Limited Access to Healthcare in Rural America

Access to health care and utilization of primary and preventative care services in rural communities across America is a national concern. The National Academy of Medicine and the Agency for Healthcare Research and Quality (AHRQ), has even made it a top priority to try and distinguish the potential challenges for these populations to access health care services (Caldwell, Ford, Wallace, Wang, & Takahashi, 2016).  According to Caldwell, Ford, Wallace, Wang, & Takahashi, “rural populations generally have higher morbidity and mortality rates relative to urban populations; individuals living in rural areas have fewer visits for preventative screenings, less access to specialists, and more preventable hospitalizations when compared to urban populations” (Caldwell, Ford, Wallce, Wang, & Takahasi, 2016). Factors contributing to these circumstances include but are not limited to, education level, poor health literacy skills, transportation, job status, health insurance status, and much more. As a registered nurse myself, I take special interest in this subject. I feel it is our duty as health care workers to reach out to those in need.

Identifying Academic Peer-Reviewed Journal Articles

I used Capella’s Library to access databases pertaining to Nursing and Health Sciences. I used two of the top databases, CINAHL Complete and the Health and Medical Collection database to search for scholarly, peer reviewed articles. I used the keywords

limited access to healthcare, access to healthcare in rural areas

,

healthcare access

, and

consumer health information.

I was also able to use their advanced search options and narrow my search to articles only pertaining to the US and articles that were published within the last three years.

Assessing Credibility and Relevance of Information Sources

To ensure that I was using credible sources, I used the search engine among the databases to select scholarly, peer-reviewed journal articles and articles that had been published within the last three years. I wanted to make sure that the articles I selected specifically discussed health care issues in rural areas of the United States. While each article focuses on the limited access to health care in rural areas of the United States, each one looks at a different issue pertaining to the subject. For example, one article discusses telepharmacy and limited access to pharmaceuticals in rural areas, while another discusses the use of technology to provide education assistance to rural communities.


Annotated Bibliography

Hunt, C. W., Henderson, K., & Chapman, R. (2018). Using Technology to Provide Diabetes

Education for Rural Communities.

Online Journal of Rural Nursing & Health Care

, 134–151. doi:

http://dx.doi.org.library.capella.edu/10.14574/ojrnhc.v18i2.525

This article discusses the prevalence of type 2 diabetes in rural areas versus urban areas and the management of the disease. People with type 2 diabetes living in rural areas face significant challenges including limited access to diabetes education (Hunt, Henderson, & Chapman, 2018). The purpose of this study was to develop, implement, and evaluate the effectiveness of diabetes self-management educational applications that were to be delivered via iPad devices to enhance self-management knowledge in adults living with type 2 diabetes in rural areas. According to Hunt, Henderson & Chapman, “ten different diabetes health applications were developed and placed on iPads and then given out to people living with type 2 diabetes in rural areas who attended health promotion clinics”. Participants in the study answered a knowledge based questionnaire about their disease before and after the use of the iPad based modules. The findings showed that there was a significant increase from before to after educational intervention.

Caldwell, J. T., Ford, C. L., Wallace, S. P., Wang, M. C., & Takahashi, L. M. (2017). Racial and

Ethnic Residential Segregation and Access to Health Care in Rural Areas .

Health and


Place

,

43

, 104–112. doi:

https://doi.org/10.1016/j.healthplace.2016.11.015

This article examined the relationship between racial/ethnic residential segregation and access to health care in rural areas. The researchers collected data from the Medical Expenditure Panel Survey, the American Community Survey, and the Area Health Resources Files. They then broke the population down further into categories of African Americans and Hispanics living in rural areas. Their studies showed that segregation amongst communities in rural populations can lead to low incomes, job restrictions, and educational restrictions, in turn leading to what they referred to as “white flight”. “White flight” is referring to the transitioning of working class White neighborhoods to predominantly African American neighborhoods. During this, there was also a health care “white flight” in which providers and hospitals relocated to more affluent and mostly White neighborhoods (Smith, 2005). The results showed that when health care is more segregated based from a racial/ethnic standpoint, minorities receive less health care and lower quality care when compared with Whites (Smith et al., 2007, Merchant et al., 2011).

McSweeney, S., M.S., Pritt, J. A., M.S., Swearingen, A., M.S., Kimble, Craig A, PharmD,

MBA,M.S., B.C.A.C.P., & Coustasse, Alberto, DrPH, MD,M.B.A., M.P.H. (2017).

Telestroke: Overcoming barriers to lifesaving treatment in rural hospitals.

Perspectives in Health Information Management,

, 1-18. Retrieved from

http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1932293451%3Faccountid%3D27965

This article discusses the use of telestroke, which according to McSweeney, Pritt, Swearingen, & Kimble, is “the use of telemedicine specifically for stroke care, in rural hospitals”. With implementation of telestroke, this can provide access to neurologists in rural areas where neurologists may not always be accessible. While the use of telestroke can be a financial burden on these rural hospitals, it can in turn save them money by improving patient outcomes. Since the implementation of telestroke, patients who may have not had access to neurologists in the past, now have access to thrombolytic therapy and one on one care from neurologists all around the country. Implementation of telestroke translates to significant financial impact for health care settings, payers, and ultimately more positive outcomes for the patients living in these rural communities.

Sarkar, Raghav, MBBS,M.P.H., M.S., Metzger, B. J., M.S., Sayre, H. M., M.H.A., Slater, C. M.,

M.H.A., Katamneni, Sruthi,B.D.S., M.D.A., & Coustasse, Alberto, DrPH, MD,M.B.A.,

M.P.H. (2018). Telepharmacy and access to pharmaceutical services in rural areas.


Perspectives in Health Information Management,

, 1-14. Retrieved from


http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2133763136%3Faccountid%3D27965

This article looked at the use of telepharmacy to increase rural hospitals’ access to pharmaceutical services. Telepharmacy is the involvement of telecommunications to deliver pharmaceutical services to consumers located in rural areas (Sarkar, Metzger, Sayer, Slater, Katamneni, & Coustasse, 2018). Sixty-six peer reviewed journal articles were reviewed and the findings suggested that telepharmacy networks indeed provided benefits to the pharmaceutical needs of rural hospitals. It also showed by implementing the use of these networks, hospitals were able to hasten medication order entries, after hours orders, and reconciled medications. By implementing the use of these telepharmacy services it could aid in reducing medication errors, which have increased as a result of the inability to recruit and retain pharmacists in rural areas. Telepharmacy should be utilized as a tool to maintain the pharmacist-consumer relationship.

Learnings From the Research

By using Capella’s online library, I was able to access thousands of scholarly, peer-reviewed journal articles concerning limited access to health care among rural communities in the United States. I was aware that this was a problem plaguing the US but I wasn’t aware of any formidable solutions to the problems. After reading the article

Using Technology to Provide Diabetes Education for Rural Communities

, I was pleased to hear of the progress achieved simply by using iPads as educational resources. While cost may be an issue in concerns to access to some of these up and coming technologically based resources, the studies prove that most of these creations pay for themselves based solely on the amount of positive patient outcomes. Reaching out to these rural communities is critical in the implementation of preventive and primary care. By creating these annotated bibliographies, I know this will make it much easier to obtain pertinent information and reliable/credible resources when writing my paper on limited access to healthcare in the near future.

References

Caldwell, J. T., Ford, C. L., Wallace, S. P., Wang, M. C., & Takahashi, L. M. (2017). Racial and

Ethnic Residential Segregation and Access to Health Care in Rural Areas .

Health and


Place

,

43

, 104–112. doi:

https://doi.org/10.1016/j.healthplace.2016.11.015

Hunt, C. W., Henderson, K., & Chapman, R. (2018). Using Technology to Provide Diabetes

Education for Rural Communities.

Online Journal of Rural Nursing & Health Care

,

134–151. doi: http://dx.doi.org.library.capella.edu/10.14574/ojrnhc.v18i2.525

McSweeney, S., M.S., Pritt, J. A., M.S., Swearingen, A., M.S., Kimble, Craig A, PharmD,

MBA,M.S., B.C.A.C.P., & Coustasse, Alberto, DrPH, MD,M.B.A., M.P.H. (2017).

Telestroke: Overcoming barriers to lifesaving treatment in rural hospitals.

Perspectives in


Health Information Management,

, 1-18. Retrieved from


http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview


%2F1932293451%3Faccountid%3D27965

Sarkar, Raghav, MBBS,M.P.H., M.S., Metzger, B. J., M.S., Sayre, H. M., M.H.A., Slater, C. M.,

M.H.A., Katamneni, Sruthi,B.D.S., M.D.A., & Coustasse, Alberto, DrPH, MD,M.B.A.,

M.P.H. (2018). Telepharmacy and access to pharmaceutical services in rural areas.


Perspectives in Health Information Management,

, 1-14. Retrieved from


http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2133763136%3Faccountid%3D2796

5


 

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