scholarly journals The Association of Broadband Internet Access and Telemedicine Utilization in rural Western Tennessee: an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jacob K. Quinton ◽  
Michael K. Ong ◽  
Sitaram Vangala ◽  
Anna Tetleton-Burns ◽  
Ashley Webb ◽  
...  
Keyword(s):  
Primary Care ◽  
Rural Communities ◽  
Observational Study ◽  
Educational Attainment ◽  
Health System ◽  
Access To Care ◽  
Broadband Access ◽  
Rural Patient ◽  
Broadband Internet ◽  
Zip Code

Abstract Background Broadband access has been highlighted as a national policy priority to improve access to care in rural communities. Objective To determine whether broadband internet availability was associated with telemedicine adoption among a rural patient population in western Tennessee. Methods Observational study using electronic medical record data from March 13th, 2019 to March 13th, 2021. Multivariable logistic regression incorporating individual-level characteristics with broadband availability, income, educational attainment, and primary care physician supply at the zip code level, and rural status as determined at the county level. Setting Single health system in western Tennessee. Participants Adult patients with one or more in-person or remote encounter in a health system in western Tennessee and residing in western Tennessee between March 13th, 2019 and March 13th, 2021 (N = 54,688). Outcome measures Completion of one or more video encounters in the year following March 13th, 2020 (N = 3199; 7%). Our primary characteristic of interest was the proportion of residents in each zip code with access to the internet meeting the Federal Communications Commission definition of broadband access, adjusting for age, gender, race, income, educational attainment, insurance type, rural status, and primary care provider supply. Results Patients in a rural western Tennessee health system were predominantly white (79%), residing in rural zip codes (73%) with median household incomes ($52,085) less than state and national averages. Patients residing in a zip code where there is 80 to 100% broadband access compared to 0 to 20% were more likely in the year following March 13th, 2020 to have completed both telemedicine and in-person visits ([OR; 95% CI] 1.57; 1.29, 1.94), completed only telemedicine visits (2.26; 1.71, 2.97), less likely to have only completed in-person visits (0.81; 0.74, 0.89), but no more or less likely to have accessed no care (1.07; 0.97, 1.18). Discussion The availability of broadband internet was shown to be one of many factors associated with the utilization of telemedicine for a rural, working-class community after March 13th, 2020. Conclusions Access to broadband internet is a determinant of access to telemedicine for patients in rural communities and should be a priority for policymakers interested in improving health and access to care for rural patients.

scholarly journals Willingness to Pay for Broadband Access by Kentucky Farmers

2012 ◽  
Vol 44 (3) ◽  
pp. 323-334 ◽  
Author(s):  
Chris Jeffcoat ◽  
Alison F. Davis ◽  
Wuyang Hu
Keyword(s):  
Rural Communities ◽  
Willingness To Pay ◽  
Urban Areas ◽  
The United States ◽  
Property Taxes ◽  
The Internet ◽  
Broadband Access ◽  
Broadband Internet ◽  
Infrastructure Investments ◽  
E Mail

Since the Internet's inception its impact has been felt across the United States, but the distribution and adoption of the Internet has not necessarily been uniform geographically. As more consumers and businesses rely on the Internet to access information, the data transmission requirements have also increased. Consequently, access to broadband has become increasingly more important since dial-up cannot realistically handle the increased requirements. The use of broadband in agriculture can provide better access to price, weather, and management information while also opening new markets. However, many rural communities lag behind urban areas in broadband access and adoption rates. This study evaluates, through the use of a producer survey, the level of broadband Internet use, motivations for its use, degree of access to broadband, and willingness-to-pay (WTP) to fund broadband infrastructure investments. Results from the producer survey suggested farmers utilize the Internet primarily for accessing weather reports, e-mail, market reports, and agricultural news. Notably, the survey's WTP questions allowed for the use of an interval regression to calculate producer WTP for varying demographics. The results suggested that producers who were younger, farmed larger farms, and those who currently use the Internet but do not have broadband access were WTP more in property taxes to support broadband infrastructure investments than those of a differing demographic. Because WTP levels varied drastically depending on the underlying demographics, it becomes difficult to pinpoint a WTP level for a one-time payment in property taxes that would be acceptable from a policy standpoint.

scholarly journals Atrial fibrillation care in rural communities: a mixed methods study of physician and patient perspectives

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Kathy L. Rush ◽  
Lindsay Burton ◽  
Fransien Van Der Merwe ◽  
Linda Hatt ◽  
Camille Galloway
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Mixed Methods ◽  
Rural Communities ◽  
Primary Care Physicians ◽  
Weight Maintenance ◽  
Care Physician ◽  
Patient Perspectives ◽  
Exercise Intolerance ◽  
Rural Patient

Abstract Background Atrial fibrillation (AF) is a serious heart arrhythmia associated with devastating outcomes such as stroke. Inequitable rural AF care may put patients at risk. Virtually delivered specialty AF care offers a viable option, but stakeholder perceptions of this option within the context of rural AF care is unknown. The study purpose was to obtain patient and primary care physician perspectives of rural AF care and virtually delivered AF care as a potential option. Methods Using a mixed methods design, AF patients (n = 101) and physicians (n = 15) from three rural communities participated in focus groups and/or surveys. Focus group data were thematically analyzed, survey data were descriptively analyzed, and data were triangulated. Results Findings captured patients’ and physicians’ perceptions of prioritized, needs, concerns and problems in AF management, available/unavailable services, and their ideas about virtual AF care. Patients and physicians identified eclectic problems in managing AF. Overall, patients felt ill informed about managing their AF and their most salient problems related to fatigue, exercise intolerance, weight maintenance, sleep apnea, and worry about stroke and bleeding. Physicians found treating patients with co-morbidities and cognitive decline problematic and balancing risks related to anticoagulation challenging. Patients and physicians identified education as a pressing need, which physicians lacked time and resources to meet. Despite available rural services, access to primary and cardiology care was a recurring challenge, and emergency department (ED) use highly contentious but often the only option for accessing care. Physicians’ managed AF care and varied in the referrals they made, often reserving them for complex situations to avoid patient travel. Patients and providers supported a broad approach to virtual AF care, tailored to an inclusive rural patient demographic. Conclusions The study offered valuable physician and patient perspectives on AF care in rural communities including diverse management challenges, gaps in access to primary and specialty services that made ED an often used but contentious option. Findings point to the potential value of virtual care designed to reach patients with AF across the spectrum and geared to local contexts that preserve the vital role of primary care physicians in AF care in their communities.

scholarly journals Time spent in primary care for hip osteoarthritis patients once the diagnosis is set: a prospective observational study

2011 ◽  
Vol 12 (1) ◽  
Author(s):  
Nienke Paans ◽  
Willem Jan van der Veen ◽  
Klaas van der Meer ◽  
Sjoerd K Bulstra ◽  
Inge van den Akker-Scheek ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Hip Osteoarthritis

scholarly journals The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ingmar Schäfer ◽  
Heike Hansen ◽  
Agata Menzel ◽  
Marion Eisele ◽  
Daniel Tajdar ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Rural Areas ◽  
Longitudinal Observational Study ◽  
Multivariable Analyses ◽  
Gastrointestinal Complaints ◽  
Urban And Rural Areas ◽  
Quota Sampling ◽  
Primary Care Practices

Abstract Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001). Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

scholarly journals Innovative Partnership Between Primary Care, AAA, and Academia Connects 4Ms and Social Determinants of Health

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 107-107
Author(s):  
Suzanne Leahy ◽  
Katie Ehlman ◽  
Lisa Maish ◽  
Brad Conrad ◽  
Jillian Hall ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health System ◽  
Preliminary Evaluation ◽  
Language And Literacy ◽  
Community Based ◽  
Primary Care Clinics ◽  
College Of Nursing ◽  
Value Based Care ◽  
The University

Abstract Nationally, there is a growing focus on addressing geriatric care in primary care settings. HRSA’s Geriatric Workforce Enhancement Program (GWEP) has called for academic and health system partners to develop a reciprocal, innovative, cross-sector partnership that includes primary care sites and community-based agencies serving older adults. Through the University of Southern Indiana’s GWEP, the College of Nursing and Health Professions, the Deaconess Health System, three primary care clinics, and two Area Agencies on Aging (AAA) have joined to transform the healthcare of older adults regionally, including rural residents in the 12-county area. Core to the project is a value-based care model that “embeds” AAA care managers in primary care clinics. Preliminary evaluation indicates early success in improving the healthcare of older adults at one primary clinic, where clinical teams have referred 64 older adult patients to the AAA care manager. Among these 64 patients, 80% were connected to supplemental, community-based health services; 22% to programs addressing housing and transportation; and, nearly 10% to a range of other services (e.g., job training; language and literacy; and technology). In addition to presenting limited data on referred patients and referral outcomes, the presentation will share copies of the AAA referral log, to illustrate how resources were categorized by SDOH and added to support integration of the 4Ms.

Implementing Enhanced Primary Care Registered Nurse Reimbursement in Rural Health Clinics: A Policy Analysis

2021 ◽  
pp. 152715442110119
Author(s):  
Tina Switzer ◽  
Erika Metzler Sawin ◽  
Melody Eaton ◽  
David Switzer ◽  
Christina Lam ◽  
...  
Keyword(s):  
Rural Communities ◽  
Policy Analysis ◽  
Rural Health ◽  
Policy Option ◽  
Care Needs ◽  
Rural Patient ◽  
Health Clinics ◽  
Sustainable Policy ◽  
Rural Health Clinics ◽  
Clinical Resource

Rural Health Clinics (RHCs) were created in 1977 to address the high health care needs, limited provider access, and poor health outcomes of rural Americans. Although innovative at their inception, the provider-centric model of RHC cost-based reimbursement structures has not evolved, leaving limited opportunities for change; many have failed. Comprehensive, proactive change is needed. Registered nurses (RNs) working at the top of their practice scope are a neglected clinical resource that can improve access, quality, value, and satisfaction for rural patient communities. RHC reimbursement policy must evolve to sustain and support this significant RN role. RNs have demonstrated value in care continuity and disease management, but there is little research on the utilization of RNs using their enhanced skill set in RHCs. Using the Bardach and Patashnik’s eight steps of policy analysis, the authors will describe the background and regulations of RHCs, identify current barriers to improving the health of America’s rural residents, and then provide evidence to support a new policy option according to the Quadruple Aim framework. The result is a sustainable policy recommendation designed to best serve rural communities.

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