NHS4000_JuhlAllison_Assessment4-1
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Capella University *
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FPX 4000
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Health Science
Date
Feb 20, 2024
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Analyzing a Current Health Care Problem or Issue
Allison Juhl
Capella University
NHS4000: Developing a Heath Care Prespective
Regina Mirabella
July, 2023
Introduction
Healthcare disparities, as discussed in the prior assessment, are an element of
healthcare which many often face. This assessment will expand on healthcare disparities
occurrences, specifically access to rural healthcare. Health care organizations should
develop a plan on how to help rural patient’s access healthcare especially when it comes
to specialists.
Elements of the Problem/Issue
“Research has found that when compared to urban communities, rural areas
have worse health outcomes including challenges with mental health, substance abuse,
physical health, and sexual health” (Reilly, 2021). There are many elements contributing
to problems with accessing rural healthcare, but in this assessment we will be focusing
on physician shortages and means to reach services.
One cause of physician shortages is the fact there are fewer rural physicians to
begin with. “Scott Shipman and coauthors find that in the years 2002–17 the number of
medical school applicants from a rural background declined by 18 percent and the
number of matriculants declined by 28 percent, while urban applicants increased by 59
percent and matriculants by 35 percent. Medical students from rural backgrounds are
more likely to practice in rural areas than those from urban backgrounds are.” (Weil,
2019). Many rural patients have to travel longer distances to access healthcare when
compared to patients who live in an urban location. With patients needing to travel
more, they must consider things such as weather, transportation (vehicle, driver, and
cost), and mobility. If a nursing home patient in a wheelchair needs to get to
appointments ,they have to coordinate appointments with days and times when there is
a wheelchair accessible vehicle and driver available. In my small rural town, something
like this could take weeks to coordinate with many specialists being one hour or more
away.
Analysis
One out of five Americans live in what the US Census Bureau defines as a rural
area. Groups affected by these problems are everyone living in rural communities,
especially the elderly. As a radiologic technologist working in a small rural hospital, I am
responsible for performing x-rays and CTs which doctors have ordered. Although I can
usually get the patients in within a day or two, they often have to wait a week or more to
get their results due to the lack of access to specialists in our rural area. Patients often
have to coordinate doctors appointments with work schedules since traveling to and
from appointments will take up hours of their day. Seeing patients struggle to access
healthcare in rural communities is an important issue to me since I am one of those who
live and work in a rural community.
Kenton Johnston and co-authors have found rural Medicare beneficiaries with
chronic conditions, experience a 40 percent higher preventable hospitalization rate and
a 23 percent higher mortality rate, compared to urban residents. Having even one
specialist visit significantly lowers this gap, leading the authors to conclude: “lack of
access to specialists was the primary driver of higher mortality and preventable
hospitalization rates” (Weil, 2019). Considering Options To combat these health
disparities, healthcare organizations can look into telehealth services and virtual
services. The Centers for Medicare and Medicaid Services (CMS) recently unveiled
several initiatives to improve access to primary care providers and specialists. These
initiatives include expanding access to telehealth and virtual services by authorizing
Medicare to pay for virtual patient check-ins by telephone; remote evaluation of
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recorded images sent by patients to clinicians; and remote wellness visits for patients
with both routine and complex care needs (Johnson, 2019). By implementing telehealth
services, patients would be able to visit with specialists in the comfort of their own
homes. Other initiatives include expanding the scope of practice of lower-level
nonphysician providers to offer primary care services and increasing the wage index of
rural hospitals to enable them to recruit more clinicians and staff (Johnson, 2019).
Right now less than 10% of US healthcare resources are located in rural areas where
approximately 20% of the American population resides. Recruiting more clinicians and
staff to rural communities would lessen the need for patients to travel great distances for
care.
Solution
In healthcare there are many times when patients need to see a specialist for
certain conditions or injuries. In rural America, specialists tend to be located far away
and hard to coordinate appointments with. Although telehealth does have its issues, it is
the most practical option to use. Telehealth provides patients a chance to get healthcare
from the comfort of their own homes without the need to travel or take time out of their
day. Implementation of Telehealth is an important mechanism for improving access to
healthcare in rural communities. Its advancement has made it a viable option to help
reduce healthcare disparities.
A recent study describes a remote practice situation where physicians and
patients reported high degrees of satisfaction in the provision of virtual healthcare (over
90% and 90%, respectively). The insights coincide with other assessments regarding
patients’ satisfaction with VHC, particularly decreased travel time and financial
considerations (Anaraki, 2022). The challenges of traveling long distances, limited
access to transportation, and mobility impairments are overcome by the use of
telehealth services, providing rural residents convenient and accessible healthcare.
However, the use of telehealth does have some ethical implications such as security
violations and lacking personal connections. Patients perceive telehealth as an
alternative when specialist care is limited or absent. Patients and physicians both
perceive deeper caring interactions enabled through face-to-face interactions, which
could not be achieved through telehealth services alone, and telehealth services are
often superficial and fragmented in nature (Sutarsa, 2021). Although virtual care
employs a combination of video calls, phone calls, and chatting services, it can be
ineffective for patients who do not have the required technological devices and struggle
with a lack of infrastructure, and/or a lack of technological literacy (Anaraki, 2022).
Conclusion
Problems with access to rural healthcare involves physician shortages and the
means to reach services. Healthcare organizations must understand these issues and
find solutions for these issues by using systems which were built to give patients better
access to healthcare professionals. Potential solutions include telehealth virtual services
and increasing the wage index for rural healthcare workers. The ethical implications of
these solutions should be considered before implementing them in the healthcare
setting.
References
Coombs, Nicholas C., et al. “A Qualitative Study of Rural Healthcare Providers’ Views of
Social, Cultural, and Programmatic Barriers to Healthcare Access.”
BMC Health Services
Research
, vol. 22, no. 1, 2022, https://doi.org/10.1186/s12913-022-07829-2.
Cyr, Melissa E., et al. “Access to Specialty Healthcare in Urban versus Rural US Populations: A
Systematic Literature Review.”
BMC Health Services Research
, vol. 19, no. 1, 2019,
https://doi.org/10.1186/s12913-019-4815-5.
Johnston, Kenton J., et al. “Lack of Access to Specialists Associated with Mortality and
Preventable Hospitalizations of Rural Medicare Beneficiaries.”
Health Affairs
, vol. 38,
no. 12, 2019, pp. 1993–2002, https://doi.org/10.1377/hlthaff.2019.00838.
Rahimipour Anaraki, N., Mukhopadhyay, M., Wilson, M., Karaivanov, Y., & Asghari, S. (2022).
Virtual Healthcare in rural and remote settings: A qualitative study of Canadian rural
family physicians’ experiences during the COVID-19 pandemic. International Journal of
Environmental Research and Public Health, 19(20), 13397.
https://doi.org/10.3390/ijerph192013397
Reilly, Megan. “Health Disparities and Access to Healthcare in Rural vs. Urban Areas.”
Theory
in Action
, vol. 14, no. 2, 2021, pp. 6–27, https://doi.org/10.3798/tia.1937-0237.2109.
Sutarsa, I. N., Kasim, R., Steward, B., Bain-Donohue, S., Slimings, C., Hall Dykgraaf, S., &
Barnard, A. (2022). Implications of telehealth services for healthcare delivery and access
in rural and remote communities: Perceptions of patients and general practitioners.
Australian Journal of Primary Health, 28(6), 522–528. https://doi.org/10.1071/py21162
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Tong, Y., Tan, C.-H., Sia, C., Shi, Y., & Teo, H.-H. (2022). Rural-Urban Healthcare Access
Inequality Challenge: Transformative ROLES OF INFORMATION TECHNOLOGY.
MIS Quarterly, 46(4), 1937–1982. https://doi.org/10.25300/misq/2022/14789
Weil, A. R. (2019). Rural Health. Health Affairs, 38(12), 1963–1963.
https://doi.org/10.1377/hlthaff.2019.01536