ELIMINATING RURAL 1

Eliminating Rural Health Disparities

Melissa Mulholland

Christopher Roth

40020 Community Health Nursing

Topic: Eliminating Rural Health Disparities

Date: 3/15/2012

Student Leaders Names:

  1. Melissa Mulholland
  2. Christopher Roth

Objectives:

  1. Student will understand the definition of a rural community.
  2. Student will describe the role of a community health nurse in eliminating rural health disparities.
  3. Student will be able to explain issues relating to affordability and access of health care services in rural communities.

Critical Thinking Questions

1.Why does Healthy People 2020 put a large amount of emphasis towards rural communities?

  1. What do you think are or would be the challenges, opportunities, and benefits of living in a rural environment?
  1. What do you think are the health care-seeking behaviors or residents who live in rural residents ?(consider economic and cultural factors)

Content

  1. Epidemiology
  2. Rural Definition
  3. United States Census Bureau classification
  4. This classification is based on population size, density, and relationship to cities(Vanderboom & Madigan, 2007)
  5. Does not differentiate populations at the county level (Vanderboom & Madigan, 2007)
  6. Rural is defined as “all territories, populations, and housing units located outside urbanized areas and urban clusters with fewer than 2,500 residents” (Vanderboom & Madigan, 2007, p. 176)
  7. Rural Ethnicities
  8. There are a higher proportion of whites in rural areas (about 82%) versus core metropolitan areas (about 62%) (Stanhope & Lancaster, 2010)
  9. Five million are African American (Stanhope & Lancaster, 2010)
  10. Four million are Hispanic (Stanhope & Lancaster, 2010)
  11. One million are Native American (Stanhope & Lancaster, 2010)
  12. Half a million are Asian-Pacific Islanders (Stanhope & Lancaster, 2010)
  13. Age Distribution
  14. Higher than average numbers of younger (Ages 6-17 years) and older residents (older than 65 years) compared to urban settings (Stanhope & Lancaster, 2010).
  15. 18 year olds in rural areas are more likely to be or to have been married than are 18 year olds in the urban setting (Stanhope & Lancaster, 2010).
  16. Rural people are more likely to be widowed (Stanhope & Lancaster, 2010)
  17. Adults have fewer years of formal schooling than urban adults (Stanhope & Lancaster, 2010)
  18. Economics
  19. Rural families are poorer than their urban counterparts (Stanhope & Lancaster, 2010)
  20. 25% live at or near the poverty level (Stanhope & Lancaster, 2010)
  21. Nearly 40% of all rural children are impoverished (Stanhope & Lancaster, 2010)
  22. Rural Public Health, Healthy People 2020
  23. Rural Public Health
  24. History
  25. 1700’S
  26. Public health began in the urban areas at this timein the United States and included issues such as sanitation, communicable disease—which were problems in the higher density urban areas (Meit & Knudson, 2009)
  27. 1800’s
  28. The population became more mobile and communicable diseases were being transmitted from urban settings to rural settings (Meit & Knudson, 2009)
  29. This created a need for rural public health services
  30. 1908 to 1940
  31. County health departments were created to expand public health into rural areas (Meit & Knudson, 2009)
  32. 1945
  33. Hill-Burton Act
  34. funded the construction ofcommunity hospitals
  35. At this time rural health focus shifted almostexclusively to ensuring access to healthcare services. (Meit & Knudson, 2009)
  36. Healthy People 2020
  37. Disparities
  38. According to Meit and Knudson (2009), “importantly, and not to be forgotten, the rural public health infrastructure never fully developed in many areas so that, even today, many rural citizens reside in communities not served by a localhealth department.”(p. 185)
  39. In addition, it is well documented that in the rural setting there is a lack of primary care providers (Hajat, Stewart, & Hayes, 2003)
  40. Naturally this makes local public health agencies and departments the place for the rural population to go for services such as immunization, family planning, and home health care (Hajat et al., 2003)
  41. But as seen from the quote above many rural communities are not served by these local health departments even in this day and age
  42. Disparities occur if a health outcome is seen in a greater or lesser extent between populations (Healthy People 2020, 2012)
  43. There are race, ethnic, sex, sexual identity, age, disability, socioeconomic status, and geographic disparities (Healthy People 2020, 2012)
  44. Healthy People 2020 strive to improve the health of all groups (Healthy People 2020, 2012).
  45. Healthy People 2020, (2012), will assess health disparities in the U.S. population by tracking rates of illness, death, chronic conditions, behaviors, and other types of outcomes in relation to demographic factors that include:
  46. Race and ethnicity
  47. Gender
  48. Sexual identity and orientation
  49. Disability status or special health care needs
  50. Health Promotion/Levels of Prevention
  51. Geographic location (rural and urban)The Office of Rural Health Policy (ORHP), established in 1987 to improve the health care for individuals in rural locations. It focused on access to rural hospitals and to rural health care
  52. Health care clinics on wheels and home care
  53. Provide screening and preventative health care services
  54. Eliminates the expense and inconvenience of traveling
  55. Decrease the expense of travel and personnel for the home care agency and improve access for rural residents
  1. Home care is cost effective and has proven to promote health, wellness, and independence.
  2. Decrease the frequency and duration of home visits and improve the patient’s involvement in their plan of care
  1. Tele-health home monitoring systems allows patients to be monitored at home by phone or internet
  2. Decrease the costs associated with home care services and it has been proven to improve patient outcomes
  1. Preventions should focus on the improvement of health services in the specific rural community including activities focused on developing safe, effective, efficient, community-centered, and timely for residents.
  2. Primary: Educate residents on how to prevent accidents and the benefits of immunizations for prevention ,especially tetanus, engage in safer and more healthful lifestyles to reduce the risk of health problems
  3. Secondary: Screenings for any chronic health problems
  4. Tertiary: Begin treatment for the symptoms of any chronic health problems
  1. . Ethical Issues
  2. Rural residents often seek health care through informal networks first, such as neighbors, church, and extended family due to professional health care being further away.
  3. Challenges of rural health practices (Stanhope et al., 2010, p. 413)
  4. Professional isolation
  5. Sparse resources (other health care providers, equipment, and materials)
  6. Heavy workloads which can decrease quality of care
  7. 10% of the U.S. physicians work in rural areas, when 25% of the population lives there (Stanhope et al., 2010)
  1. The barriers rural areas encounter create unfair treatment such as increased distances to healthcare, lack of public and personal transportation, lack out outreach services, language barriers, and lack of knowledge about rural populations.
  1. Health Planning
  2. Community Based Participatory Research is an approach to research to enhance understanding of a phenomenon (rural health disparities) to improve the health and well-being of the community members.(Graves, 2009, p.1)
  3. Recognizes the community as a unit.
  4. Builds on the community strengths and resources available.
  5. Recognizes public health problems to build interventions that benefit all its members
  6. Benefits of CBPR include, community gains knowledge on the phenomenon being researched, resources are provided within the community, the community joins with experts to address their health problems, increases trust and bridges culture gaps, and has the potential to guide further interventions and policy changes from previous research. CBPR can target public health disparities to develop interventions in underserved communities which will lead to improved healthcare access and improved health outcomes.
  7. Case Study
    Jose, a 65-year-old male was diagnosed with type II diabetes. He is a new immigrant just beginning to learn English. Jose’s two older sisters have been living in California for two years while his brother lives in the next town from Jose. Jose lives in a small Midwestern rural county consisting of seven towns with populations ranging from 200 to 1000 residents. It provides beautiful scenery and privacy for its residents. The nearest health care is about 100 miles away. Two physicians staff a clinic that provides offices in three of the nearby towns. The county hospital is located on the east end of the county making a 90 minute commute for Jose. The hospital does support tele-health monitoring systems as a means of care for the community. Jose used to manage his diabetes with diet and exercise, but recently had a hyperglycemic episode that led him to hospitalization. After discharged, a home health nurse was assigned as his case manager. The case manager’s office is located in the next town and provides services for the whole county. Her activities include nutrition, hydration, pharmacological care, routine activities, and emergency backup services.
    1. What are Jose’s barriers/disparities in obtaining his health care services?
    -He lives 90 min away from the hospital.

-His two older sisters which would be a great support system nearby, but they live in California.

- Jose is a new immigrant who is just learning English therefore a language barrier may exist
2. Identify resources available for Jose?
-His brother lives a town over so Jose may be able to receive rides from him from appointments if it is not an emergency.

– The hospital uses tele-health which we discussed earlier in our clinical conference. This could provide Jose with some basic care and education needed for his diabetes if he was unable to get to the hospital.
3. Identify primary, secondary, and tertiary levels of prevention that Jose’s nurse will most likely provide?
-Primary: would include education about the complications that can arise from not adequately controlling his blood sugars, such as heart, kidney, eye, and nerve disease

-Secondary: would include screening for possible diabetes induced side effects/complications.
-Tertiary: Insulin administration to prevent further complication about the disease.
4. Does Jose’s rural living provide any benefits towards his health and health care services?
-The privacy could be relaxing as well as the slower paced environment of the rural community. - Having less residents, people tend to get to know each other more creating a support system within the community for Jose.

- The scenery as well can be peaceful and relaxing and provide for great places for Jose to “be one with nature” and to help with exercise

References

Graves, B. (2009). Community-based participatory research: toward eliminating rural health disparities. Online Journal of Rural Nursing & Health Care, 9(1), 12-14. Retrieved from CINAHL Plus with Full Text database.

Hajat, A., Stewart, K., & Hayes, K.L. (2003). The local public health workforce in rural

Communities. Journal of Public Health Management and Practice, 9 (6), 481-488

Healthy People 2020. (2012). Disparities. Retrieved from

Meit, M., & Knudson, A. (2009). Why is rural public health important? A look to

the future. Journal of Public Health Management and Practice, 15 (3), 185–190.

Stanhope, M. & Lancaster, J. (2010). Foundations of nursing in the community: Community-oriented practice (3rd ed.). St. Louis, MO: Mosby, Inc.

Vanderboom, C.P., & Madigan, E.A. (2007). Federal definitions of rurality and the impact on nursing research. Research in Nursing and Health, 30,175–184. DOI: 10.1002/nur.20194