Category: Rural Health Research Gateway

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:

Types of Rural and Urban Hospitals and Counties Where They Are Located

Date: August 1, 2022

Types of Rural and Urban Hospitals and Counties Where They Are Located

This brief provides a snapshot of the types of rural and urban hospitals and the counties where they are located.

Key Findings
As of December 2020, there are 4,306 acute hospitals in the U.S.—1,334 Critical Access Hospitals (CAHs), 11 cancer hospitals, 1,924 Prospective Payment System hospitals (PPS-only), and 1,037 PPS hospitals with special payment designations. 2,176 hospitals are in rural locations and 2,130 are in urban locations.

  • There are CAHs, PPS-only hospitals, and PPS hospitals with special payment designations in both urban and rural locations.
  • Hospitals in rural locations are primarily CAHs and hospitals in urban locations are primarily PPS-only hospitals.
  • Counties with < 50K population are primarily served by CAHs and counties with > 50K population by PPS-only hospitals.
  • The acute average daily censes (ADCs) in hospitals in counties with < 50K population are much lower than the acute ADCs in hospitals in counties with > 50K population.

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:

Updated Resources from Rural Health Value

Date: July 28, 2022

The Rural Health Value team recently released two updated resources:

Related resources on the Rural Health Value website:

One-page summaries describe rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).

This tool helps a rural healthcare organization assess readiness for the shift of payments from volume to value. The resulting report may be used to guide the development of action plans.

 Contact information:

Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu

Increased Rates of Death from Unintentional Injury Among non-Hispanic White, American Indian/Alaska Native, and Nonmetropolitan Communities

Date: July 25, 2022

Increased Rates of Death from Unintentional Injury Among non-Hispanic White, American Indian/Alaska Native, and Nonmetropolitan Communities

Unintentional injury is the third leading cause of death in the U.S., with an age-adjusted death rate of 48.0 per 100,000 in 2018. The National Hospital Ambulatory Medical Care Survey public use datafile for 2018 was used to generate estimates of nonfatal unintentional injury rates.

Key Findings

  • Visits to the emergency department (ED) for unintentional injuries in 2018 were similar in metropolitan and nonmetropolitan areas.
  • The rate of deaths from unintentional injuries in 2018 was higher in nonmetropolitan areas, compared to metropolitan areas, for all racial/ethnic groups except non-Hispanic Black.
  • Living in a nonmetropolitan area was associated with the largest increase in deaths for those who are American Indian or Alaska Native.
  • Residents of nonmetropolitan areas are more likely than those living in metropolitan areas to suffer a fatal unintentional injury, though there was no difference in the rates of nonfatal unintentional injury ED visits.

Contact Information:

Jeffery Talbert, PhD
Rural and Underserved Health Research Center
Phone: 859.323.7141
jeff.talbert@uky.edu

Additional Resources of Interest:

New Articles Published on Health Care Access, Hospital Closures, Obstetrics, Medicare, Social Isolation, and Aging

Date: July 21, 2022

New Articles Published on Health Care Access, Hospital Closures, Obstetrics, Medicare, Social Isolation, and Aging

These journal articles written by the Rural Health Research Centers were recently added to Gateway.

Gateway lists the journal, a brief summary, and a link to additional information and access to the full text of the article, if available. While some journal articles are freely available, many require a subscription or affiliation with a subscribing library.

Additional Resources of Interest:

Rural Children with 4+ Adverse Childhood Experiences Often Lack Positive Experiences

Date: July 18, 2022

Rural Children with 4+ Adverse Childhood Experiences Often Lack Positive Experiences

Using the 2016-2018 National Survey of Children’s Health, this study looked at rural children with four or more adverse childhood experiences to determine the number and type of positive experiences for these rural children. The positive childhood experiences include after school activities, interaction with a community volunteer or connected caregiver, residing in a safe and supportive neighborhood, and living in a resilient family.

Contact Information:

Elizabeth Crouch, PhD
Rural and Minority Health Research Center
Phone: 803.576.6055
crouchel@mailbox.sc.edu

Additional Resources of Interest:

County-Level Availability of Obstetric Care and Economic Implications of Hospital Closures on Obstetric Care

Date: July 14, 2022

County-Level Availability of Obstetric Care and Economic Implications of Hospital Closures on Obstetric Care

This policy brief provides descriptive data on the economic changes underway in counties that lost obstetric care facilities between 2012 and 2019.

Key Findings

  • The majority of rural counties in the United States do not have an obstetric care provider within their borders.
  • Counties without obstetric care facilities have higher rates of poverty and lower rates of health insurance coverage across all ages.
  • For the years studied, data illustrate a decline in economic activity after counties experienced a loss in obstetric facilities, either through facility conversion or through hospital closure.
  • Counties which lost obstetric care access also had decreases in their labor forces and population of reproductive age.

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:

Racial Inequities in the Availability of Evidence-Based Supports for Maternal and Infant Health

Date: July 12, 2022

Racial Inequities in the Availability of Evidence-Based Supports for Maternal and Infant Health in 93 Rural U.S. Counties within Hospital-Based Obstetric Care

Being pregnant in rural America means facing interconnected challenges: a greater risk of pregnancy related complications or death and declining access to maternity care during pregnancy and childbirth. Rural residents who are Black, Indigenous, and People of Color (BIPOC) experience even poorer pregnancy-related health outcomes. Racial disparities in rural maternal and infant health outcomes may be related to limited accessibility of clinical care and pregnancy/postnatal support programs and services in rural communities. This policy brief describes these differences between majority-BIPOC versus majority-white rural counties’ available maternal and infant health evidence-based supports.

Contact Information:

Katy Kozhimannil, PhD, MPA
University of Minnesota Rural Health Research Center
Phone: 612-626-3812
kbk@umn.edu

Additional Resources of Interest:

Nursing Homes in Rural America: A Chartbook

Date: July 8, 2022

Nursing Homes in Rural America: A Chartbook

In this chartbook, the Rural Health Research & Policy Centers document nursing home availability at the county level and identify counties without nursing homes. The Rural Health Research & Policy Centers also evaluate the supply of nursing home beds per 1,000 population aged 65 and older. In addition, the Rural Health Research & Policy Centers identify county-level nursing home availability for counties with and without hospitals with swing beds. Finally, the Rural Health Research & Policy Centers describe the resident and nursing home characteristics including occupancy levels, payer mix, demographics, and health care needs. The Rural Health Research & Policy Centers summarize data for the noncore, micropolitan, and metropolitan counties.

Key Findings

  • A lower proportion of noncore counties have nursing home post-acute care and long-term care services. Even the inclusion of hospitals with swing beds does not eliminate the differences in access to post-acute care and long-term care services between noncore counties and metro/micropolitan counties.
  • Many noncore counties have a higher number of nursing home beds per 1,000 population aged 65 and older, particularly in the Midwest. However, differences in the beds per 1,000 population aged 65 and older between noncore counties and metropolitan counties vary by states/regions.
  • Residents of nursing homes in noncore counties are less likely to have functional limitations but are more likely to have behavioral/mental health needs.

Contact Information:

Hari Sharma, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.4368
hari-sharma@uiowa.edu

Additional Resources of Interest: