rural patients
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2022 ◽  
Author(s):  
Xiaohui Wang ◽  
Chao Jiang ◽  
Jinpeng Du ◽  
Yongyuan Zhang ◽  
Fang Tian ◽  
...  

Abstract Introduction: Traumatic spinal cord injuries (TSCI) are worldwide public health problems. There has been a lack of extensive multi-center study of TSCI epidemiology in Northwest China in pre- and post-pandemic period of COVID-19. Materials and Methods: A multi-center retrospective study of 14 hospitals of Northwest China was conducted on patients with TSCI between 2017 and 2020. Variables assessed included patient demographics, etiology, segmental distribution, treatment, waiting time for treatment and outcomes.Results: The number of patients with TSCI showed an increasing trend from 2017 to 2019 while there were fewer patients in 2020 than in 2019. The male-to-female ratio was 3.67:1 and the mean age was 48±14.9. The major cause of TSCI was high fall (38.8%), low fall (27.7%), traffic accidents (23.9%), sports (2.6%) and others (7.0%). The segmental distribution showed a bimodal pattern, peak segments were C6 and Tl1, L1(14.7%) was the most frequently injured segments. Incomplete injury (72.8%) occurred more often than complete injury (27.2%). ASIA scale of most patients did not change before and after treatment both in operational or conservative group. 975 patients from urban and 1646 patients from rural areas were conducted, most urban residents could rush to get treatment after injured immediately (<1 h), whereas most rural patients get treatment spend several hours since injured. The rough annual incidence from 2017-2020 are 112.4, 143.4,152.2 and 132.6 per million people calculated by the population-coverage-rate.Conclusion: The incidence of TSCI in Northwest China is high and growing. However, under the pandemic policy reasons, it has decreased in 2020. The promotion of online work may be an effective primary prevention measures for trauma. Also, due to the distance from the hospitals with proper conditions, rural patients need to spend long time to there, the timely treatment of them should be paid attention.


Kidney360 ◽  
2022 ◽  
pp. 10.34067/KID.0006932021
Author(s):  
Joel T. Adler ◽  
S. Ali Husain ◽  
Lingwei Xiang ◽  
James R. Rodrigue ◽  
Sushrut S. Waikar

Background: The 240,000 rural patients with end stage kidney disease in the United States have less access to nephrology care and higher mortality than those in urban settings. The Advancing American Kidney Health initiative aims to increase the use of home renal replacement therapy. Little is known about how rural patients access home dialysis and the availability and quality of rural dialysis facilities. Methods: Incident dialysis patients in 2017 and their facilities were identified in the United States Renal Data System. Facility quality and service availability was analyzed with descriptive statistics. We assessed the availability of home dialysis methods depending on rural versus urban counties, and then we used multivariate logistic regression to identify the likelihood of rural patients with home dialysis as their initial modality and the likelihood of rural patients changing to home dialysis within 90 days. Finally, we assessed mortality after dialysis initiation based on patient home location. Results: Of the 97,930 dialysis initiates, 15,310 (15.6%) were rural. Rural dialysis facilities were less likely to offer home dialysis (51.4% vs 54.1%, P<0.001). While a greater proportion of rural patients (9.2 vs 8.2%, P<0.001) were on home dialysis, this was achieved by traveling to urban facilities to obtain home dialysis (OR 2.74, P<0.001). After adjusting for patient and facility factors, rural patients had a higher risk of mortality (HR 1.06, P=0.004). Conclusions: Despite having fewer facilities that offer home dialysis, rural patients were more often on home dialysis methods because they traveled to urban facilities, representing an access gap. Even if rural patients accessed home dialysis at urban facilities, rural patients still suffered worse mortality. Future dialysis policy should address this access gap to improve care and overall mortality for rural patients.


Author(s):  
Elizabeth A. Kobe ◽  
Allison A. Lewinski ◽  
Amy S. Jeffreys ◽  
Valerie A. Smith ◽  
Cynthia J. Coffman ◽  
...  

2022 ◽  
Vol 9 ◽  
pp. 237437352110698
Author(s):  
Andrew Ridge ◽  
Gregory M Peterson ◽  
Bastian M Seidel ◽  
Vinah Anderson ◽  
Rosie Nash

Potentially preventable hospitalisations (PPHs) occur when patients receive hospital care for a condition that could have been more appropriately managed in the primary healthcare setting. It is anticipated that the causes of PPHs in rural populations may differ from those in urban populations; however, this is understudied. Semi-structured interviews with 10 rural Australian patients enabled them to describe their recent PPH experience. Reflexive thematic analysis was used to identify the common factors that may have led to their PPH. The analysis revealed that most participants had challenges associated with their health and its optimal self-management. Self-referral to hospital with the belief that this was the only treatment option available was also common. Most participants had limited social networks to call on in times of need or ill health. Finally, difficulty in accessing primary healthcare, especially urgently or after-hours, was described as a frequent cause of PPH. These qualitative accounts revealed that patients describe nonclinical risk factors as contributing to their recent PPH and reinforces that the views of patients should be included when designing interventions to reduce PPHs.


2021 ◽  
Author(s):  
Jane M Carrington ◽  
Rene Love

Telehealth is a means for providing care to our rural patients. This mode of healthcare delivery is not without challenges with technology, research, quality improvement, practice and education. Here we present the TRIP-E Meta Model. This model was derived from a two phased process. First, we performed a review of literature and from this developed the first attempt at model development. Second, we took student evaluations from a telehealth education program for Doctor of Nursing Practice students. Based on their feedback, we then further advanced the first model to the TRIP-E Meta Model. This model is a comprehensive guide to research, quality improvement, practice and education. As a meta model, the TRIP-E can have other theories applied for projects. This feature of meta models provide flexibility for the model. We invite others to test this model for its flexibility and usability.


2021 ◽  
Vol 14 ◽  
pp. 292-297
Author(s):  
Joseph Brungardt ◽  
Omar A. Almoghrabi, M.D. ◽  
Carolyn B. Moore, M.D. ◽  
G. John Chen M.D., Ph.D. ◽  
Alykhan S. Nagji, M.D.

Background: Patients who are socioeconomically disadvantaged or in rural areas may not pursue surgery at high-volume centers, where outcomes are better for some complex procedures. The objective of this study was to determine and compare rural and urban patient differences and outcomes after undergoing esophagectomy for cancer. Study Design: An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS) database was performed, capturing adult patients with esophageal cancer who underwent esophagectomy. Patients were stratified into rural or urban groups by the National Center for Health Statistics Urban-Rural Classification Scheme. Demographics, hospital variables, and outcomes were compared. Results: A total of 2,877 patients undergoing esophagectomy for esophageal cancer were captured by the database, with 228 (7.92%) rural and 2,575 (89.50%) urban patients. The rural and urban groups had no difference in age, race, insurance status, and many common comorbidities. Major outcomes of mortality and length of stay were similar for both rural and urban patients (3.95% versus 4.27%, p=0.815) and (15.75±13.22 versus 15.55±14.91 days, p=0.828), respectively. There was a trend for rural patients to be more likely to discharge home (35.96% versus 29.79%, OR 0.667 [95%CI 0.479-0.929]; p=0.0167). Conclusions: This retrospective administrative database study indicates that rural and urban patients receive equivalent postoperative care after undergoing esophagectomy. The findings are reassuring as there does not appear to be a disparity in major outcomes depending on the location of residence, but further studies are necessary to assure equitable treatment for rural patients.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 468-468
Author(s):  
Yvonne Jonk ◽  
Erika Ziller ◽  
Heidi O'Connor

Abstract The COVID-19 pandemic has created substantial disruptions to all aspects of rural and urban U.S. life. At the same time, it has provided opportunities for shifts in health service delivery, including policy innovations to increase telehealth availability and use for diagnosis and treatment of health concerns. However, it is unclear whether rural residents, particularly older adults, have the same access to telehealth services as their urban counterparts. Rural providers may face unique barriers to delivering telehealth services, and rural patients may have more difficulty accessing those services from their homes. This study used the Fall and Summer 2020 Medicare Current Beneficiary Survey COVID-19 Supplement Public Use Files to examine rural-urban differences in the telemedicine services available to Medicare beneficiaries from their primary care providers, as well as their ability to access those services. Preliminary findings suggest that rural beneficiaries are less likely to have access to telehealth services during the pandemic, they were more likely to exhibit hesitancy towards receiving the COVID-19 vaccine, they were less likely to engage in preventive behaviors such as hand washing and sterilizing surfaces, and more likely to have missed diagnostic or medical screening tests (37%) compared to urban (27%) beneficiaries. Finally, rural beneficiaries were less likely to have a smartphone, computer, or tablet at home and less likely to have access to the internet (78% rural; 84% urban). Policy implications include the need for outreach efforts to better inform the provider community, and efforts to improve rural health system infrastructure available to support telehealth.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 118-119
Author(s):  
Eileen Dryden ◽  
Lauren Moo

Abstract Older, rural adults have limited access to quality geriatric specialty care for several reasons including relatively few geriatric specialists in rural areas and lack of transportation options or patient ability to travel to more urban centers. GRECC Connect is a promising telehealth-hub and spoke model that provides rural patients access to teams of multidisciplinary geriatric specialists in more urban medical centers primarily by video connection with affiliated community-based outpatient clinics (CBOCs). This model provides a viable option for increasing access to geriatric specialty care for rural patients but is not used to the extent it could be. To date, much of our understanding of this model has come from the experts at the hub medical centers. To learn more about the experience of this model from the field we interviewed CBOC staff and providers as well as Veterans and their caregivers about geriatric specialty telehealth services. In this symposium we will discuss facilitators and barriers to implementing this model from the perspective of the field and then explore more deeply both the context of the CBOC environment and the older patient population served by rural CBOCs to further understand the challenges that are faced in attempting to connect older patients with telehealth services. Finally, we will share the perceived value of the service and alignment with local needs. This deeper understanding of the experience of the ‘spoke’ may help enhance access to much needed geriatric specialty care for rural veterans.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 119-119
Author(s):  
Eileen Dryden ◽  
Laura Kernan ◽  
Kathryn Nearing ◽  
Camilla Pimentel ◽  
Lauren Moo

Abstract The aim of GRECC Connect is to increase access to specialty care for medically complex, older, rural patients through e-consultations and telehealth visits. We interviewed 50 outpatient clinic staff and providers as well as 30 patients and caregivers about these services. Overall, the services were considered beneficial. For patients and caregivers, services alleviated the stress and cost of travel, they improved quality of life by increasing their understanding of the progression of an illness and providing treatment and guidance to increase patient functioning and reduce disruptive behaviors, and they eased anxiety associated with not receiving needed care. Having ‘another set of eyes’ on the patients reduced stress and anxiety for providers. Concerns included alignment of telehealth modality with the capabilities of older patients with cognitive problems, hearing loss and/or limited technological abilities and, for some providers, that the referral for and recommendations resulting from the service added to their workload.


2021 ◽  
Author(s):  
Ujjwal Ramtekkar ◽  
Jin Peng ◽  
Yungui Huang ◽  
Simon Linwood

BACKGROUND The rural-urban disparities in access to child behavioral health services are well known and are further exacerbated by the COVID-19 pandemic related restrictions on travel and in person visits. Fortunately, regulatory flexibilities allowed rapid transition of telehealth to reduce contagion while maintaining continuity of care. However, there has been contradicting evidence on whether telehealth narrows the rural-urban gap. OBJECTIVE To examine the telehealth utilization trends and no-show rates between urban vs rural areas for pediatric psychiatry visits after the public health emergency was declared. METHODS Using 2020-2021 electronic health records (EHR) data from the psychiatry department at a large urban academic pediatric hospital, we calculated the telemedicine utilization rates by patient’s residence area (urban vs rural). We used two proportions z-tests to examine whether the observed differences in no-show rates among 4 types of visit (urban office visit, urban telemedicine visit, rural office visit, and rural telemedicine visit) were statistically significant. RESULTS Telemedicine utilization rates (~80%) are comparable in urban and rural areas. The average no-show rates for telemedicine visits were around 17% for both urban and rural patients, while the average no-show rates for office visits were around 20% for urban patients and fluctuated between 15% and 36% for rural patients. Two proportions z-tests indicated that, for rural patients, telemedicine visits had significantly lower no-show rates than office visits between Sept 2020 and Feb 2021, but such difference turned insignificant after March 2021. CONCLUSIONS Telehealth improved access to child psychiatric services for rural families when primary delivery of services was telehealth-based. Returning to in-person only options and limiting telehealth access would be detrimental to behavioral health outcomes of rural children that have been traditionally underserved. CLINICALTRIAL N/A


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