The Journal Of Rural Health[JOURNAL]
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200 papers
Barriers to consulting for symptoms of possible colorectal cancer among rural patients in England: A cross-sectional survey.
Haworth EJ, Sharp L, Deane J … +6 more , Ellwood C, Rubin GP, Murchie P, Macdonald S, Angell L, Dobson CM
J Rural Health · 2026 Mar · PMID 41910385 · Full text
BACKGROUND: Rural cancer inequalities are well-documented globally, but their causes remain unclear. Late diagnosis may impact rural cancer outcomes; however, little is known about rural patients' beliefs and experiences...
BACKGROUND: Rural cancer inequalities are well-documented globally, but their causes remain unclear. Late diagnosis may impact rural cancer outcomes; however, little is known about rural patients' beliefs and experiences of consulting for cancer symptoms. METHODS: 3400 eligible patients from four primary care practices in rural England were invited to participate. Participants completed a survey about recent symptomatic experience and beliefs about accessing health care. Barriers to accessing primary care were grouped into three domains (individual level, primary care, contextual) and scored. ANOVAs (analysis of variance) were used to investigate variation in scores by fixed socio-demographic characteristics. RESULTS: 722 surveys were returned (response rate = 21%). Consultation for symptoms was significantly associated with deprivation and age. Participants in the least rural areas, or registered at larger practices, had significantly higher mean scores for barriers to help-seeking across all three domains. Participants in the least deprived areas had the highest scores across all three domains. Women, younger participants, and those currently working had significantly higher scores for contextual barriers. The most commonly reported barriers to help-seeking were work commitments, appointment availability, relationship with General Practitioners and road infrastructure. CONCLUSIONS: This is one of the first studies to undertake a granular examination of help-seeking behaviors and barriers for rural residents. We found no association between degree of rurality and likelihood of consultation. The higher reporting of help-seeking barriers among people in the least remote areas, or registered at larger practices, challenges assumptions that the most remote patients face the greatest obstacles to consultation.
Growth in Medicare Advantage by organizational size across rural and urban counties.
Shane DM, Ullrich F, Mueller KJ
J Rural Health · 2026 Mar · PMID 41910368 · Full text
PURPOSE: To understand the changing landscape of Medicare Advantage (MA) markets in urban and rural counties with particular focus on the size of MA organizations. With MA covering more than half of all Medicare enrollee...
PURPOSE: To understand the changing landscape of Medicare Advantage (MA) markets in urban and rural counties with particular focus on the size of MA organizations. With MA covering more than half of all Medicare enrollees and notably different health and access conditions in rural areas, understanding the extent of participation in MA markets in both urban and rural areas is critical. In this paper, we establish which organizations are offering MA plans and which organizations' plans are being chosen by eligible Medicare beneficiaries. METHODS: Data on MA plan availability, parent organizations, and enrollment for 2019 through 2026 were obtained from CMS websites. Classification of counties was based on 2024 Urban Influence Codes (UIC): metropolitan (1, 4); micropolitan (2, 5, 7); nonmetropolitan (3, 6, 8, 9). We offer a taxonomy of MA organizations based on the number of states where MA organizations offer plans: national (29-50 states), large regional (6-18 states), small regional (2-5 states), local (1 state). FINDINGS: The overall size of the MA population grew 59% from 2019 to 2025, including doubling growth in the most rural counties. The proportion of the MA population enrolled in plans from national MA organizations and small regional organizations has increased monotonically over this period. Notably, this trend has featured across both urban and rural counties. Enrollment in plans from local MA organizations has declined across all geographic locations. CONCLUSION: National MA organizations continue to dominate the landscape across both urban and rural counties, with nearly 65% of total enrollment in 2025. Moreover, over 80% of the growth in available plans from 2019 to 2025 were offered by these same four or five organizations.
Rural perspectives on for-profit health care in rural Georgia.
Anglim CE, DeGarmo J, Carter DE … +1 more , Jacques EJ
J Rural Health · 2026 Mar · PMID 41891209 · Publisher ↗
PURPOSE: This study aims to describe how rural residents in Georgia (USA) perceive for-profit health care and the impacts on rural patients and their communities. METHODS: Researchers conducted interviews with adults res...
PURPOSE: This study aims to describe how rural residents in Georgia (USA) perceive for-profit health care and the impacts on rural patients and their communities. METHODS: Researchers conducted interviews with adults residing in rural Georgia counties (determined by residence or work in counties designated as fully rural by the Federal Office of Rural Health Policy (FORHP)) and analyzed participants' perspectives for themes on for-profit health care models in rural areas. Methods cohere with SRQR guidelines. FINDINGS: Across the dataset, four themes captured participant perspectives: (1) acknowledgement of the difficulty of operating rural health care facilities; (2) ambivalence about the commodification of rural health care; (3) advocacy for more government support of rural health care facilities, providers, and patients; and (4) mixed views about the professional autonomy, work-life balance, and burnout of doctors working in doctor-owned practices. Together these themes highlight the complex interplay of ethical, financial, and practical considerations shaping rural residents' attitudes toward for-profit (and especially private equity-owned) health care facilities. CONCLUSIONS: Participants expressed ambivalence about the commodification of rural health care. They were concerned about the consequences of for-profit companies buying up their local health care services but more worried about those services shutting down altogether. They seemed to adopt a "better than nothing" attitude, though they were acutely aware of the negative impacts of reduced federal support for rural health care.
The role of residence tenure on rural Medicare beneficiaries' health outcomes.
Ligus K, Bellizzi K, Robison J
J Rural Health · 2026 Mar · PMID 41891140 · Publisher ↗
PURPOSE: Rural older adults with chronic disease face greater health care access and quality barriers than non-rural older adults which may result in poorer health-related quality of life (HRQoL). Few studies have explor...
PURPOSE: Rural older adults with chronic disease face greater health care access and quality barriers than non-rural older adults which may result in poorer health-related quality of life (HRQoL). Few studies have explored if rural health disparities are related to geographic mobility, specifically, how long an individual has lived in a particular area. This study explored the relationship between residence tenure (aging-in-place vs. in-migrants), HRQoL and preference for health care decision-making among a nationally representative sample of Medicare beneficiaries living with a chronic disease. METHODS: Using National Health and Aging Trends (NHATS) data, we examined 1012 older Medicare beneficiaries living with a chronic disease who participated in a supplemental chronic disease self-management (CDSM) module. FINDINGS: Of the rural residents (n = 218) in the sample, 76% were aging-in-place (n = 166) and 24% were in-migrants (n = 52). Aging-in-place older adults reported lower self-rated health (M = 3.12, p < 0.05) than in-migrants (M = 3.31) and non-rural residents (M = 3.35) and reported higher anxiety (M = 0.99, p < 0.05) than in-migrants (M = 0.54) and non-rural residents (M = 0.73). CONCLUSIONS: Results showed that rural older adults were not more likely to prefer independent health care decision-making, contrasting some previous studies. Implications of this research point to needed improvements in delivering person-centered care in clinical settings and in Medicare mental health coverage. The role of residence tenure in health outcomes is an important topic for ongoing examination.
Expanding access to low-barrier opioid use disorder treatment in non-traditional settings: Washington's opioid treatment network.
Daily SM, Reif S, Speaker E … +3 more , Panas L, Ritter GT, Stewart MT
J Rural Health · 2026 Mar · PMID 41891139 · Full text
PURPOSE: Increasing utilization of medications that treat opioid use disorders (MOUD) remains an essential strategy to curb the opioid crisis nationwide, especially among rural areas where access can present challenges....
PURPOSE: Increasing utilization of medications that treat opioid use disorders (MOUD) remains an essential strategy to curb the opioid crisis nationwide, especially among rural areas where access can present challenges. Washington State expanded access to MOUD through its opioid treatment networks (OTN), which provide low-barrier access to MOUD in non-traditional settings with an emphasis on buprenorphine and rural locations. We examined changes in buprenorphine utilization between Medicaid beneficiaries who initiated treatment at OTNs compared to individuals outside OTN facilities and by rural-urban residence. METHODS: We used comparative time-series analyses to examine longitudinal patterns of buprenorphine utilization among a sample (n = 93,401) of age 18 to 64 Washington State Medicaid beneficiaries diagnosed with OUD between 2019 and 2022. Monthly aggregated rates of buprenorphine utilization, stratified by OTN versus non-OTN and rural-urban residence, were calculated for analysis. FINDINGS: Between 2019 and 2022, rates of buprenorphine utilization were significantly higher among Medicaid beneficiaries initiating treatment at OTNs compared to beneficiaries treated at non-OTN facilities regardless of rural-urban status. Furthermore, utilization was most prevalent among rural OTNs (β = 25.5, SE = 1.91, p < 0.001, 95% CI 21.7, 29.2). Despite increases in OUD prevalence, buprenorphine rates remained consistent during the study period, except for a decrease within micropolitan OTNs. CONCLUSIONS: Washington's OTN provides an example of one strategy that may support greater prescribing of buprenorphine and help mitigate the opioid crisis in small town/rural areas. Except among micropolitan areas, OTNs were able to keep pace in buprenorphine utilization despite demand from increased OUD prevalence.
Heart failure readmissions in urban and rural hospital settings: An analysis of 30-day readmissions using the 2021 Nationwide Readmissions Database.
Duran KJ, Hinkle JL, Copel LC
J Rural Health · 2026 Mar · PMID 41891134 · Publisher ↗
PURPOSE: Heart failure is a leading cause of hospital readmissions in the United States. Rural populations experience higher mortality and fragmented care, yet limited research has explored how demographic, clinical, str...
PURPOSE: Heart failure is a leading cause of hospital readmissions in the United States. Rural populations experience higher mortality and fragmented care, yet limited research has explored how demographic, clinical, structural, and socioeconomic factors influence 30-day readmission risk across geographic locations. This study examined predictors of 30-day heart failure readmissions and assessed how associations differ between rural and urban hospitals. METHODS: This secondary analysis used the 2021 Nationwide Readmissions Database and included adults hospitalized with a primary diagnosis of heart failure. The primary outcome was 30-day hospital readmission, defined as the first non-elective inpatient admission for heart failure occurring within 30 days of discharge from an index hospitalization. Covariates included age, sex, diabetes, chronic obstructive pulmonary disease, length of hospital stay, discharge disposition, insurance payer type, median household income, hospital bed size, teaching status, geographic location, and total charges. Hospital rural-urban classification was based on the Urban-Rural Classification Scheme (HOSP_URCAT4) provided by the Healthcare Cost and Utilization Project. Weighted multivariable logistic regression with interaction terms was used to assess geographic variation in readmission risk. FINDINGS: Rural hospitals had lower overall odds of readmission; however, this pattern did not extend to patients with self-pay or no-charge status. Among rural patients, those with no-charge hospitalizations had the highest risk (aOR = 1.830, 95% CI [1.059, 3.161]), followed by self-pay (aOR = 1.301, 95% CI [1.143, 1.480]). Diabetes (aOR = 1.181), COPD (aOR = 1.258), and longer hospital stays (aOR = 1.246) were strong clinical predictors. Private insurance (aOR = 0.684) and higher income (aOR = 0.917) were protective. Model performance was modest (AUC = 0.589; Brier score = 0.167). CONCLUSIONS: Findings indicate that structural inequities persist in rural heart failure readmissions, warranting targeted policy and care interventions.
Dementia incidence trends in rural Spain: Ten-year cohort findings from NEDICES cohort.
Vega-Quiroga S, Bermejo-Pareja F, Martín-Arriscado C … +1 more , Benito-León J
J Rural Health · 2026 Jan · PMID 41853992 · Publisher ↗
PURPOSE: To estimate dementia incidence in the rural population enrolled in the Neurological Diseases in Central Spain (NEDICES) cohort and to evaluate the impact of ascertainment strategies on temporal trend estimates....
PURPOSE: To estimate dementia incidence in the rural population enrolled in the Neurological Diseases in Central Spain (NEDICES) cohort and to evaluate the impact of ascertainment strategies on temporal trend estimates. METHODS: Residents aged ≥65 years were examined at baseline (1994-1995), in 1997-1998, and in 2004-2005. Incident dementia was identified through clinical reassessment, medical record review, and, for decedents between waves, via linkage to the Spanish National Death Registry. Person-time accrued from baseline to dementia, death, or censoring; incidence rates (per 1000 person-years) with 95% confidence intervals (CIs) were estimated using exact Poisson methods; incidence rate ratios (IRRs) contrasted 1994-1998 with 1999-2005. FINDINGS: Of 2148 eligible residents in the 1993 census, 1937 were screened; 113 prevalent cases were excluded, leaving 1824 dementia-free participants. In 1994-1998, 60 incident cases occurred over 4427.3 person-years (13.6; 95% CI, 10.5-17.5): 41 detected at first follow-up, 13 reclassified at the third wave, and 6 identified from death certificates. In 1999-2005, 76 cases accrued over 2584.9 person-years (29.4; 95% CI, 23.3-36.9); 23 were actively ascertained, and 53 were registry-only, resulting in an IRR of 2.17 (95% CI, 1.55-3.04; p < 0.001). Restricting to actively ascertained cases, rates were 12.2 versus 8.9 (IRR = 0.73; 95% CI, 0.45-1.19; p = 0.20). Alzheimer's disease was the most frequent subtype. CONCLUSIONS: The incidence increased only when death certificate diagnoses were included; active follow-up suggested stability. This higher incidence may reflect older age structure, lower educational attainment/cognitive reserve, heavier vascular risk burden, and constrained diagnostic access that shifts detection to death certification.
Rural specialty care for Veterans with the chronic overlapping pain conditions: Fibromyalgia, migraine, or irritable bowel syndrome.
Hadlandsmyth K, Driscoll MA, Adamowicz JL … +2 more , Garvin L, Lund BC
J Rural Health · 2026 Jan · PMID 41839795 · Full text
PURPOSE: This study examines primary and specialty health care among rural and urban Veterans with three common chronic overlapping pain conditions (COPCs): fibromyalgia, migraine, and irritable bowel syndrome (IBS) and...
PURPOSE: This study examines primary and specialty health care among rural and urban Veterans with three common chronic overlapping pain conditions (COPCs): fibromyalgia, migraine, and irritable bowel syndrome (IBS) and the impact of both rural residence and rural primary care site on access to specialty care. METHODS: The cohort included all Veterans treated for fibromyalgia, migraine, and/or IBS in the VA in 2022. The frequency of outpatient primary care and specialty care encounters for these COPCs in the following year was contrasted by residence (urban/rural) and primary care site (medical center, urban clinic, or rural clinic) using multivariate log-binomial regression. Models were adjusted for demographics and comorbidities. FINDINGS: 250,533 Veterans were treated in the VA for the COPCs fibromyalgia, migraine, and/or IBS in 2022; 30.5% were rural residing. Relative to urban Veterans, rural Veterans were significantly more likely to have a primary care visit coded for a COPC (79.5% vs. 74.8%; p < 0.001) and less likely to have a specialty care visit coded for a COPC (31.8% vs. 37.8%; p < 0.001). After adjustment, rural residents were somewhat less likely to receive specialty care for their COPC, relative to urban residing Veterans (RR = 0.91, 95% CI: 0.90-0.92). Further, Veterans receiving care at urban clinics (RR = 0.81, 95% CI: 0.80-0.81) and rural clinics (RR = 0.66, 95% CI: 0.64-0.67) were substantially less likely to have a specialty care visit coded for a COPC, relative to larger VA medical centers. Rural/urban differences are also presented for a referent cohort of musculoskeletal pain conditions. CONCLUSIONS: Rural Veterans with COPCs may benefit from increased access to specialty pain care, which may also reduce burden on rural primary care providers.
County health rankings, provider shortages, and the health of incarcerated women with opioid use disorder.
Urhahn M, Tillson M, Gagen B … +1 more , Staton M
J Rural Health · 2026 Jan · PMID 41728810 · Publisher ↗
PURPOSE: Incarcerated women in rural Kentucky face significant barriers to healthcare, including provider shortages, geographic isolation, and limited access to preventive services. This study examines how county health...
PURPOSE: Incarcerated women in rural Kentucky face significant barriers to healthcare, including provider shortages, geographic isolation, and limited access to preventive services. This study examines how county health rankings and primary care provider (PCP) availability relate to women's self-reported health conditions and healthcare utilization prior to incarceration (PIT). METHODS: A total of 900 incarcerated women across nine Kentucky jails were screened for opioid use disorder and enrolled as part of a larger clinical trial. County-level data, including 2023 County Health Rankings and 2022 PCP-to-population ratios, were merged with self-reported data on health conditions and service use PIT. Logistic regression models assessed associations between county-level indicators and pre-incarceration healthcare utilization and health status. FINDINGS: On average, women were 37.3 years old, 92.6% non-Hispanic White, and 67.1% lived in a rural county before jail. Women from counties with better health rankings were more likely to access substance use treatment (AOR = 0.993, p = 0.028) before incarceration. Those from counties with poorer rankings were more likely to report hepatitis C (AOR = 1.008, p = 0.002) but less likely to report other health concerns, possibly reflecting reduced access or awareness. Fewer available PCPs were associated with higher rates of chronic conditions, such as issues with blood pressure (e.g., hypertension; AOR = 0.782, p = 0.010). CONCLUSION: County-level disparities in healthcare infrastructure may significantly affect the health of women involved in the criminal legal system. Strengthening provider networks, expanding telehealth, and investing in rural health systems are critical to improving access and outcomes for this vulnerable population and may reduce recidivism and adverse post-release health events.
Geospatial structural isolation analysis of emergency services in New York State.
Bedenbender B
J Rural Health · 2026 Jan · PMID 41728758 · Full text
PURPOSE: Access to emergency health care is a fundamental component of public health, yet rural regions, particularly in New York State, face persistent disparities. With 3.5 million residents living in rural areas spann...
PURPOSE: Access to emergency health care is a fundamental component of public health, yet rural regions, particularly in New York State, face persistent disparities. With 3.5 million residents living in rural areas spanning more than 41,000 mi, distance, travel infrastructure, and limited transportation create barriers to care. This study evaluates structural isolation of hospitals providing emergency services by quantifying inter-facility spacing, travel-time catchments, and resulting coverage responsibilities, with attention to border contexts. METHODS: The study employs geospatial analysis to evaluate hospital structural isolation, focusing on emergency services, and identifies facilities with extensive coverage responsibilities or limited inter-facility connectivity. Research integrates US and Canadian datasets, applying various measures to determine the isolation of health care facilities and assess catchment areas. KEY FINDINGS: Large gaps in emergency access persist in rural and border regions of NYS. The most isolated facilities exhibited up to 60- to 70-mile diameters between coverage edges and catchments exceeding 3000 mi. After reassignment of >60-min areas, several regions remained beyond timely ground access, indicating heightened vulnerability despite low resident density and challenging terrain/road networks. CONCLUSIONS: Structural isolation concentrates service burden on a small set of rural hospitals. Integrating cross-border facilities, drive-time isochrones, and reassignment of uncovered areas yields a more realistic depiction of emergency coverage than distance alone. By adopting a multifaceted approach that includes community needs and regional collaboration, New York State can improve emergency health care access and foster a more equitable health care system.
The impact of social and solitary activities on loneliness in older rural male adults: A path analysis study.
Yun S, Okada H, Matsuzaki Y … +2 more , Miyajima M, Takashima R
J Rural Health · 2026 Jan · PMID 41728756 · Publisher ↗
PURPOSE: Loneliness is a serious concern among older rural men. This study examined how social and solitary activities are associated with each other and collectively relate to loneliness through path analysis. Two model...
PURPOSE: Loneliness is a serious concern among older rural men. This study examined how social and solitary activities are associated with each other and collectively relate to loneliness through path analysis. Two models were hypothesized: (1) solitary activities performance is associated with social activities, thereby relating to loneliness, and (2) social activity participation is associated with solitary activities, which in turn relates to loneliness. METHODS: Data were collected from 510 men aged 65 years and older residing in a rural Japanese town using self-administered questionnaires. The study measured loneliness (Japanese version of the UCLA Loneliness Scale), performance in social and solitary activities (Self-completed Occupational Performance Index), number of social activities (Vivid Social Activities Checklist), and depressive symptoms (Geriatric Depression Scale). Structural equation modeling was conducted; model fit was assessed using absolute, incremental, and parsimony indices. FINDINGS: Model 2 demonstrated acceptable fit (χ = 0.923, comparative fit index = 1.000, normed fit index = 1.000, root mean square error of approximation<0.001, Akaike information criterion = 38.009, Expected Cross-Validation Index = 0.074, and Hoelter = 208.044). Social activities were associated with solitary activities, which were in turn related to loneliness. Solitary activities were indirectly associated with loneliness through depression. CONCLUSIONS: This study demonstrates that higher performance in social activities may support healthier, more autonomous solitary engagement as a component of the social-solitary balance that shapes loneliness among older rural men. Locally grounded opportunities that enable meaningful social connection in addition to enhancing rural work rhythms and self-directed solitary routines may help reduce loneliness and support well-being in later life.
Understanding how personalized pediatric asthma information and support addresses rural families' unmet needs.
de Groot A, Mackle R, Gray M … +20 more , Chan M, Hodgins M, Hu N, Angell B, Campbell N, Owens L, Fletcher J, McCrossin T, Piper S, Du H, Haggie S, Doyle AK, Woolfenden S, Gould B, Ward F, Jaffe A, Homaira N, Lingam R, Crespo-Gonzalez C, Asthma Care from Home Collaborative Group
J Rural Health · 2026 Jan · PMID 41699845 · Full text
PURPOSE: Asthma is a leading cause of disease burden in children and is associated with high hospitalization rates, particularly in rural areas. The Asthma Care from Home project implemented a co-developed pediatric asth...
PURPOSE: Asthma is a leading cause of disease burden in children and is associated with high hospitalization rates, particularly in rural areas. The Asthma Care from Home project implemented a co-developed pediatric asthma care model to reduce unscheduled hospitalizations by improving evidence-based asthma discharge support for children with asthma and their families living in rural Australia. As part of an implementation evaluation, this study aimed to understand the acceptability, relevance and usefulness of the model from families' perspectives. METHODS: A purposive sample of parents of children aged 5-12 years, enrolled in the Asthma Care from Home project, participated in semi-structured interviews. Interview guides were developed following the Consolidated Framework for Implementation Research. Data were analyzed using an iterative hybrid inductive-deductive thematic analysis. FINDINGS: Twenty-nine parents participated in interviews. Families of children with asthma in rural areas face significant challenges, including limited access to timely, appropriate support and a lack of personalized care. The model helped address these needs by offering individualized support, reliable information, and education on asthma triggers. Families reported feeling empowered by the guidance provided through the model, which enhanced their ability to manage their child's asthma. Engagement with the model was, however, influenced on occasion by families' expectations, the complexity of asthma-related resources, and practical constraints such as time and financial pressures. CONCLUSIONS: The asthma care model was acceptable and useful for rural families. These findings highlight the value of delivering personalized asthma support in rural areas that enable families to manage and prevent children's asthma exacerbations.
Rural-serving primary care practitioners' and cardiologists' care adaptations for cardiovascular services: A qualitative analysis.
Miller SG, Burchim S, Beima-Sofie K … +13 more , Spencer AG, Wadden E, Selah B, Jaffari A, Suchsland MZ, Cole A, Elrod S, Gehring P, Gilles R, Jose CG, McGrath K, Baker RT, Longenecker CT
J Rural Health · 2026 Jan · PMID 41699827 · Full text
PURPOSE: Rural populations in the United States have less access to cardiovascular care relative to their urban counterparts while bearing a higher burden of heart disease. To understand rural patients' access to cardiov...
PURPOSE: Rural populations in the United States have less access to cardiovascular care relative to their urban counterparts while bearing a higher burden of heart disease. To understand rural patients' access to cardiovascular care services, we conducted a qualitative study investigating which cardiovascular services rural-serving primary care practitioners offered, how they adapted care, and what factors influenced cardiovascular scope of practice and adaptations among rural-serving primary care practitioners and cardiologists. METHODS: We conducted semi-structured interviews with rural-serving primary care physicians, advanced practice providers, and pharmacists, as well as cardiologists, in Alaska, Idaho, and Washington state. FINDINGS: Twenty health care practitioners participated in this study. We identified two themes characterizing cardiovascular services: expanded scope of practice (e.g., primary care physician prescribing a higher-risk anti-arrhythmic medication, dofetilide, for atrial fibrillation) and altered care (e.g., cardiologist ordering fewer cardiovascular imaging tests when needed technology was unavailable). Using a socio-ecological approach, we found factors affecting care adaptations at four levels: local communities; individual practitioners; local clinics and health systems; and the broader health care, law, and policy environment. CONCLUSIONS: When caring for rural cardiovascular patients, primary care practitioners and referring cardiologists expanded their scope of practice and altered care. Multiple factors affected these shifts. Future research could address whether and how expansion of scope of practice (e.g., through team-based care) may improve access to cardiovascular care among rural populations.
Health care access from the rural perspective: A narrative review.
Kaboli P, Blaine A, Mares J … +3 more , Fortney J, Ono S, O'Shea AMJ
J Rural Health · 2026 Jan · PMID 41685945 · Full text
PURPOSE: Health care access has been described using several definitions and frameworks, but none are specific to rural populations. We describe ways access to care is measured using the model of access developed by Fort...
PURPOSE: Health care access has been described using several definitions and frameworks, but none are specific to rural populations. We describe ways access to care is measured using the model of access developed by Fortney et al., with a focus on the differential impact on rural populations. METHODS: We describe patient-centered access metrics in rural and urban populations using the Fortney model's five access dimensions: geographic, temporal, financial, cultural, and virtual. Patient-level access is put into context of the broader environment in which they live (i.e., their community, health care providers, and health care system). FINDINGS: Rural populations face similar access challenges as urban residents but are disproportionally impacted by four interrelated challenges: (1) geographic access barriers of distance and available transportation, (2) virtual access care barriers manifested by broadband internet access and digital literacy, (3) health care workforce shortages, and (4) differential impact of social determinants of health. Key facilitators to overcome these include: (1) integrated public transportation services when in-person care is required; (2) expanded broadband coverage, affordability, and education to ensure access to telemedicine services; and (3) training, incentives, and support for the rural workforce. CONCLUSIONS: Health care systems should incorporate access metrics into routine data collection to drive improvement and ensure equitable access to quality health care. Rural systems of care may be disproportionally impacted by access challenges which require unique approaches for improvement.
Clinical and demographic characteristics of participants in a hepatitis C treatment trial in rural Kentucky: How policies around treatment access may impact elimination efforts in the United States.
Havens JR, Williams BD, Schaninger T … +5 more , Shepherd-Tackett VA, Lofwall MR, Staton M, Walsh SL, Knudsen HK
J Rural Health · 2026 Jan · PMID 41653055 · Full text
INTRODUCTION: The advent of curative direct acting antiviral (DAA) drugs to treat those actively infected with the hepatitis C virus (HCV) has allowed for discussion around HCV elimination. Restrictive state-by-state pol...
INTRODUCTION: The advent of curative direct acting antiviral (DAA) drugs to treat those actively infected with the hepatitis C virus (HCV) has allowed for discussion around HCV elimination. Restrictive state-by-state policies for the coverage of DAAs for Medicaid recipients may hamper elimination efforts in the United States by limiting access to these curative treatments. METHODS: The purpose of the current analysis was to examine the sociodemographic, drug use and clinical characteristics of participants in the Kentucky Viral Hepatitis C Treatment (KeY Treat) study in the context of Medicaid policies in the United States. The goal of KeY Treat was to reduce barriers to accessing curative DAAs by providing screening and treatment free of charge. RESULTS: Results suggest that fewer than one in five KeY Treat participants would be eligible for HCV treatment in states without Medicaid expansion. A third of KeY Treat participants were actively injecting drugs and 40% indicated recent drug use, which would negatively impact their ability to easily access treatment in seven US states. More than 85% of KeY Treat participants started treatment the same day as screening. However, same-day test and treat models would not be possible in almost half of US states because of preauthorization requirements that limit the ability of providers to employ innovative point-of-care RNA screening. CONCLUSIONS: As an elimination plan takes shape in the United States, it is clear that it will be necessary to remove all restrictions for accessing treatment to allow for meaningful increases in HCV treatment uptake and cure.
Geriatrics needs among rural older Veterans receiving virtual mental health services.
Davis CH, Peeples AD, Carlson C … +5 more , Lindsey MB, Humber MB, Lloyd AM, Trivedi RB, Gould CE
J Rural Health · 2026 Jan · PMID 41641930 · Publisher ↗
PURPOSE: Rural older Veterans have limited access to specialty care. In the Veterans Health Administration (VHA), tele-geriatric mental health (tele-GMH) services provide mental health care to older Veterans through regi...
PURPOSE: Rural older Veterans have limited access to specialty care. In the Veterans Health Administration (VHA), tele-geriatric mental health (tele-GMH) services provide mental health care to older Veterans through regional telehealth hubs. However, older Veterans may still face gaps in access to geriatric medicine and specialty services, exacerbating unmet needs at the intersection of mental and physical health. We assessed unmet needs for geriatric medicine and related specialty services for rural older Veterans served by tele-GMH. METHODS: We surveyed 32 clinicians in 6 VHA geographic regions who referred Veterans to tele-GMH services in fiscal year 2023, 25 of whom served rural Veterans. We also conducted semi-structured interviews with 11 tele-GMH clinicians. Survey data were summarized using descriptive statistics, and interviews were analyzed utilizing rapid qualitative analysis. We also described workflows of tele-GMH clinicians as they align with the "4Ms" of age-friendly care (Mentation, Medications, Mobility, What Matters). FINDINGS: Referring clinicians serving rural Veterans reported lower access to geriatricians than those serving both rural and nonrural Veterans (14.3% vs 36.4%, respectively). Reported access to additional specialty services, as well as local aging services, was also limited. Based on interviews, facilitators for connecting Veterans to services included tele-GMH clinicians' knowledge of local resources. Tele-GMH clinicians reported barriers including high demand, geography, and frequent staff turnover. Tele-GMH clinicians highlighted the utility of the 4Ms to enhance quality of care. CONCLUSIONS: Integrating geriatric medicine into tele-GMH programs supports the delivery of high-quality, age-friendly health care, optimizing VHA workforce capacity and improving care coordination within VHA and non-VHA systems.
Provider-to-provider telehealth use for obstetric services by rural practitioners: A scoping review.
Ford C, Orr E, Hudson H … +5 more , Pluta D, Zimmermann K, Pirkle J, Khare MM, Garry J
J Rural Health · 2026 Jan · PMID 41636340 · Publisher ↗
PURPOSE: This review aims to assess interventions connecting providers of perinatal care in rural areas to other providers or training. The main questions we assessed were: (1) what programs are in the academic or gray l...
PURPOSE: This review aims to assess interventions connecting providers of perinatal care in rural areas to other providers or training. The main questions we assessed were: (1) what programs are in the academic or gray literature that connect rural providers with other providers regarding perinatal care using telehealth, (2) what are the purposes/goals of these interventions and to what extent are they intended to support provider retention or address gaps in care due to shortages of obstetrics providers in rural areas, and (3) what program evaluation has been done to examine the effectiveness of these interventions? METHODS: We searched PubMed, Web of Science, Embase, Gender Watch, and Sociological Abstracts from January 2002 to November 2024 and included relevant articles. The search produced a total of 12,790 citations, and 62 additional articles were identified through gray literature and citation searching. After screening, 56 articles met the inclusion criteria. FINDINGS: The 56 included articles described 21 interventions in the USA, Canada, and Australia. Programs rarely identified increasing access to care for rural communities as a goal, with many programs stating their scope was much narrower. The full scope of perinatal care is covered, and providers involved were mostly family medicine physicians and obstetricians. Programs used a variety of technologies, but synchronous connections were most common. CONCLUSIONS: Programs show promise, but little is known about the effectiveness of most programs. Gray literature was crucial for finding many programs, which highlights the potential for a lack of awareness of some of these resources.
Provider-level variation in the delivery of primary care telehealth for the rural Medicare Advantage population.
Bozzi D, Sutherland A, Canterberry M … +2 more , Boudreau E, Sylwestrzak G
J Rural Health · 2026 Jan · PMID 41636330 · Full text
PURPOSE: The role of telehealth use in primary care among rural Medicare Advantage (MA) beneficiaries following Medicare's expanded telehealth coverage during COVID-19 is not well understood. With increasing evidence tha...
PURPOSE: The role of telehealth use in primary care among rural Medicare Advantage (MA) beneficiaries following Medicare's expanded telehealth coverage during COVID-19 is not well understood. With increasing evidence that provider characteristics influence patient access to telehealth, this study compared receipt of telehealth primary care between rural and nonrural MA beneficiaries by providers' level of telehealth delivery. METHODS: Using claims for MA beneficiaries from January 2021 to June 2024, we compared the proportion of primary care visits that were delivered via telehealth between rural and nonrural beneficiaries. We then categorized primary care physician (PCP) groups into quartiles based on the provision of telehealth as a share of total primary care visits. We conducted visit-level generalized linear regression analyses to assess whether differences in telehealth primary care receipt between rural and nonrural beneficiaries varied by PCP telehealth quartile. FINDINGS: PCPs delivering the highest rates of telehealth were significantly more likely to provide primary care via telehealth to rural MA beneficiaries than nonrural ones (4th quartile odds ratio: 1.12, 95% confidence interval: 1.02, 1.22). This finding differed from the overall disparity in telehealth use between rural and nonrural populations, in which rural beneficiaries used less telehealth. CONCLUSIONS: Results showing increased telehealth use among rural MA beneficiaries receiving care from PCPs delivering the highest rates of telehealth may partly stem from unique capabilities among these providers, who are potentially better equipped with tools for implementing telehealth. As such, we provide insight on provider-oriented factors that can bolster telehealth access for rural MA populations.
Rural-urban disparities in diabetes quality of care with accountable care organization participation.
Ouayogodé MH, Hu X
J Rural Health · 2026 Jan · PMID 41627059 · Full text
PURPOSE: To evaluate rural-urban disparities over time in the association of ACO participation and diabetes-related quality measures among health clinics. METHODS: We used data from the Wisconsin Collaborative for Health...
PURPOSE: To evaluate rural-urban disparities over time in the association of ACO participation and diabetes-related quality measures among health clinics. METHODS: We used data from the Wisconsin Collaborative for Healthcare Quality all-patient all-payer electronic health records data system between 2011 and 2018, for patients 18-75 years. Difference-in-differences regression models estimated the association between ACO participation and eight diabetes quality measures among populations in rural and urban areas, separately. Triple-difference models were also estimated to assess urban-rural disparities. FINDINGS: Considering the two measures used in ACO performance evaluation, patients in ACO clinics were less likely to receive tobacco cessation advice relative to those in non-ACO clinics (rural: marginal effect estimate (MEE) = -0.025, p = 0.033; urban: MEE = -0.231, p < 0.001). The triple difference across rurality was not statistically significant (MEE = -0.007 p = 0.56). For the remaining six ACO-non-incentivized measures, rural patients at ACO clinics performed better relative to their non-ACO counterparts on kidney function monitored, and diabetes all-or-none optimal testing and control. CONCLUSIONS: ACO participation appeared to be more favorable for rural versus urban patients with diabetes. ACOs have potential to contribute to reducing existing rural-urban disparities in diabetes process measures.
Rural-urban disparities in primary care and geographic continuity of care for children with medical complexity.
Arakelyan M, Schaefer AP, Freyleue SD … +4 more , Moen EL, O'Malley AJ, Goodman DC, Leyenaar JK
J Rural Health · 2026 Jan · PMID 41626991 · Full text
PURPOSE: Rural-residing children with medical complexity (CMC) may receive fragmented care given clinician shortages in rural communities. This study characterized differences in continuity of care between rural- and urb...
PURPOSE: Rural-residing children with medical complexity (CMC) may receive fragmented care given clinician shortages in rural communities. This study characterized differences in continuity of care between rural- and urban-residing CMC, applying novel measures of geographic care continuity and assessing associations between continuity, neighborhood social disadvantage, and unplanned hospital utilization. METHODS: This retrospective cohort study analyzed 2012-2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire. After identifying CMC using validated algorithms, we calculated three continuity measures: (i) primary care continuity using the Bice-Boxerman Continuity of Care Index (CoCi), (ii) geographic continuity applying the CoCi at the county-level, and (iii) proportion of clinic visits within one's home county. We specified regression models to estimate rural-urban differences and interactions between rurality and neighborhood disadvantage, and to model associations between care continuity and unplanned hospital utilization. FINDINGS: Among 93,948 CMC, those who were rural-residing had higher mean primary care CoCi (50.6 [95% CI: 49.6-51.6] vs. 46.9 [95% CI: 46.6-47.2] for urban-residing), lower mean county-level CoCi (66.8 [95% CI: 66.1-67.5] vs. 70.4 [95% CI: 70.2-70.6]) and a lower local care continuity (53.5% [95% CI: 52.5%-54.5% vs. 60.3% [95% CI: 60.0%-60.5%]). Neighborhood social disadvantage was a significant effect modifier of the relationship between rurality and all continuity measures. Higher care continuity was associated with lower risk of unplanned hospitalization and emergency department visits. CONCLUSION: Rural-residing CMC had higher primary care continuity than their urban-residing peers but lower geographic continuity. Several associations between rurality and care continuity were moderated by neighborhood social disadvantage, highlighting the importance of considering area-level characteristics when implementing programs and policies to support this population.
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