Data on aging, maternal health, mental health, travel burden

November 4, 2022

Data on aging, maternal health, mental health, travel burden

Rural Health Research Gateway recently compiled research coauthored by multiple NRHA members related to aging in place, race and rurality regarding maternal health disparities, rural mental health, and the travel burden to receive care. Additionally, a recording is available of a recent EMSC Innovation and Improvement Center webinar on optimizing clinical care processes for children and adolescents presenting to the ED with acute suicidality through quality improvement collaboratives. Teams can enroll through Jan. 13. Advocate for the mental health needs of your rural community by joining NRHA and hundreds of rural health stakeholders Feb. 7-9 at NRHA’s 34th Rural Health Policy Institute.

Key Informant Perspectives on Supporting Health and Well-Being for LGBTQ+ Rural Residents

September 22. 2022

Key Informant Perspectives on Supporting Health and Well-Being for LGBTQ+ Rural Residents

Estimates indicate that lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) individuals make up approximately 3-5% of rural residents in the U.S., equaling approximately 3 million people. The impact of intersecting challenges related to rurality, combined with those related to sexual orientation and gender identity are not well known. More information is needed from experts focused on LGBTQ+ health on the specific challenges and opportunities related to supporting the well-being of LGBTQ+ rural residents.

This policy brief presents findings from interviews with national LGBTQ+ support organizations regarding challenges to physical and mental health and well-being for LGBTQ+ individuals in rural communities, as well as considerations for improving the ability to meet the needs of LGBTQ+ individuals living in rural areas.

Contact Information:

Megan Lahr, MPH
University of Minnesota Rural Health Research Center
Phone: 612.624.3921
lahrx074@umn.edu

Additional Resources of Interest:

Review of Rural U.S. Economic and Health Care Trends

Date: September 19, 2022

Review of Rural U.S. Economic and Health Care Trends

This report reviews recent literature and publicly available data to explore important issues at the nexus of health care and local economic vibrancy. The report also explores the economic implications associated with COVID-19, however full impacts will not be known for several years.

Key Takeaways

  • There have been 140 rural hospital closures between January 2010 and July 2022. While some facilities have converted to other health care purposes, the majority have completely shut down.
  • There are additional losses to a community associated with a rural hospital closure including both the loss of hospital spending as well as a reduction in employee spending (due to a loss of employment). Other industries including restaurants, professional services, and other healthcare services are negatively impacted when a rural hospital closes or contracts in size.
  • Rural ambulance services are facing significant challenges including reimbursement, workforce, and funding for operations. The closure of rural hospitals further exacerbates these issues.
  • There continues to be a shortage of health professionals in many rural areas. For some professions, there is an excess supply of providers in urban areas and a shortage in rural places.
  • Those states that opted to expand Medicaid have lower uninsured rates (in both rural and urban areas). Insurance premiums through health insurance markets continue to climb as number of insurance companies decline.

Contact Information:

Alison F. Davis, PhD
Center for Economic Analysis of Rural Health
Phone: 859.257.7260
alison.davis@uky.edu

Additional Resources of Interest:

Availability of Emergency Department, Nursing Home, and Substance Use Disorder Services in Minoritized Racial/Ethnic Group Areas

Date: September 15, 2022

Availability of Emergency Department, Nursing Home, and Substance Use Disorder Services in Minoritized Racial/Ethnic Group Areas

This series of briefs documents disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic group (MRG) residents.

Availability of Hospital-Based Emergency Department and Trauma Services in Minoritized Racial/Ethnic Group Areas

  • The median distance to the nearest emergency department in rural ZCTAs with a top proportion of minoritized groups was 16.2 miles compared to 3.9 miles for urban ZCTAs of the same classification. Similarly, rural MRG ZCTAs were a median of 25.6 miles from trauma services versus 6.4 miles for urban MRG ZCTAs.
  • Within rural ZCTAs, the ZCTAs at the top of the distribution for minoritized populations were slightly farther from an emergency department or trauma center.

Availability of Nursing Homes in Minoritized Racial/Ethnic Group Areas

  • Top MRG ZCTAs having the greatest median distance to a nursing home were American Indian/Alaska Native (AI/AN) (13.2 miles), Hispanic (10.6 miles), and multiple MRGs (11.3 miles). Rural ZCTAs were a median of 8.2 miles from the nearest nursing home compared to 2.9 miles for urban ZCTAs.
  • Overall, only 4.6% of rural ZCTAs lacked access to a nursing home within 30 miles. However, when looking at the top MRG ZCTAs, the percentage of rural ZCTAs lacking access to a nursing home within 30 miles was 14.7% for more than one MRG population ZCTAs, 13.6% for top AI/AN ZCTAs, and 11.1% for top Hispanic ZCTAs.

Availability of Substance Use Disorder Treatment in Minoritized Racial/Ethnic Group Areas

  • The median distance to the nearest methadone treatment program across all rural ZCTAs was 27.7 miles versus 8.0 miles for urban ZCTAs.
  • Overall, rural ZCTAs were more distant from the nearest buprenorphine provider than urban ZCTAs at a median of 8.0 versus 4.2 miles respectively.
  • Access to buprenorphine providers appeared poorest for top AI/AN ZCTAs with 11.9% of rural and 10.6% of urban top AI/AN ZCTAs being more than 30 miles from the nearest buprenorphine provider.

Contact Information:

Janice C. Probst, PhD
Rural and Minority Health Research Center
Phone: 803.251.6317
jprobst@mailbox.sc.edu

Additional Resources of Interest:

Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22

Date: September 14, 2022

Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22

Since the 2014 implementation of Health Insurance Marketplaces (HIMs), authorized by the Patient Protection and Affordable Care Act of 2010, considerable changes have been observed in the number of insurance companies offering plans across the 50 states and the District of Columbia. This policy brief describes the changes in HIM plan issuers over the 2014-2022 period with an emphasis on the variation across metropolitan and non-metropolitan places.

Key Findings

  • Non-metropolitan counties have had less marketplace participation than metropolitan counties since their implementation in 2014. However, issuer participation in metropolitan and non-metropolitan counties fluctuates in a similar manner over time.
  • Since 2018, metropolitan, micropolitan, and noncore counties have experienced steady growth in the number of competing issuers in the marketplaces.
  • A larger percentage of non-metropolitan counties (micropolitan: 37.9 percent; noncore: 42.3 percent) had fewer than three issuers participating in the marketplaces, compared to metropolitan counties (20.8 percent).
  • Non-metropolitan counties in states that have expanded Medicaid have had greater marketplace participation on average than their counterparts in states that have not expanded Medicaid. However, this difference appears to be closing as of 2022.

Contact Information:

Timothy D. McBride, MS, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 314.935.4356
tmcbride@wustl.edu

Additional Resources of Interest:

Providing High-Quality Support to Pregnant People and Their Families in Racially Diverse Rural Communities

Date: August 29, 2022

Providing High-Quality Support to Pregnant People and Their Families in Racially Diverse Rural Communities

Compared with urban birthing people, rural residents experience higher rates of infant mortality, maternal mortality, and severe maternal morbidity. Rural residents who are Black, Indigenous, and People of Color have the highest maternal mortality and infant mortality rates in the country. At the same time as mortality and morbidity are rising, a steady trend of rural hospital and maternity unit closures has reduced access to care for pregnant rural residents. Still, some rural communities thrive, providing high-quality support to pregnant people, parents, infants, and families. This case series highlights examples from racially diverse rural communities, where hospitals and health systems with obstetric units strive to meet patient needs and provide evidence-based, supportive services during pregnancy, childbirth, and the postpartum period.

Contact Information:

Mariana Story Tuttle, MPH
University of Minnesota Rural Health Research Center
Phone: 612.626.8401
tuttl090@umn.edu

Additional Resources of Interest:

Availability of Home Health, Hospice, and Pharmacy Services in Minoritized Racial/Ethnic Group Areas

Date: August 25, 2022

Availability of Home Health, Hospice, and Pharmacy Services in Minoritized Racial/Ethnic Group Areas

This series of briefs documents disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic group (MRG) residents.

Availability of Home Health Services in Minoritized Racial/Ethnic Group Areas

  • In the U.S., home health agency reporting services are not available in 5.9% of all ZCTAs and an additional 10.3% of ZCTAs receive services from a single agency.
  • In 2020, 10.3% of all rural ZCTAs and 2.2% of all urban ZCTAs lacked home health service access. As a ZCTA becomes more rural and remote, these communities are more likely to lack any home health care or have limited service.
  • Within rural ZCTAs in the top 5th percent for minoritized population group representation, non-Hispanic Black representation was less likely to lack all home health services and non-Hispanic American Indian/Alaska Native representation was more likely to lack all home health services when compared to “all other” rural ZCTAs.

Availability of Medicare-Certified Hospice Services in Minoritized Racial/Ethnic Group Areas

  • Centers for Medicare & Medicaid Services-certified hospice providing services are not available in 5.6% of ZCTAs and 14.2% are served by a single hospice.
  • In 2020, 2.4% of all urban ZCTAs had no service while 9.4% of all rural ZCTAs had no service.
  • Within rural ZCTAs in the top 5th percent for minoritized population group representation, American Indian/Alaska Native (32.6%), Asian American/Pacific Islander (12.9%), non-Hispanic white (24.7%), and multiple MRG groups (23.1%) were each more likely than “all other” rural ZCTAs to lack any hospice service (4.5%).

Availability of Pharmacies in Minoritized Racial/Ethnic Areas

  • The mean density of pharmacies across rural ZCTAs was 1.2 pharmacies per 10,000 persons. The mean density of pharmacies across urban ZCTAs was 1.7 pharmacies per 10,000 persons.
  • The lowest density of pharmacies across rural-urban MRG designation was found in rural Hispanic ZCTAs.

Contact Information:

Janice C. Probst, PhD
Rural and Minority Health Research Center
Phone: 803.251.6317
jprobst@mailbox.sc.edu

Additional Resources of Interest:

More information from the Rural Health Information Hub’s topic guides: Healthcare Access in Rural Communities, Rural Home Health Services, Rural Hospice and Palliative Care, Rural Pharmacy and Prescription Drugs

Medicare Beneficiary Access to Prescription Drugs in Rural Areas

Date: August 24, 2022

Medicare Beneficiary Access to Prescription Drugs in Rural Areas

Data from the National Council for Prescription Drug Programs from 2016-2017 was used to identify four cohorts of rural counties based on pharmacy availability: counties with no retail pharmacy, counties with an independent pharmacy only, counties with one chain or franchise pharmacy only, and other rural counties with more than one pharmacy. Medicare Part D claims data from 2017 for beneficiaries residing in each of the county cohorts was analyzed to determine the source of their prescription medications.

Key Findings:

  • More Part D beneficiaries residing in rural counties with no retail pharmacy (19.5 percent) used a mail-order pharmacy compared to beneficiaries in rural counties with a pharmacy presence (15.8 – 17.1 percent across the three other cohorts).
  • Part D beneficiaries in rural counties with no retail pharmacy used a higher number of pharmacies overall (1.84 pharmacies) compared to Part D beneficiaries in rural counties with a pharmacy presence (1.68-1.74 pharmacies).
  • Beneficiaries residing in rural counties with no retail pharmacy traveled an average of 28.5 miles to use a community pharmacy compared to an average range of 6.5 – 13.1 miles for beneficiaries residing in rural counties with some type of pharmacy presence.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Additional Resources of Interest:

Rural and Urban Pharmacy Presence – Pharmacy Deserts

Date: August 22, 2022

Rural and Urban Pharmacy Presence – Pharmacy Deserts

The purpose of this brief is to examine the availability of community pharmacies and their provided services in rural areas of the U.S. The brief also provides a deeper analysis of counties with no retail pharmacies (i.e., pharmacy deserts) based on metropolitan/nonmetropolitan locations.

In 2021, there were 138 counties with no retail pharmacy, including 101 noncore, 15 micropolitan, and 22 metropolitan counties. By most measures, the proportion of the population considered vulnerable, including nonwhite, uninsured, unemployed, and income below the federal poverty level, is higher in noncore counties with no retail pharmacies than in other counties with no retail pharmacies. Further, the percent of population aged 65 and older and the percent aged 85 and older are higher in noncore and micropolitan counties with no pharmacy than in metropolitan counties.

Despite the possibility of using telepharmacy to improve access to health services in medically underserved regions, only around half of U.S. states have passed legislation authorizing telepharmacy.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Additional Resources of Interest:

Changes in the Provision of Health Care Services by Rural Critical Access Hospitals and Prospective Payment System Hospitals

Date: August 18, 2022

Changes in the Provision of Health Care Services by Rural Critical Access Hospitals and Prospective  Payment System Hospitals in 2009 compared to 2017

The purpose of this brief is to explore changes in the availability and provision of different health care services among rural Critical Access Hospitals (CAHs) and Prospective Payment System (PPS) hospitals in 2009 compared to 2017. We analyzed data regarding the availability of different health care services from the American Hospital Association (AHA) Annual Survey DatabaseTM.

Key Findings:

  • Of the 29 services considered, most increased by 2017. Twenty-three services increased among rural CAHs, and 21 increased among rural PPS hospitals.
  • One service remained the same among rural CAHs (assisted living), and three services remained the same among rural PPS hospitals (assisted living, emergency department, and adult general medicine/surgery). These also changed very little among rural CAHs.
  • The percentage of hospitals offering four service specialties—birthing/postpartum services, medical/surgical intensive care, obstetrics, and skilled nursing— declined in both rural CAHs and rural PPS hospitals when comparing 2009 to 2017.
  • In addition to the aforementioned services, rural CAHs were less likely to offer adult general medicine/surgery and home health services in 2017 than they were in 2009.
  • Rural PPS hospitals were less likely to offer pediatric general medicine/surgery in 2017 than in 2009.

Contact Information:

George H. Pink, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.843.2728
gpink@email.unc.edu

Additional Resources of Interest: