I work in a small rural healthcare hospital that is critical access. I have found a journal article that talks about barriers to primary care access. Journal Club Assignment- Inquiry
The article that I have chosen is, “Barriers to Primary Care access in Rural Medically Underserved Areas.” This article talks about how patients’ certain factors that limit or make them unable to get to primary care in rural areas. There was a study done in this article that is discussed of which two focus groups were performed. These two focus groups were composed of eight participants each responded to open ended questions and then they were able to generate their answers based on these sessions relating to primary care and access to healthcare. In this article the results then go to show about how 10% of the nation’s primary providers do not have enough time to perform effective or safe care.
Residents of rural areas have difficulty obtaining access to healthcare. Rural residents are more likely to be elderly, poor, and have chronic medical conditions compared to residents of metropolitan areas (Douthit, Kiv, Dwolatzky, & Biswas, 2015). Additionally, they have less access to transportation and poor availability of internet services (Douthit, Kiv, Dwolatzky, & Biswas, 2015). They often have to travel far distances to receive high-quality care. Another problem deals with primary care providers. There is a lack of trained physicians, difficulty in attracting and retaining physicians, and maintaining health services in rural communities (Douthit, Kiv, Dwolatzky, & Biswas, 2015). Rural providers often have limited time, staff, and infrastructure to provide quality healthcare. A solution to improve access to care is to help patients find the least expensive option for transportation, insurance, and medication.
Did the study mention health literacy, education, employment, housing, and transportation? These are factors that affect health care outcomes. Were the individuals reluctant to seek health care services? Do you think the results would be different if the sample size was bigger than 8 individuals?
Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some important barriers to health care access in the rural usa. Public Health, 129(6), 611-620.
Unfortunately this study did not mention health literacy, education, emolument, housing, and transportation. These factors would definitely be good things to take into account to see if we had the information to show what we would be able to get more access to, to be able to help people with access. I don’t think that the results would be that much different if the sample size was bigger honestly. Being from a small rural area myself I do see how that the size of the study won’t impact as many people around me do not have the access as they should.
I live in a rural community with our closest hospital being 13 miles away. It was interesting looking through the research provided. The sample size seemed questionable to me. “There were only eight people that participated.” Having such a small sample number can lead to radical outcomes. For example, if two people had issues with transportation then that would leave the results to 25%. A larger sample size can prevent such radical outcomes. This has no reflection on you as a student, there were just issues with the study used in the article.
Ali. (2009, November 30). The Sampling Issues in Quantitative Research. Retrieved from https://eric.ed.gov/?id=EJ919871
I was reluctant myself with the sample size only being eight people. At the same time I do see how that it could maybe not change as much since it is a problem all around for rural communities and I feel as if the outcomes would stay around the same.
Limited access to primary care in rural communities is a growing concern. “About 20 percent of Americans live in rural areas, but barely one-tenth of physicians practice there. The federal government projects a shortage of over 20,000 primary care physicians in rural areas by 2025” (Nielsen, D’Agostino, & Gregory, 2017). The shortage of primary care in rural communities can cause many issues. One of them being delayed care, which can lead to severe complications or secondary issues.
I grew up in Dodge City, KS, which is in Southwestern Kansas. Growing up in Dodge, I did see many disparities in the health care system related to geographical location. For example, there were few specialists in the town. Most of the time you would either have to travel out of town to Wichita, KS, which is about two and a half hours away, or wait until a specialist went to the town on their biweekly or monthly visits. Now that I live in Wichita, KS, I rarely hear of people having to travel to see specialists. Also, there are many more urgent/immediate-care clinics. I truly appreciate these resources because I witnessed first-hand how difficult it was for people back home who couldn’t take the time off of work or find a ride to take them to their out of town appointments.
As for the study you selected, like our other peers, I too question the sample size and its implications on the results. Did you find any other studies that might have had a larger sample size but just didn’t meet the assignment requirements (like within the last year)?
Nielsen, M., D’Agostino, D., & Gregory, P. (2017). Addressing Rural Health Challenges Head On. Missouri medicine, 114(5), 363–366.
I have not yet found any studies on this yet. But I do agree that I need to find more to be able to compare the entries to this study to see if this still holds up true.
I also reside in a rural community in Kansas. I work for a Magnet organization and they provide many specialty services even in rural clinics. The particular clinic that I work in provides nephrology, cardiology, allergy and immunology, neurology, endocrinology, orthopedics, pediatric cardiology, and pediatric endocrinology. These specialty providers have regular rotations at our clinic saving patients time and money. This are specialties that patients would otherwise have to travel 55 to 120 miles one way to receive. In my current role as a care manager I encounter many patients that do not have transportation. Being that we are in a rural area we are very limited in public transportation as well. We have one taxi service and one small county transportation van. Due to lower service demand, specialists and subspecialists generally cluster in more urbanized areas with larger populations to support their practice, resulting in fewer rurally located specialists and thus greater reliance on primary care providers (Cyr, Etchin, Guthrie, Benneyan, 2019). The access to specialty providers is beneficial to our patients and our primary care providers.
Elderly, women, children, racial and ethnic minorities, socioeconomically disadvantaged, and individuals with chronic health conditions disproportionately experience greater specialty care access challenges and poorer health outcomes despite geographic residence, especially in medically underserved urban and rural areas (Cyr et al, 2019). Social determents are also barriers in access to healthcare in rural areas. This can include education level, access to food which affects diet, exercising status, family dynamics, alcohol or drug abuse, employment status, etc. Healthcare is finally starting to give more leverage to the social determents of health and the role they play. What social determents of health do you see as a barrier in your communities?
My community has three factories so we have a large immigrant population with language as a large barrier. Also, for this population education level is a barrier.
Reference:
Cyr, M. E., Etchin, A. G., Guthrie, B. J., & Benneyan, J. C. (2019). Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC health services research, 19(1), 974. https://doi.org/10.1186/s12913-019-4815-5
In my community I would definitely say that money is our biggest barrier. As many of the people in my community are from lower income status I feel as if they don’t seek out medical help as much as they should. Along with elderly, and ways to commute are other barriers that I would say unfortunately my community has as barriers. I wish there was ways that we could help the community with these barriers to be able to help people seek medical attention.
Rural healthcare is a very difficult area to work. There are barriers that in the urban setting do not have to be addressed in an article by Douthit, Kiv, Dwolatzky, & Biswas they focused on the differences between the rural and urban areas. Some examples were ” Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by a scarcity of services, a lack of trained physicians, insufficient public transport, and poor availability of broadband internet services” Biswas, Douthit, Dwolatzky &Kiv, 2015)
The focus on these disparities alone make rural nursing hard. I have definitely seen patients’ hold off on seeking medical attention because of lack of financial means. Being a small area where everyone knows everyone some patients would rather go out with being seen instead of being faced with community members knowing their lack of ability to pay.
Has this been an issue you have encountered? Do you think the article you choose had an adequate sample size to get true results?
Biswas, S.,Douthit, N., Dwolatzky, T., & Kiv, S. (2015). Exposing some important barriers to health care access in the rural usa. Public Health, 129(6), 611-620.
This definitely is an issue that I encounter quite a few times within my community and out hospital. I do think that I need to find another study that has a little more of a comparison with more study subjects in it though as the results may vary.
This is a small study with limited diversity of those interviewed, as admitted by the authors (Hewitt, McNiesh, & Fink, 2019). I could not tell if this was IRB reviewed or not. I would be interested to see the subject go beyond primary care as well, as specialty care is a huge issue for those in rural communities as well. Mental health and substance abuse are other areas in which rural residents have limited access to treatment and prevention. Living in a small community can make individuals fear getting “outed” for their mental health or substance abuse struggles and can make them not want to seek care locally out of desire for privacy (Rigg, Monnat, & Chavez, 2018). I would be curious to know Additionally, where I live, it is over an hour to even get to a substance abuse treatment center which can be a huge challenge for those in rural communities. I am wondering how this could also be addressed as rural primary care providers often lack specialized training to address these issues?
Hewitt, S., McNiesh, S., & Fink, L. (2019). Barriers to Primary Care Access in Rural Medically Underserved Areas. Online Journal of Rural Nursing and Health Care, 19(2), 127–155.
Rigg, K. K., Monnat, S. M., & Chavez, M. N. (2018). Opioid-related mortality in rural America: Geographic heterogeneity and intervention strategies. International Journal of Drug Policy, 119-129. https://doi.org/10.1016/j.drugpo.2018.04.011
This article didn’t exactly say that it was IRB reviewed. Unfortunately all it had said was that it was reviewed by the people that needed to view it which makes me hesitate with this article at times. But the information I do still see being relevant in my community.
I used to live in a very rural area in Haskell county in southwest Kansas. I lived in Sublette and worked in Satanta which was only 7 miles away and both communities shared resources. The hospital, nursing home and assisted living were all connected in one building. The hospital was a 12 bed and the nursing home held up to 42 patients. I worked as a nurse on the nursing home side and access to specialty doctors was very difficult. Many doctors travelled to Garden City and even at times we had to transport a resident 4 hours away for care and depending on the resident a CNA and a nurse would travel with them. With a such rural area access to care is difficult as not a lot of people want to live in such a rural area. I didnt realize how limited we were as it was the normal, until I moved to Colorado Springs. There is so much that my hometown doesn’t have access to that the community would benefit from if they could.