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Introduction: Interprofessional consultations ("eConsults"), which facilitate asynchronous specialist consultations, remain understudied in neurological disorders. We aimed to describe the patient population receiving eConsult services for neurological disorders nationwide and to conduct a comparative analysis between rural and urban patients within this eConsult cohort. Methods: We analyzed a dataset of U.S. outpatient claims from employer-sponsored commercial and Medicare plans. Using standardized mean differences, we compared clinical and sociodemographic patient characteristics between urban and rural patients within the eConsult group. Results: We identified 1,374 patients who had an eConsult order for a neurological disorder. Overall eConsult volume increased by 548.5% between 2019 and 2021. A majority of the cohort were aged 65 years or older (23.7%), had an eConsult order in 2021 (52.4%), and live in an urban area (90.4%). The primary diagnosis for our cohort was likely to be a sleep-wake disorder (21.9%), cerebrovascular disease (14.3%), neurological sign or symptom (14.2%), or headache (13.7%). In the secondary analysis, rural eConsult patients exhibited higher rates of primary diagnoses for traumatic brain injury, neuroophthalmic disorders, or neuropathy than their urban counterparts. Discussion: In this national sample of commercially insured patients, the utilization of eConsults for neurological conditions increased nationwide since 2019, especially for patients living in rural areas. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic exposed the vulnerability of pregnant women to excess morbidity and mortality, as well as the disproportionate disease burden in certain racial, ethnic, and sociodemographic groups. Vaccine hesitancy represents a major threat to public health, and crafting messages that reach vulnerable groups and address their intersectionality remains a weakness for pandemic preparedness. We sought to investigate factors that influenced vaccine acceptance and social media ad response in a mixed-methods study of Spanish-speaking women living in the rural Western United States who were pregnant or recently pregnant between November 2022 and June 2023. Direct interviews were translated, transcribed, and coded, while the ad ratings were analyzed using linear mixed models. Participants most favorably rated ads that featured doctors and text-heavy content describing benefits of vaccination. Qualitative data illustrated how information from trusted medical providers along with generational and cultural history of vaccine acceptance positively impacted perspectives on vaccination. Immigration status had varying influences on vaccination perspectives. Future vaccination campaigns targeting Spanish-speaking pregnant individuals in rural communities should use medical providers as ad messengers and dispel fears that vaccine acceptance may lead to problems with immigration status. [ABSTRACT FROM AUTHOR]

One-fifth of all adults in the United States have a mental health disorder. More than 60% of rural Americans live in a mental health provider shortage area. However, psychiatric pharmacist integration has not been widely used to full capacity at many rural, private institutions. To assess the impact of psychiatric pharmacist integration into an outpatient, rural primary care office. A rural health institution that provides both inpatient and outpatient care. A psychiatric pharmacist was integrated within the outpatient internal medicine clinic. On referral from the primary care provider, the pharmacist, in consultation with the primary care provider, can make pharmacotherapy and monitoring recommendation and determine time to follow-up. Single-center, retrospective cohort study from July 1, 2018, to May 23, 2022, with 3 main components: (1) patient outcomes using a within-subject comparison; (2) potential revenue from billable services and pharmacist interventions from all encounters September 12, 2019, to May 23, 2022; and (3) provider satisfaction using an adapted, anonymous survey. Descriptive statistics or percentages were used for both primary and secondary end points. A McNemar test was performed for repeated measures of nominal data, and a Wilcoxon matched-pairs signed rank test was used to analyze continuous data. A P value of < 0.05 was considered statistically significant. A statistically significant increase in guideline-driven treatments was seen after psychiatric pharmacist integration. A statistically significant improvement in Patient Health Questionnaire-9 scores was also seen after pharmacist integration in contrast to standard of care. Provider time and health care utilization also showed positive results after pharmacist integration. A total of $29,600 is estimated to have been billable for pharmacist services, and clinic staff perceptions of pharmacist integration proved positive. Psychiatric pharmacist integration showed a statistically significant positive impact on patient care in a rural internal medicine outpatient clinic. [ABSTRACT FROM AUTHOR]

Background/Objectives: Up to 30% of pediatric primary care visits include a cutaneous complaint, yet the pediatric dermatology workforce has historically been too small to provide adequate specialized care. This study assesses the geographic distribution of pediatric dermatologists to determine physician‐to‐patient ratios, analyzes urban–rural disparities, and determines post‐fellowship migration patterns. Methods: Board‐certified pediatric dermatologists were identified using the Society for Pediatric Dermatology's public database, and their demographics and credentials were subsequently verified by an online search. Analysis included physician density per 100 000 children for each state and region, along with geographic distribution for rural and urban areas, based on the United States Census Bureau's definitions. The distances between practice locations and the American Board of Dermatology‐approved Pediatric Dermatology fellowship training sites were reviewed. Results: An estimated 336 board‐certified pediatric dermatologists currently work in the United States with 76.8% being women and 71.1% practicing within 50 miles of the nearest fellowship program. 96.4% are located in urban areas and 3.6% in rural areas with an average ratio of 0.54 and 0.09 per 100 000 children, respectively. The average ratio of pediatric dermatologists in the United States was 0.46 per 100 000 children. On average (standard deviation), there are 6.6 (8.8) pediatric dermatologists per state but with 7 states having zero. Conclusions: The demand for pediatric dermatologists continues to outpace the current physician availability with a disparity between urban and rural areas. Further awareness and emphasis on training and recruitment of additional pediatric dermatologists are essential to addressing this important issue. [ABSTRACT FROM AUTHOR]

BACKGROUND: Disparities in healthcare access and delivery, caused by transportation and health workforce difficulties, negatively impact individuals living in rural areas. These challenges are especially prominent in older adults. DESIGN: We systematically evaluated the feasibility, acceptability, and effectiveness in providing telemedicine (TMed), searching the English‐language literature for studies (January 2012 to July 2018) in the following databases: Medline (PubMed); Cochrane Library (Wiley); Web of Science; CINAHL; EMBASE (Ovid); and PsycINFO (EBSCO). PARTICIPANTS: Older adults (mean age = 65 years or older, and none were younger than 60 years). INTERVENTIONS: Interventions consisted of live, synchronous, two‐way videoconferencing communication in nonhospital settings. All medical interventions were included. MEASUREMENTS: Quality assessment, using the Cochrane Collaboration's Risk‐of‐Bias Tool, was applied on all included articles, including a qualitative summary of all articles. RESULTS: Of 6616 citations, we reviewed the full text of 1173 articles, excluding 1047 that did not meet criteria. Of the 17 randomized controlled trials, the United States was the country with the most trials (6 [35%]), with cohort sizes ranging from 3 to 844 (median = 35) participants. Risk of bias among included studies varied from low to high. Our qualitative analysis suggests that TMed can improve health outcomes in older adults and that it could be used in this population. CONCLUSIONS: TMed is feasible and acceptable in delivering care to older adults. Research should focus on well‐designed randomized trials to overcome the high degree of bias observed in our synthesis. Clinicians should consider using TMed in routine practice to overcome barriers of distance and access to care. J Am Geriatr Soc 67:1737–1749, 2019 [ABSTRACT FROM AUTHOR]

Study Objective: There is little knowledge of rural hospitals' roles in the care of chronic pain patients nationwide in the United States of America. We hypothesized that very few (≅5%) critical access hospitals provide patients with interventional pain procedures performed by pain medicine physicians.Design: Random sample of the 1346 critical access hospitals in USA.Measurements: Public websites were used for collection of listed services.Main Results: Nine pain medicine physicians were listed as performing interventional chronic pain procedures at 7 of the 110 randomly selected critical access hospitals nationwide (6.4%; P = 0.63 compared with 5.0%). All listed locations for the care provided by the pain medicine physicians were within a critical access hospital or a hospital building adjacent to the hospital. Seven of the 9 physicians were listed as having active American Board of Medical Specialties (ABMS) certification in pain medicine. The 7 physicians with ABMS certification were at 6 of the hospitals, giving a percentage of 5.5% (P = 0.95). The proportions of critical access hospitals reporting interventional pain procedures were homogeneously distributed among census bureau divisions (P = 0.38). Fewer than half of the clinicians listed as providing pain management were pain medicine physicians (26.5% [9/34]; P = 0.0090).Conclusions: A very small percentage of critical access hospitals list at their websites that they offer interventional pain services by pain medicine-trained physicians, and most clinicians listed as performing these procedures are not pain medicine certified. Increasing access to pain medicine physicians may present an opportunity for improved pain care in rural communities. [ABSTRACT FROM AUTHOR]

The article discusses the medical practice, accomplishments, and significant contributions of dentist and physician Charles A. McNulty to the rural community of Madison County, Montana in the late 1800s. Topics explored include the transportation and communication-related challenges commonly faced by medical practitioners in the region, the educational and family background of McNulty, and the medical assistance extended by McNulty to other physicians particularly in surgical procedures.

Opioid use disorder is a serious public health problem. Management with buprenorphine is an effective, office-based, medication-assisted treatment, but 60.1% of rural counties in the United States lack a physician with a Drug Enforcement Agency waiver to prescribe buprenorphine. This national study surveyed all rural physicians who have received a waiver in the United States and found that those who were not actively prescribing buprenorphine reported significantly more barriers than those who were, regardless of whether they were treating the maximum number of patients their waiver allowed. These findings suggest the need for tailored strategies to address barriers to providing buprenorphine for opioid use disorder and to support physicians who are adding or maintaining this service. [ABSTRACT FROM AUTHOR]

Purpose: Despite considerable investment in increasing the number of primary care physicians in rural shortage areas, little is known about their movement rates and factors influencing their mobility. We aimed to characterize geographic mobility among rural primary care physicians, and to identify location and individual factors that influence such mobility.Methods: Using data from the American Medical Association Physician Masterfile for each clinically active US physician, we created seven 2-year (biennial) mobility periods during 2000-2014. These periods were merged with county-level "rurality," physician supply, economic characteristics, key demographic measures, and individual physician characteristics. We computed (1) mobility rates of physicians by rurality; (2) linear regression models of county-level rural nonretention (departure); and (3) logit models of physicians leaving rural practice.Results: Biennial turnover was about 17% among physicians aged 45 and younger, compared with 9% among physicians aged 46 to 65, with little difference between rural and metropolitan groups. County-level physician mobility was higher for counties that lacked a hospital (absolute increase = 5.7%), had a smaller population size, and had lower primary care physician supply, but area-level economic and demographic factors had little impact. Female physicians (odds ratios = 1.24 and 1.46 for those aged 45 or younger and those aged 46 to 65, respectively) and physicians born in a metropolitan area (odds ratios = 1.75 and 1.56 for those aged 45 or younger and those aged 46 to 65, respectively) were more likely to leave rural practice.Conclusions: These flndings provide national-level evidence of rural physician mobility rates and factors associated with both county-level retention and individual-level departures. Outcomes were notably poorer in the most remote locations and those already having poorer physician supply and professional support. Rural health workforce planners and policymakers must be cognizant of these key factors to more effectively target retention policies and to take into account the additional support needed by these more vulnerable communities. [ABSTRACT FROM AUTHOR]

Background: Surgical telementoring, consisting of an expert surgeon guiding a less experienced surgeon through advanced or novel cases from a remote location, is an evolving technology which has potential to become an integral part of surgical practice. This study sought to apprise the attitudes of rural general surgeons toward the possible benefits and applications of surgical telementoring in their practices.Methods: A survey assessing demographics and attitudes toward telementoring was e-mailed to members of the American College of Surgeons (ACS) Advisory Council for Rural Surgery and posted to the ACS website in areas targeting rural surgeons. A link to a webpage with a description of surgical telementoring and brief demonstrative video were included with the survey.Results: There were 159 respondents, with 82.3 % of them practicing in communities smaller than 50,000 people. Overall, 78.6 % felt that telementoring would be useful to their practice, and 69.8 % thought it would benefit their hospitals. There was no correlation between years of practice and perceived usefulness of surgical telementoring. When asked the single most useful, or primary, application of surgical telementoring there was a split between learning new techniques (46.5 %) and intraoperative assistance with unexpected findings (39.0 %). When asked to select all applications in which they would be interested in using telementoring from a list of possible uses, surgeons most frequently selected: intraoperative consultation for unexpected findings (67.7 %), trauma consultation (32.9 %), and laparoscopic colectomy (32.9 %).Conclusions: Surgical telementoring is on the verge of widespread use but industry and surgical societies remain ambivalent about supporting its implementation due to concerns over lack of interest. This study demonstrates interest among rural surgeons. While there are differing opinions regarding compensation of the telementoring, the most common, single interest in the use of surgical telementoring was for learning new techniques or skill sets. [ABSTRACT FROM AUTHOR]

There are many challenges faced by family physicians who choose to practice medicine in rural areas with underserved populations. A decision to practice medicine as a physician in the United States Public Health Service, serving American Indians and Alaska Natives, became a fascinating and rewarding journey across the nation and abroad, to the highest levels of government. [ABSTRACT FROM AUTHOR]

In the 1960s, general practitioners organized themselves into a state-based nationwide political movement that lobbied state legislators and state-funded medical schools to create departments of family practice. They framed their calls in the context of the national shortages of primary care physicians by arguing that those medical schools that received state funding had an obligation to the state to train sufficient numbers of primary care physicians to ensure the health care needs of the state's residents would be met. As this article reveals, two defining features of this activism were rural politics and the politics of town and gown. The history of family practice thus introduces a new dimension to the familiar dyad of town and gown relations: the plow--rural physicians who brought to the medical politics of the post-World War II United States a distinctive and powerful set of political, social, and economic interests. [ABSTRACT FROM AUTHOR]

Focus on the social service and health care needs of rural dwellers has emerged due to changing demographics and advocacy efforts. All rural health providers are faced with numerous unique challenges. As a valuable part of hospice teams, social workers are well equipped to have an integral role in understanding and addressing the specific challenges in end-of-life care in rural communities. In this study, a Web-based survey was completed by 339 hospice social workers spanning 40 states in the United States. Both quantitative and qualitative methods and data analysis strategies were utilized. The results reveal environmental and cultural challenges impacting social work practice. The results also unveil solutions and suggestions for addressing challenges such as creative use of resources and increased collaboration within the local resident, health care, and social work communities. Implications include potential strategies for enhanced social work practice in rural areas, yielding a quality end-of-life care for individuals and families. [ABSTRACT FROM AUTHOR]

The article presents research assessing access to kidney transplantation for patients with end-stage renal disease (ESRD) as a function of distance from the closest transplant center or rural rather than urban residence in the U.S. The methods and design of the observational study involving nearly 700,000 adult patients with kidney failure who registered for renal replacement between 1995 and 2007 is explained. The outcomes measured include time to placement on kidney transplant waiting lists and time to kidney transplantation. Results indicated that remote or rural residence was not a factor associated with increased time to kidney transplantation among ESRD patients in the U.S.

Among 10,384 rural Colorado female patients who received MDC 14 (obstetric services) from 2000 to 2003, 6,615 (63.7%) were admitted to their local rural hospitals; 1,654 (15.9%) were admitted to other rural hospitals; and 2,115 (20.4%) traveled to urban hospitals for inpatient services. This study is to examine how network participation, service scopes, and market competition influences rural women’s choice of hospital for their obstetric care. A conditional logistic regression analysis was used. The network participation ( p < 0.01), the number of services offered ( p < 0.05), and the hospital market competition had a positive and significant relationship with patients’ choice to receive obstetric care. That is, rural patients prefer to receive care from a hospital that participates in a network, that provides more number of services, and that has a greater market share (i.e., a lower level of market competition) in their locality. Rural hospitals could actively increase their competitiveness and market share by increasing the number of health care services provided and seeking to network with other hospitals. [ABSTRACT FROM AUTHOR]

The article discusses the role of teleradiology in medical care administration in rural communities in the U.S. It projects the benefits of teleradiology including the reduction of cost of diagnostic services and the improvement of medical efficiency and productivity. It presents the situation of rural medicine and visualizes the application of the process in a rural medical context. It suggests the government to endorse teleradiology and examine its state licensure and medical negligence law.

A pipeline model has been suggested to increase the rural physician supply. This study is an institutional case report used to describe the context, development, and in-house evaluation of the University of Alabama Rural Health Leaders Pipeline, 1990-2005. This program was developed at a University of Alabama School of Medicine branch campus to target rural students at multiple levels, elementary schools through residency, and includes a minority focus. Requirements to enter the medical program include living 8 years in rural Alabama, meeting admission requirements, and affinity for rural lifestyles. Twenty-six percent of 316 high school participants, all 40 students in the minority- focused college program, and 3% of 90 medical program students were African American. The program includes (1) puppet shows in elementary schools depicting different health professions, (2) Rural Health Scholars Program for 11th-grade students, (3) Minority Rural Health Pipeline Program for college students, (4) Rural Medical Scholars Program, a 5-year track of study in rural community health and medicine, and (5) assured admission to family medicine residency. Outcomes studied in this case report included medical school performance, graduation rate, selection of family medicine specialty, and rural practice location. Medical scholars were anticipated to experience academic difficulty, select family medicine specialty, and locate in rural practice more often than peers. Compared to peers, medical scholars showed lower scores on preclinical courses and USMLE steps 1 and 2, reflective of their lower MCAT and GPA scores, but had (1) similar graduation rates (95% vs peers 84%), (2) higher family medicine selection rate (47% vs Huntsville 27% vs Tuscaloosa 12% vs Birmingham 4% [OR compared to Birmingham 22.7, 95% CI 10.5-49.4]), and (3) higher rural practice rate (67% vs peers 14% vs national group 9%) in the first RMSP classes. Based on these important outcomes being better than or equal to the traditional student cohorts, the institution concluded that the Rural Health Leaders Pipeline demonstrates successful use of the rural pipeline model. [ABSTRACT FROM AUTHOR]

Farming within the Anabaptist (within this article defined as various religious groups that do not believe in infant baptism; Amish, Hutterites, Mennonites, and Brethren are included within the definition and usually practice selective use of technology) population creates a unique situation with regards to teaching farm safety and health to children. Children working at an age younger than typical farm families, using older equipment and with increased exposure to livestock, affect injuries among Anabaptist children and youth. Addressing social differences and using low-tech methods for demonstrations help when planning resources and programs. An existing Farm Safety 4 Just Kids (FS4JK) magnetic farm scene, hazard hunt program was adapted for Anabaptist youth to include more images related to the Anabaptist lifestyle. The adapted educational display was piloted in 5 locations (Iowa, Pennsylvania, Ohio (2), and Ontario). Fifty-four boys and 54 girls participated in the pilot programs. Youth survey results indicated that animal-related issues were primary in Anabaptist youths' learning from the lessons. Behaviors most likely mentioned by youth as unsafe actions involved jumping off moving vehicles, mowing with bare feet, and approaching animals unsafely. Youth were most likely to change behavior when working with animals. Instructors indicated that the magnetic display medium was well received by the Anabaptist audience. Pilot testing led to adaptations to content and pictorial images. [ABSTRACT FROM AUTHOR]

Currently, little is known about the role of nurses' aides (NAs) in rural long-term care facilities or their impact on the process of death and dying in rural healthcare environments. Focus groups with NAs were held in 6 rural counties located in 5 states to assess attitudes and perceptions about end-of-life care and training needs. Key informants from 8 states and the District of Columbia added to the understandings. Nurses' aides (N= 63) and key informants (N = 21) worked in a variety of rural settings that provide end-of-life care (i.e., nursing homes, hospitals, hospices, home healthcare agencies). Five themes about the needs of rural NAs around end-of-life care were identified in the focus groups, and 4 themes emerged from key informant interviews. A prototype computer-based training module on communication about end-of-life issues was developed, tested, and found useful and compelling. [ABSTRACT FROM AUTHOR]

The model of family health advocacy built firmly upon principles of empowerment theory seeks to help individuals, families. and communities to improve their circumstances by incorporating multiple levels of intervention. The goal of family health advocacy is to improve the well-being of pregnant women and mothers of children younger than 2 years by providing social support and health education about risk factors related to infant mortality and prematurity This program primarily targets rural African American women, a group at high risk. Advocacy and referral for needed medical and social services are provided. This article presents a comprehensive model of health advocacy, including social marketing strategies, recruitment efforts, and curriculum development. [ABSTRACT FROM AUTHOR]

Understanding the experiences of low-income Appalachians living with type 2 diabetes mellitus is needed to provide culturally sensitive care. For this qualitative study, 13 adults were recruited from 2 low-income clinics in northern West Virginia through purposive sampling. Through in-depth interviews with the participants, 4 themes were identified: (1) achieving a balance between diet and family needs, (2) adapting to fluctuations in energy levels, (3) balancing family relationships with self-reliance, and (4) dealing with the uncertainty of future health. Nurses working with low-income adults in Appalachia need to provide family-centered diabetes education to meet the cultural needs of this group. [ABSTRACT FROM AUTHOR]

Using a national dataset, the influence of the community and individual provider characteristics on the availability of healthcare resources in rural areas was evaluated. Disparities continue to exist in the availability of providers including organizational types of providers such as Community Health Centers and Community Mental Health Centers. A lower percentage of nonmetropolitan counties have such centers, and more rural counties within the general grouping of nonmetropolitan counties have fewer of these organizational resources. A case study on the Southwestern region of Virginia is presented to highlight the impact on health outcomes and an innovative community response to the lack of availability of needed healthcare services. [ABSTRACT FROM AUTHOR]

Context. While there is debate over whether the U.S. is training too many physicians, many seem to agree that physicians are geographically maldistributed, with too few in rural areas. Objective. Official definitions of shortage areas assume the market for physician services is based on county boundaries. We wished to ascertain how the picture of a possible shortage changes using alternative measures of geographic access. We measure geographic access by the number of full-time equivalent physicians serving a community divided by the expected number of patients (possibly both from within the community and outside) receiving care from those physicians. Moreover, we wished to determine how the geographic distribution of physicians had changed since previous studies, in light of the large increase in physician numbers. Design. Cross-sectional data analyses of alternative measures of geographic access to physicians in 23 states with low physician–population ratios. Results. Between 1979 and 1999, the number of physicians doubled in the sample states. Although most specialties experienced greater diffusion everywhere, smaller specialties had not yet diffused to the smallest towns. Multiple measures of geographic access, including physician-to-population ratios, average distance traveled to the nearest physician, and projected average caseload per physician, confirm that residents of metropolitan areas have better geographic access to physicians. Physician-to-population ratios exhibit the largest degree of geographic disparity, but ratios in rural counties adjacent to metropolitan areas are smaller than in those not adjacent to metropolitan areas. Distance-traveled and caseload models that allow patients to cross county lines show less disparity and indicate that residents of isolated rural counties have less access than those living in counties adjacent to metropolitan areas. Conclusion. Geographic access to physicians has continued to improve over the past two decades, although some smaller specialties have not diffused to the most rural areas. While substantial variation in the supply of physicians across communities remains, current measures of geographic access to physicians overstate the extent of maldistribution and yield an incorrect ranking of areas according to geographic accessibility of physicians. [ABSTRACT FROM AUTHOR]

In the United States, injuries are the leading cause of death among individuals aged 1 to 45 years and the fourth leading cause of death overall. Rural populations exhibit disproportionately high injury mortality rates. Deaths resulting from motor vehicle crashes, traumatic occupational injuries, drowning, residential fires, and suicide all increase with increasing rurality. We describe differences in rates and patterns of injury among rural and urban populations and discuss factors that contribute to these differences. (Am J Public Health. 2004;94:1689-1693). [ABSTRACT FROM AUTHOR]

People living in rural areas make up 20 percent of the U.S. population, but only 9 percent of physicians practice there. This uneven distribution is significant because rural areas have higher percentages of people in poverty, elderly people, people lacking health insurance coverage, and people with chronic diseases. As a way of ameliorating these disparities, e-health initiatives are being implemented. But the rural e-health movement raises its own set of distributive justice concerns about the digital divide. Moreover, even if the digital divide is overcome, e-health services may be of an inferior quality compared to face-to-face medical encounters. In this paper, I argue that before we can fully understand the distributive justice implications of e-health, we must first understand what distributive justice means. I argue that five elements—fairness, quality, accessibility, availability, and efficiency—constitute a general conception of justice and that all of these elements must be considered when evaluating e-health for rural health profession shortage areas. In doing so, it may be necessary to make important tradeoffs among these elements. I then examine the development of e-health programs in light of Rawls's principle of equal opportunity and Daniels's notion of species-typical functioning. I conclude that in the context of e-health, Rawls's principle should be expanded to include geography as a prima facie morally relevant criterion for allocating healthcare benefits. I also conclude that Daniels's notion of species-typical functioning provides grounds for thinking of health and some healthcare services as special goods. [ABSTRACT FROM AUTHOR]

ABSTRACT. Meeting public health information needs in a rural setting presents unique problems for health information providers. Getting this information to both health consumers and health care personnel is equally challenging. Further complicating this problem is a scarcity of hospitals in the 29 parishes of north Louisiana. To meet this challenge, the Health Sciences Library at Louisiana State University Health Sciences Center/Shreveport (LSUHSC/S) set out to develop the Web site "Health e-Links" . This site was promoted through the public librarians in the northern part of the state. [ABSTRACT FROM AUTHOR]

Analyzes the American Medical Association (AMA) Masterfile and Area Resource File to calculate the percentage of primary care international medical graduates (IMG), relative to United States medical graduates (USMG), working in rural underserved areas (RUA). Study methods; Percentage of both primary care USMG and IMG in RUA; Policy implications.

This paper focuses on the issue of how a research project can shift from a positivist to a nonpositivist framework. Specific attention is given to changes in research methods and philosophical paradigm that emerged while conducting a study on the replacement of immigrant physicians in rural America. In its original conceptualization, the study was expected to yield a simple, right answer. Specifically, one or more types of health professionals (e.g., nurse practitioners, National Health Service Corps physicians) would be identified as expected replacements in the event of a cutback on immigrant physicians. However, as the research progressed, the quest for a simple, right answer became less realistic. The theoretical framework, methods, and research question changed, thereby allowing for greater complexity and ambiguity than anticipated at the outset of the study. What had been a positivist, statistical study was now a nonpositivist, qualitative study, and the research question shifted to include individual perspectives. An overview of such transitions leads to a discussion of the importance of context and ambiguity in research. [ABSTRACT FROM AUTHOR]

Reports on the agromedicine highlights of the 50th Annual Epidemic Intelligence Service (EIS) Conference of the U.S. Centers for Disease Control and Prevention held in Atlanta, Georgia from April 23-27, 2001. Retrospective review of major investigations conducted by the EIS with agromedicine implications; Abstracts of papers presented at the conference.

The term 'telemedicine' refers to health care and health education transmitted over large distances via computer with interactive audio and video capabilities. Over the past decade, telemedicine has been widely hailed as a means of administering health care to rural areas where doctors are scarce. Most research on the subject emphasizes technological, regulatory, and utilitarian aspects of telemedicine. This study, however, develops a cultural studies perspective in order to examine how social relationships are negotiated with regard to telemedicine in a particular context. The contextual focus is South Dakota -- a state where telemedicine has rapidly developed in response to an ongoing crisis in health care access. An overview of economic and health care conditions in South Dakota is followed by examinations of network structures through which telemedicine operates in the state and an analysis of how telemedicine is rhetorically constructed in the state's leading newspaper. Concluding sections discuss the hegemonic nature of telemedicine in South Dakota and raise questions about telemedicine in other contexts. [ABSTRACT FROM AUTHOR]

AbstractOver the past two decades, the majority of medical schools in the USA have embarked upon curricular initiatives to enhance the teaching of ambulatory or office-based primary care. Identifying characteristics of these primary care experiences that make for the most effective learning is a top priority in medical education research. In this paper we examine what is known about the influence of variability in the structure of primary care experiences on student learning outcomes. We examine the questions of how rotations are scheduled, who does the teaching and where the teaching takes place. Given the variability in curricula across the 125 accredited medical schools in the USA and the absence of agreed-upon objectives, outcomes or assessment measures for primary care education, it is not surprising that the current literature has fallen short in providing definitive answers. There is much debate about the benefits of community vs. campus sites, longitudinal vs. block experiences, and the influence of specialty training of the preceptor, but little in the current literature to guide and substantiate a programme's choice. What can be concluded with relative confidence is that clinics currently offer more active student experiences than do private offices, that students may be more satisfied with rural experiences than with urban or suburban experiences, and that longitudinal and block experiences have different learning advantages. Research in primary care medical education will benefit from the current movement towards a cross-institutional consensus on educational objectives and outcome measures and on the general application of a more rigorous research methodology. [ABSTRACT FROM AUTHOR]

Medical education for agricultural health and safety is evolving to intersect primary care, rural community health, and occupational and environmental medicine (OEM). Agricultural hazards are concentrated among the diverse concerns of primary care and community health. Family physicians who respond to this diversity can maintain their rural practices while establishing the credibility necessary for acceptance as partners in programs for agricultural community health. Rural family physicians with expertise in community health and OEM can be the front line of agricultural medicine. Several educational efforts are relevant to producing these physicians: (1) rural medicine, (2) rural public health, (3) family medicine, and (4) OEM (including agricultural medicine). Agromedicine education to prepare physicians to partner with agricultural scientists and cooperative extension agents should also be considered. Each of these efforts requires faculty with special expertise and resources. Few institutions are prepared currently to merge and coordinate these programs into a coherent rural and agricultural medicine program. We recommend that a medical school in each distinctive agricultural region construct a model for developing agricultural medicine physicians and seek partners and resources to operationalize the model. Examples include the Iowa, South Carolina, and Alabama models. A vocal rural and agricultural constituency may be required for success. [ABSTRACT FROM AUTHOR]

Profiles college teachers in the United States specializing in rural medicine. John R. Wheat, University of Alabama-Tuscaloosa; Kelley J. Donham, University of Iowa; William M. Simpson, Medical University of South Carolina.

Describes the development of multidisciplinary healthcare teams in rural communities in the United States. Positive results; Delineation of limiting factors; Components of team development; Training and preparation of various types of clinicians.

Examines aspects of the dynamics of prescription drug information sources in the United States and their consequences for rural consumers and pharmacies. Baby boomers' representation of a larger proportion of the population that is experiencing health-related problems; Pharmaceutical companies' increase of their use of the Internet for direct-to-consumer advertising.

Supraventricular tachydysrhythmias (SVTs) are a common presenting complaint, with a national prevalence of 3/1000 persons. While most commonly stable, prolonged paroxysms can deteriorate into haemodynamically unstable subtypes or ventricular dysrhythmias. Early recognition with appropriate management is critical to reducing the morbidity associated with this condition. The American Heart Association holds that vagal manoeuvres are a first-line therapy in the management algorithm of stable SVTs. However, they state that no clear recommendations can be made around which manoeuvre to use, highlighting that future research should examine the efficacy and safety profiles of the various manoeuvres. In the South African primary care setting, clinicians must be at the forefront of pragmatic management strategies in the face of resource limitations, such as the unavailability of adenosine - a second-line therapy when vagal manoeuvres fail. In this article, we begin with a case study and review the literature around vagal manoeuvres.

Discusses the impact of the 1997 Balanced Budget Act (BBA) on Medicare managed care payments for rural areas in the United States. Changes in the way Medicare risk plans are made; Simulations of the likely impact of the changes throughout the BBA implementation period ending in 2003.

Focuses on the evolution of the medical education program at the University of New Mexico School of Medicine in Albuquerque in response to the health care needs of underserved rural and ethnic communities. Change in clinical clerkships; Creation of interdisciplinary learning teams; Change in the residency program.

Context: The shortage of physicians in rural areas is a longstanding and serious problem, and national and state policymakers and educators continue to face the challenge of finding effective ways to increase the supply of rural physicians.Objective: To determine the direct and long-term impact of the Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) on the rural physician workforce.Design: Retrospective cohort study.Participants and Setting: A total of 206 PSAP graduates from the classes of 1978 to 1991.Main Outcome Measures: The PSAP graduates currently practicing family medicine in rural and underserved areas of Pennsylvania, compared with all allopathic medical school graduates in the state, and with all US and international allopathic graduates. All PSAP graduates were also compared with their non-PSAP peers at JMC regarding their US practice location, medical specialty, and retention for the past 5 to 10 years.Results: The PSAP graduates account for 21% (32/150) of family physicians practicing in rural Pennsylvania who graduated from one of the state's 7 medical schools, even though they represent only 1% (206/14710) of graduates from those schools (relative risk [RR], 19.1). Among all US and international medical school graduates, PSAP graduates represent 12% of all family physicians in rural Pennsylvania. Results were similar for PSAP graduates practicing in underserved areas. Overall, PSAP graduates were much more likely than their non-PSAP classmates at JMC to practice in a rural area of the United States (34% vs 11%; RR, 3.0), to practice in an underserved area (30% vs 9%; RR, 3.2), to practice family medicine (52% vs 13%; RR, 4.0), and to have combined a career in family practice with practice in a rural area (21% vs 2%; RR, 8.5). Of PSAP graduates, 84% were practicing in either a rural or small metropolitan area, or one of the primary care specialties. Program retention has remained high, with the number of PSAP graduates currently practicing rural family medicine equal to 87% of those practicing between 5 and 10 years ago, and the number practicing in underserved areas, 94%.Conclusions: The PSAP, after more than 22 years, has had a disproportionately large impact on the rural physician workforce, and this effect has persisted over time. Based on these program results, policymakers and medical schools can have a substantial impact on the shortage of physicians in rural areas. [ABSTRACT FROM AUTHOR]

Discusses a study which explored the nature and extent of visual disability in an underserved area in rural Kentucky. Prevalence of binocular blindness; Causes of visual impairment; Factors associated with visual loss.

Focuses on the trend of physicians who are dropping the practice of obstetrics and the increasing reluctance of those who remain in practice to serve women who receive Medicaid assistance. Some of the factors that physicians perceive as barriers to providing care to low-income women.

Presents an overview of rural primary care in the United States. Role of internal medicine in the delivery of primary care to rural populations; Demographic characteristics of populations and physicians; Training of rural physicians; Use of delivery systems that emphasize coordination among health care providers.

The article discusses the factors to consider in extending clinical services for exceptional children in rural areas in the U.S. There are two aspects considered to be essential in providing clinical services which include (1) the location and diagnosis of exceptional children, and (2) the need for the recommendation regarding the placement of those children in special classes. It must be put into reality that the success of clinical programs depends on the adequacy of clinical services, for those who deal with special education. The State of Pennsylvania, nevertheless, provides the most thorough pattern of clinical services to rural areas. Other States as well provide similar but limited services.

Data from an enumerative survey in Cortland and Oswego counties, New York, show the percentage of rural persons and households reporting the use of physician, dentist, nonmedical personnel, hospital and selected types of public health services (including school) during a 12 month period. Selected hypotheses used in the exploratory study and others formulated as a result of it are presented, together with testing data available. Seven are hypotheses of relationships, two are hypotheses of trends, and three are hypotheses of method. The hypothesis that utilization of private health resources by rural people is closely related to the availability of these resources located within the county as measured by county indices of availability is critically examined; the hypothesis is not supported by the data for the two New York counties. [ABSTRACT FROM AUTHOR]

The article presents a medical student perspective of the joys and challenges of rural medicine in the U.S. and Canada. It highlights the shortages of rural physicians due to a number of factors including professional, social and cultural isolation. It recognizes thousands of rural physicians who service in communities despite the challenges. In addition, the article comments on the ignorance of the larger medical community regarding rural practice.