weeks post-intervention follow up.Results: Significant improvement seen in VAS, WOMAC-pain, stiffness and physical function and total scores in both the groups at 8- and 24-weeks follow-ups (p˂0.001). Steroid group showed better result than the PRP group in VAS (2.78±0.76 vs 3.58±1.03) and WOMAC-total (30.42±6.85 vs 36.25±10.87) scores at 8 weeks respectively (p˂0.001). But at 24 weeks follow-up, PRP showed significantly more effective than the steroid group in reducing pain (2.0±.0.87 vs 2.45±0.78) and disability (22.95±3.78 vs 25.25±6.67) respectively (p˂0.001).Conclusions: Intra-articular injection of methylprednisolone was found to be more effective in reducing pain and disability in primary knee osteoarthritis of KL grade 2 and 3 at the end of 8 weeks whereas 2 doses of PRP intra-articular injection 2 weeks apart was significantly more effective than methylprednisolone at the end of 24 weeks. However, the long-term benefit of PRP is to be determined by studies with a larger sample size and longer duration of follow-up.

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