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PURPOSE We sought to ascertain factors associated with the quality of diabetes care, comparing rural vs urban diabetic patients in a large health care system. METHODS We conducted a retrospective cohort study assessing patients' attainment of the D5 metric, a diabetes care metric having 5 components (no tobacco use, glycated hemoglobin [[A.sub.1c]] level less than 8%, blood pressure less than 140/90 mm Hg, low-density lipoprotein cholesterol level at goal or statin prescribed, and aspirin use consistent with clinical recommendations). Covariates included age, sex, race, adjusted clinical group (ACG) score as a marker of complexity, insurance type, primary care clinician type, and health care use data. RESULTS The study cohort consisted of 45,279 patients with diabetes, 54.4% of whom resided in rural locations. The D5 composite metric was met in 39.9% of rural patients and 43.2% of urban patients (P CONCLUSIONS Rural patients had worse diabetes quality outcomes than their urban counterparts, even after adjustment for other contributing factors and despite being part of the same integrated health system. Lower visit frequency and less specialty involvement in the rural setting are possible contributing factors. Key words: primary care; diabetes control; rural health; rural health disparities; population health; health care delivery; health services; health care disparities; quality of care; health metrics; health services accessibility; vulnerable populations https://doi.org/10.1370/afm.2962, INTRODUCTION Diabetes continues to grow as a national health priority. Recent estimates suggest it now affects more than 11% of the US population, with approximately 90% to 95% of cases [...]

Breast cancer survivorship guidelines recommend at least annual follow-up visits, yet the degree to which this occurs in clinical practice is uncertain. Claims data from a US commercial insurance database (OptumLabs) were used to identify women treated with curative intent surgery for newly diagnosed breast cancer between 2006 and 2014. In 25 035 women, median follow-up was 3 years. In the second year after surgery, 9.6% of the patients did not visit a primary care provider, an oncologist, or a surgeon (guideline-nonadherent). The guideline-nonadherent proportion increased from 7.8% in women diagnosed in 2006 to 12.2% in those diagnosed in 2014 (two-sided Wald P

PURPOSE Access to health care is a long-standing concern for rural patients; however, administrative measures fail to capture the subjective patient experience of accessing health care. The purpose of this review was to synthesize the qualitative literature on patient and caregiver experiences of accessing health care services for chronic disease management among US residents of rural areas. METHODS We searched Embase, MEDLINE, PsycInfo, CINAHL, and Scopus to identify qualitative studies published during 2010-2019. A thematic synthesis approach was used to analyze findings from included studies. RESULTS A total of 62 studies involving 1,354 unique participants were included. The largest share of studies (24.2%) was focused on the experience of patients with cancer, followed by behavioral health (16.1%), HIV and AIDS (14.5%), and diabetes (12.9%). We identified 4 primary analytic themes of barriers and facilitators associated with the experience of accessing health care services for chronic disease management in rural areas: (1) navigating the rural environment, (2) navigating the health care system, (3) financing chronic disease management, and (4) rural life (ie, common elements of a distinct 'rural' way of thinking and behaving). CONCLUSIONS In this comprehensive review, we found that important cultural, structural, and individual factors influenced the rural patient's experience of health care access and use, including barriers and facilitators posed by geographic and built environments, and distinct rural mores. Our findings can inform policies and programs that both facilitate structural aspects of access and include culturally appropriate interventions. Key words: rural health; health care access; barriers; facilitators; chronic disease management; systematic review; qualitative research; vulnerable populations; public health Ann Fam Med 2022;20:266-272. https://doi.org/10.1370/afm.2798, INTRODUCTION Nearly 1 in 5 people in the United States live in rural areas. (1) Chronic health conditions are both more prevalent and associated with higher rates of disease-attributable mortality [...]

Context: Type 2 diabetes mellitus continues to grow as a national health priority that disproportionately affects rural patients. Objective: To compare patient level quality outcome data between rural and urban patients across a large integrated health system and assess healthcare utilization differences. Study Design and Analysis: Retrospective cross-sectional study Setting or Dataset: Clinical data was collected those with type 2 diabetes across Mayo Clinic Family Medicine Midwest practice. Patient level data included address, age, sex, race, ACG score (marker of complexity), insurance status, primary care clinician, and utilization data. Population Studied: Empaneled patients with an ICD-10 diagnosis of type 2 diabetes mellitus (45,279). Intervention/Instrument: Patients were divided into rural and urban cohorts based on RUCA codes then outcomes and utilization were analyzed using logistic regression and linear mixed models, with site and provider as random effects. Outcome Measures: Patients meeting 5 criteria included in a composite quality metric for diabetes management (D5) Results: Rural patients were significantly less likely to have met all D5 criteria than urban patients (OR 0.93 (95% CI 0.88-0.97)). Utilization analysis shows that rural patients had fewer outpatient visits than their urban counterparts (mean visits 3.2 v 3.9, p, Presenters Randy Foss, MD, Michelle Lampman, PhD, Matthew Bernard, MD, FAAFP, Susan Laabs, Jessica Sosso, MD, MPH, Gregory Garrison, MD, MSc, Thomas Thacher, MD, Summer Allen, MD, Karen [...]

Context: Social Determinants of Health (SDOH) contribute significantly to health outcomes such as chronic disease management and screening test completion. Electronic medical record (EMR) data can provide insight into individual-level SDOH factors for a patient population. Objective: To determine which patient-level SDOH factors are correlated with attainment of quality metrics (diabetes control and colorectal screening) in a rural community Study Design and Analysis: Cross-sectional analysis assessing patient- entered SDOH questionnaires for patients who do not meet the above quality metrics compared to those who do meet quality metrics Setting or Dataset: Epic EMR data was collected on Sparta, WI eligible patients from 7/1/2019 to 12/31/2020 Population Studied: Sparta, WI adults age 18-75 with diabetes type 1 or 2 diagnosis (503 patients) and adults age 50-75 eligible for colon cancer screening (2162 patients) Intervention/Instrument: Chi-square test of Epic EMR patient-entered SDOH data comparing patients not meeting quality metrics to those patients meeting quality metrics, controlling for patient-level variables such as age, sex, race, marital status with logistic regression model. Outcome Measures: SDOH questionnaires in Epic EMR (tobacco use, alcohol use, stress, transportation concerns, food insecurity, social isolation, intimate partner violence, dental care, diet and exercise). Patient SDOH answers are divided into at-risk and no risk groups. Results: Patients not meeting diabetes control measures are more likely to give at-risk SDOH responses in the following categories: financial concerns (26.5% vs 14.7%, p-value 0.0134) and food insecurity (18.0% vs 8.0%, p-value 0.0184). Patients not meeting colorectal screening measures are more likely to give at-risk SDOH answers in the following categories: financial concerns (16.4% vs 9.7%, p-value 0.0034), food insecurity (11.5% vs 4.4%, p-value Conclusions: Patients' high-risk answers to SDOH questions regarding financial concerns, food insecurity, depression and transportation concerns may be correlated with lower attainment of quality outcomes such as diabetes control and/or colorectal screening. Use of individual-level EMR data may be useful to generate local quality improvement initiatives. Further study of different patient populations is warranted., Presenters Jessica Sosso, MD, MPH, Michelle Lampman, PhD, Karen Fischer, Gerald Sobolik, MBA, Randy Foss, MD, Matthew Bernard, MD, FAAFP, Gregory Garrison, MD, MSc, Susan Laabs, Summer Allen, MD, Thomas [...]

Agroforestry has the potential to support more resilient livelihoods, soil health, and biodiversity, when compared to monocropping. In Ecuador, the Union of Cacao Peasant Organizations (UNOCACE) has been working with producers since 2016 to transition cacao plots to a dynamic agroforestry system that includes timber and fruit species as well as ground cover in addition to cacao. This study evaluates the application of this model and its implications for agricultural production, livelihoods, and soil health through producer surveys and field-based sampling. The program is resulting in significantly more timber and fruit trees on the cacao plots. Despite this, cacao production and income have not decreased in a significant way, once accounting for the number of producing trees on the plots. In addition, while additional labor is utilized on the dynamic agroforestry plots, after utilizing a matching procedure, no significant difference is seen in total crop productivity for each day of labor utilized. Over time, total productivity could increase for the dynamic agroforestry plots as the companion crops and trees mature. As the program is relatively new and has undergone some changes, additional studies are needed to understand the benefits or challenges, especially for soil health, that might be realized further in the lifespan of the program. [ABSTRACT FROM AUTHOR]

Purpose: This research contributes to the literature on workplace energy conservation by examining the predictors of individual employee behaviors and policy support in a university. The purpose of this research is to better understand what factors influence energy conservation behaviors in this setting to inform programs and interventions. Design/methodology/approach: This project gathered survey data from employee-occupants of three campus buildings. Ordinary least squares regression analyses were used to investigate the theory of planned behavior (TPB) and attitudes-behavior-constraints (ABC) models examining what drives energy behaviors. Findings: This study finds a large proportion of respondents would support energy use reduction policies, more technology-based interventions and increased use of renewable sources. Respondents report positive attitudes toward individual energy conservation behavior but mild agreement with the influence of social norms. Self-efficacy reports also are positive. Although the TPB model is not fully supported in this group, the ABC model appears to perform well. Originality/value: In addition to adding to the relatively limited data on employee energy-saving behaviors in the university workplace, this study provides initial evidence that the ABC model is pertinent to this behavioral context. It also provides specific, usable data about policies and actions that campus community members might deem feasible and acceptable to relevant university offices.

Across the world, people are living longer. This phenomenon is creating a demographic shift: by 2050, the number of people aged 60 and older is expected to double and the number of people older than 80 is expected to triple. A growing elderly population also means an increase in age-related health concerns. In particular, with age comes normal memory decline as well as an increased risk of Alzheimer’s and other dementias. All this means that now more than ever the world needs interventions to support memory. From developing memory protheses to improving memory consolidation during sleep, neurostimulation is one particularly promising type of intervention for enhancing memory. [ABSTRACT FROM AUTHOR]