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Article
Publication date: 15 October 2018

Bret Hicken and Kimber Parry

The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to…

Abstract

Purpose

The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.

Design/methodology/approach

This is a descriptive paper summarizing population and program data about rural veterans.

Findings

VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.

Originality/value

This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.

Details

Quality in Ageing and Older Adults, vol. 19 no. 4
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 14 September 2018

Joyce Weil, Gwyneth Milbrath, Teresa Sharp, Jeanette McNeill, Elizabeth Gilbert, Kathleen Dunemn, Marcia Patterson and Audrey Snyder

Integrated transitions of care for rural older persons are key issues in policy and practice. Interdisciplinary partnerships are suggested as ways to improve rural-care…

Abstract

Purpose

Integrated transitions of care for rural older persons are key issues in policy and practice. Interdisciplinary partnerships are suggested as ways to improve rural-care transitions by blending complementary skills of disciplines to increase care’s holistic nature. Yet, only multidisciplinary efforts are frequently used in practice and often lack synergy and collaboration. The purpose of this paper is to present a case of a partnership model using nursing, gerontology and public health integration to support rural-residing elders as a part of building an Adult-Gerontology Acute Care Nurse Practitioner program.

Design/methodology/approach

This paper uses the Centre for Ageing Research and Development in Ireland/O’Sullivan framework to examine the creation of an interdisciplinary team. Two examples of interdisciplinary work are discussed. They are the creation of an interdisciplinary public health course and its team-based on-campus live simulations with a panel and site visit.

Findings

With team-building successes and challenges, outcomes show the need for knowledge exchange among practitioners to enhance population-centered and person-centered care to improve health care services to older persons in rural areas.

Practical implications

There is a need to educate providers about the importance of developing interdisciplinary partnerships. Educational programming illustrates ways to move team building through the interdisciplinary continuum. Dependent upon the needs of the community, other similarly integrated partnership models can be developed.

Originality/value

Transitions of care work for older people tends to be multi- or cross-disciplinary. A model for interdisciplinary training of gerontological practitioners in rural and frontier settings broadens the scope of care and improves the health of the rural older persons served.

Details

Quality in Ageing and Older Adults, vol. 19 no. 4
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 1 March 1998

Michael E. Samuels, Leiyu Shi and Norma J. Campbell

This article is a descriptive revenue profile of Community and Migrant Health Centers providing preventive and primary health care services to underserved rural and urban…

Abstract

This article is a descriptive revenue profile of Community and Migrant Health Centers providing preventive and primary health care services to underserved rural and urban populations throughout the United States. The study is a secondary data analysis of the 1994 Bureau Common Reporting Requirements (BCRR) reports of the 626 Community and Migrant Health Centers to the Bureau of Primary Health Care. The purpose of the analysis is to examine the sources of revenue of the centers and consider the implications for public policy. In 1994, the 626 centers generated more than $2 billion from all payment sources to care for more than 7 million users. The findings should guide and assist policy makers at the state and federal levels in first deciding the role of C/MHCs in developing managed health care strategies for underserved rural and urban populations and developing the appropriate funding policies to support these decisions.

Details

Journal of Public Budgeting, Accounting & Financial Management, vol. 10 no. 4
Type: Research Article
ISSN: 1096-3367

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Book part
Publication date: 28 September 2020

Matt T. Bagwell and Thomas T. H. Wan

Purpose – This study analyzed individual factors of race and dual eligibility on emergency room (ER) utilization of older adult Medicare patients treated by RHCs in CMS…

Abstract

Purpose – This study analyzed individual factors of race and dual eligibility on emergency room (ER) utilization of older adult Medicare patients treated by RHCs in CMS Region 4.

Methodology/approach – A prospective, longitudinal design was employed to analyze health disparities that potentially exist among RHC Medicare beneficiary patients (+65) in terms of ER use. The years of investigation were 2010 through 2012, using mixed multilevel, binary logistic regression.

Findings – This study found that dual eligible RHC patients utilized ER services at higher rates than nondual eligible, Medicare only RHC patients at: 77%, 80%, and 66%, in 2010, 2011, and 2012, respectively; and above the White reference group, Black RHC Medicare patients utilized ER services at higher rates of: 18%, 20%, and 34%, in 2010, 2011, and 2012, respectively.

Research limitations/implications – Regarding limitations, cohort data observations within the window of 3 years were only analyzed; regarding generalizability, in different CMS regions, results will likely vary; and linking other variables together in the study was limited by the accessible data. Future research should consider these limitations, and attempt to refine. The findings support that dual Medicare and Medicaid eligibility, as a proxy measure of socioeconomic status, and race continue to influence higher rates of ER utilization in CMS Region 4.

Originality/value – In terms of ER utilization disparities, persistently, as recent as 2012, Black, dual eligible RHC Medicare beneficiary patients age 65 years and over may be twice as likely to utilize ER services for care than their counterparts in the Southeastern United States.

Details

Race, Ethnicity, Gender and Other Social Characteristics as Factors in Health and Health Care Disparities
Type: Book
ISBN: 978-1-83982-798-3

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Book part
Publication date: 10 December 2016

Heidi Hodge, Dean Carson, Peter Berggren and Roger Strasser

This chapter examines the extent to which place based and research oriented university-community engagement (UCE) models can sustain UCE in “non-campus” rural settings. It…

Abstract

This chapter examines the extent to which place based and research oriented university-community engagement (UCE) models can sustain UCE in “non-campus” rural settings. It examines how effective partnerships function in non-campus rural settings, and their contributions to achieving the reciprocal aims of communities and universities. It highlights the key successes, challenges, and opportunities experienced through case studies in non-campus locations in rural Australia (Flinders University Rural Clinical School), rural Sweden (Centre for Rural Health, Storuman), and rural Canada (Northern Ontario School of Medicine). Information provided about the discussed case studies has been provided by the organizations themselves, and the chapter authors are heads of these organizations. The authors share their knowledge of the history, the challenges, the opportunities, and the mechanisms through which the models interact with the partners.

Details

University Partnerships for International Development
Type: Book
ISBN: 978-1-78635-301-6

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Book part
Publication date: 20 October 2014

Valentina Bodrug-Lungu and Erin Kostina-Ritchey

The purpose of this paper is to provide an overview of post-Soviet and demographic challenges faced by the government in Moldova that have posed as challenges to reform of…

Abstract

Purpose

The purpose of this paper is to provide an overview of post-Soviet and demographic challenges faced by the government in Moldova that have posed as challenges to reform of the healthcare system. Since independence from the Soviet Union in 1991, Moldova has undergone significant challenges and reforms throughout the society. Healthcare has been no exception. Changes in family structures due to migration, a decreased birthrate, and an aging population have placed strain on the healthcare system which is working to both modernize and provide specialized care. Legislation has helped to streamline and reform the healthcare system but systemic challenges are still faced by at-risk populations including the elderly, women, and rural populations.

Design

Information presented in this paper is based on a review of independent research, United Nations and government reports.

Findings

Findings show that progress has been made through legislative reform, new government programming, and most recently volunteer/nonprofit involvement in healthcare reform. Currently, the government is working to establish holistic patient centered care and to bridge the healthcare divide between rural and urban populations. Healthcare reforms include basic universal health care services and family support programming. Additionally, there has been a renewed emphasis on how environmental factors, like housing and nutrition, interact with health quality.

Value

Moldova faces an increasing challenge of caring for elderly populations at the family and societal level due to the increased number of elderly, shifts in family structures, and international migration for employment. A discussion of the developing role of nonprofit and nongovernment organizations is included.

Details

Family and Health: Evolving Needs, Responsibilities, and Experiences
Type: Book
ISBN: 978-1-78441-126-8

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Article
Publication date: 27 January 2012

Jill N. Peltzer and Cynthia S. Teel

This paper seeks to identify strategies that promote the development and sustainability of a successful comprehensive community health center located in a rural Mid‐western state.

Abstract

Purpose

This paper seeks to identify strategies that promote the development and sustainability of a successful comprehensive community health center located in a rural Mid‐western state.

Design/methodology/approach

The authors used a qualitative case study methodology, using a purposive sample of 15 employees and board members of a rural community health center. Semi‐structured interviews were conducted, transcribed, and analyzed for common themes and sub‐themes that would describe the strategies used to develop and sustain the successful center.

Findings

Leading with Consideration was identified as the dominant theme in the interviews, field notes and archival data. Four sub‐themes: Living the Mission, Fostering Individual Growth, Building a Community, and Encouraging Innovation, emerged from the narratives. Leadership was the most important theme that emerged from the data, resulting in a workforce culture that upholds the mission of the center, leadership that seeks to inspire the growth of both employees and clients. As a result, there is a sense of community and innovative health care endeavours that have created a sustainable holistic health care model.

Research limitations/implications

The themes that emerged from the narratives of the participants may not be transferable to other community health centers. The case selected for this study was located in a rural, primarily Caucasian setting, so the findings may not be transferable to urban or more racially diverse settings.

Practical implications

Transformational leadership may be an important concept for safety net clinics to promote a positive work environment that continually addresses the important mission of the organization, promotes retention of staff, and promotes staff to provide quality, continuity of care to clients to promote their health. Within current safety net organizations, the findings from this research may affirm leaders' servant leadership styles and how they positively impact their organization. Healthy work environments guided by transformational leaders promote retention of quality health care professionals, who in turn, provide quality care in medically underserved communities.

Originality/value

This study is one of the first qualitative studies to describe concepts that support the development of a successful, sustainable community health center.

Details

Leadership in Health Services, vol. 25 no. 1
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 21 November 2018

Martha R. Crowther, Cassandra D. Ford, Latrice D. Vinson, Chao-Hui Huang, Ernest Wayde and Susan Guin

Older adults are at risk for developing metabolic syndrome (MSX). Given the growing rural older adult population and the unknown prevalence rate of MSX in rural

Abstract

Purpose

Older adults are at risk for developing metabolic syndrome (MSX). Given the growing rural older adult population and the unknown prevalence rate of MSX in rural communities, the purpose of this paper is to assess the risk factors for MSX among rural elders.

Design/methodology/approach

Individuals aged 55+ from four West Alabama rural communities were assessed by an interdisciplinary healthcare team via a mobile unit (n=216). Descriptive analyses and analysis of variances (ANOVA) were conducted to assess the effect of gender, race and community on the number of risk factors of MSX among rural elders.

Findings

Results of a three-way ANOVA revealed a significant interaction between gender, age and community on the number of MSX risk factors [F (16,193)= 2.41, p <0.01]. Rural communities with lower social economic status (SES) and predominantly African American residents were at higher risk for developing MSX compared to communities with higher SES [F(3, 68) = 7.42, p<0.05].

Practical implications

Findings suggest low SES rural communities are at risk of developing MSX. Innovative approaches such as mobile healthcare delivery are crucial to providing quality healthcare and preventive health screens to underserved rural older adult communities.

Originality/value

Limited research is available on assessing rural midlife and older adults at risk for metabolic syndrome largely due to lack of communication or transportation infrastructure and their history of negative experiences with public institutions. This research demonstrates that these barriers can be addressed.

Details

Quality in Ageing and Older Adults, vol. 19 no. 4
Type: Research Article
ISSN: 1471-7794

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Book part
Publication date: 20 October 2014

Jacy Downey and Kimberly Greder

The demographics of rural America are rapidly changing and concerns about mental health are growing. This study examined relationships between individual, family, and…

Abstract

Purpose

The demographics of rural America are rapidly changing and concerns about mental health are growing. This study examined relationships between individual, family, and community factors and depressive symptomology among rural low-income Latina and non-Latina White mothers.

Design

The sample for this study was drawn from the study, Rural Families Speak about Health. Data from interviews with 371 rural low-income mothers (36% Latina; 64% non-Latina White) were analyzed and descriptive and multivariate analyses were performed.

Findings

One-third of mothers experienced clinically significant depressive symptomology; non-Latinas experienced twice the rate as Latinas. Limitation in daily activities due to poor physical health predicted clinically significant depressive symptomology among both groups. Among non-Latinas, high levels of financial distress and lack of healthcare insurance predicted clinically significant depressive symptomology, and use of WIC and high levels of healthful eating and physical activity routines were protective factors. Age, single marital status, unemployment, transportation barriers, food insecurity, and inadequate health insurance predicted clinically significant depressive symptomology among Latinas.

Practical implications

Program administrators should consider factors associated with depression among specific populations as they design programs and services.

Research limitations

Factors not accounted (e.g., nativity of mothers) should be explored to more fully understand predictors of depressive symptomology among rural Latina and non-Latina mothers.

Value

This original research considers how the relationships between individual, family, and community factors and depressive symptomology differ between rural low-income Latina and non-Latina White mothers. The authors discuss potential factors and outcomes related to depressive symptomology and provide suggestions for research, programs and services.

Details

Family and Health: Evolving Needs, Responsibilities, and Experiences
Type: Book
ISBN: 978-1-78441-126-8

Keywords

Content available
Article
Publication date: 4 December 2017

Bita A. Kash, Paul Ogden, Elizabeth Popp, Melissa Shaffer and Jane Bolin

The purpose of this study is to identify best practices for innovative primary care models and to describe a potential future primary care (PC) model for Texas to address…

Abstract

Purpose

The purpose of this study is to identify best practices for innovative primary care models and to describe a potential future primary care (PC) model for Texas to address the burden of chronic disease in a population-based approach.

Design/methodology/approach

A systematic literature review was conducted and identified 1,880 published records through PubMed using 26 search terms. After abstract and full-text review, 70 articles remained as potential models.

Findings

Although there is already a severe shortage of physicians in Texas, emerging practice patterns and choices among physicians are likely to erode access to primary care services in the state. Health-care leaders are encouraged to consider models such as complex adaptive systems for team-based care, pharmacist hypertension care management program and combined nurse-led care management with group visit structure.

Research limitations/implications

As with any study, this research has its limitations; for example, models that might work in one state, or under a unique state-funded academic medical center, might not be “do-able” in another state within the nuances of a different funding mechanism.

Practical implications

Results of this research provide a model for implementing IPCM for the state of Texas first and will guide IPCM planning and implementation in other states.

Originality/value

This study is “land grant-centric” and focused on carrying out the mission of a major, top-tier research university with an emerging college of medicine at an academic medical center.

Details

International Journal of Innovation Science, vol. 9 no. 4
Type: Research Article
ISSN: 1757-2223

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