Running head: Medically underserved rural community 1
Medically underserved rural community 9
Introduction
SASE, Ivy Tech Community College
AGRI 201: Communication Across Cultures
Dr. Shalyse Iseminger
December 6, 2020
Introduction
When the rural community is discussed, its very nature pertains to the community that is opposite that of the urban population. In place of the towering skyscrapers, swaths of streets, cars, and concrete are sprawling towns, forestry, rolling hills, and/or flat plains that contain a fraction of the population density as compared to the “concrete jungle” that was mentioned prior. Given this description, it comes as no surprise that the people of this community lack access to resources more heavily populated centers have come to enjoy, access to healthcare being at the center of the discussion within the research that is to be presented. The bulk of these issues are outside of these residents’ control. For instance, medical students’ express disinterest in practicing in underserved areas fearing debt and lack of exposure (Stephens, et. al. 2015)). Specialists, such as neurosurgeons, prefer not to treat in these areas due to a lack of financial incentive, often leaving one specialist to serve tens of thousands of people (Upadhyayula, et. al. 2018; Hewitt & Mcniesh, 2019). Healthcare as a whole has been experiencing practitioner shortages for numerous years leaving rural communities especially vulnerable due to lack of interest, as previously stated; however a ray of hope exists in programs, such as the National Health Services Corps, that provides assistance to petition healthcare providers in rural communities (Scarbrough, et. al., 2020). These issues discussed only begin to scratch the surface of the medically underserved rural community, a community that is often overlooked being out of sight, and thus, out of mind. A significant number of the rural community is underserved due to inadequate transportation and access to medical equipment and interventions, available specialists, and timely medical diagnostic testing. These issues have only been compounded further due to the COVID-19 pandemic.
Purpose
A young couple lives thirty-five minutes away from the nearest health clinic with the pregnant mother going into distress needing immediate medical attention; however, her significant other is at work with their only car. Also, they have no health insurance and the COVID-19 pandemic has most hospitals nearing peak capacity. All the issues here in this hypothetical situation are issues real families struggle with every day, especially amplified by the current pandemic. This mother needs to see an OB-GYN and/or a women’s health specialist; the most she can probably hope for is a family medicine doctor, but even that is doubtful. Likely she will see nursing and a physician assistant or nurse practitioner. Due to being uninsured, she will have to go to a clinic that is funded by public subsidies. Finally, assuming all of these dominos miraculously fall in line, she will need to secure transportation, such as from a neighbor, or maybe an ambulance, assuming the mother justifies the costs of one and one is available in her area. This may sound like the perfect storm of problems, but this is just one example of what the medically underserved rural communities face. What would likely happen in this scenario is either her significant other would hurry home from work, jeopardizing his/her employment to take the mother for medical attention, or the mother would wait until her significant other came home. Both of these likely solutions are problematic and gravely increase the probability of an unfavorable outcome. Just for mothers-to-be alone, this is an all too real situation (Najmabadi, 2020).
The goal here is to display the extent at which situations such as the one above, as well as numerous other medical issues exist in this community. It is all too obvious that the current system is one of haves, including those with adequate insurance or financial means, and have nots, those who are under or uninsured and/or lack the means to acquire the medical care they need. The privileged classes enjoy the ability to seek and obtain the care they need when they need it while others are left fending for themselves. It’s clear that a disparity exists between who is given proper healthcare which is largely based on financial ability to pay. One example of this is the type 2 diabetes rural community. A random control trial of a part of this population in South Carolina found that diabetic patients did better when they were given more education in managing their disease. The reason for this gap in education stims back to the lack of reimbursable time provided by Medicare and other insurances for patient education (Mayer-Davis, et. al. 2004). More or less these patients are made to suffer due to economic inequality, even if it is not mentioned directly.
Methods
Between the five of us, we had many different ways in which we collected data. For our immersion activities all of us researched a documentary, various YouTube videos, as well consulted peer reviewed articles from academic research journals. We all conducted interviews with professionals within the medically underserved rural community. We used surveys for our service-learning project along with others who brainstormed ideas and implemented ways to put them to use within the community, while a couple of us even volunteered at a patient simulation training center focused on training healthcare professionals for the rural environment. Throughout all of these processes, this project flowed flawlessly because we had a broad spectrum of sources to better understand the community as a whole.
Though one tries to avoid biased information, this is not always possible. Our academic journal articles provided the least amount of bias; nevertheless, some still exist in these sources for various reasons: author(s) credentials, focus of the research within the journal, etc. The various videos and documentaries would also have some biases in them due to the intent mostly being to persuade its audience and/or being centered around providers who are engrossed in the rural community causing their views to be skewed towards it. These views were seen in the interviews as well.
Results
The research gathered centered around three overarching details: lack of available medical interventions, lack of specialists to provide care and provided these interventions, and lack of timely diagnosis. These all stemmed back to a lack of transportation. Per our interviews, we discovered that a disproportionate number of rural residents would average between half an hour or longer to receive healthcare, with this timeframe going even higher if any type of specialty care was required.
Though much of our research indicated a lack of specialty care in general, such as that indicated by Upadhyayula, et. al., (2018), interviews with professionals on the front lines for this community often stated that family care physicians were the most sought-after specialty. To alleviate this problem, other healthcare providers have been turned to to fill these shoes, such as nurse practitioners (Lindeke, et. al., 2005). This trend has continued since the research of Lindeke, et. al., (2005) was conducted as it has been sent that fewer medical students have shown interest in working in the rural community (Hewitt & Mcniesh, 2019). With this decline, the care for these individuals would naturally have to shift. A glimmer of hope from research conducted by Kost, et. al., (2014) indicated that medical students who showed interest in family medicine showed more interest in an extracurricular program designed to expose them to the rural community. Due to the collective indications from our interviews pointing to the need for more of these practitioners in this specialty, this is encouraging.
A larger issue is the lack of interest from medical students due to no real incentive to practice in the rural community. Between the debt incurred as well as the lesser financial return, medical students often choose not to risk their financial security by opening a rural clinic (Stephens, et. al., 2015). This has created a disproportionate number of practitioners and specialists in populated areas leaving rural communities with more patients and less doctors to treat them. Some areas have doctors treating upwards to nearly five hundred patients a piece (Healthcare Access in Indiana, 2020; Rural Access to Health Care Services Request for Information, 2020). Research conducted at the University of Louisville found that by incorporating a clinical rotation in the rural community into its medical program, students from urban-based areas were more likely to have their perceptions of rural healthcare changed. Often these students had unfavorable beliefs about working in this community but learned that these beliefs were unfounded once they completed this rotation. In it, they learned they were still able to get the same support and resources that doctors in urban settings did, albeit it was still slightly more difficult, but not impossible (Crump et. al., 2019). Similar findings have been found in other countries around the world. One study from Australia found that placing students in rural rotations increased their desire to treat in such an area. This study took it further by exploring other factors and found that having an effective mentor as well as opportunities to practice both rurally and in an urban setting created more satisfactory results. They concluded that a possible change to the model of practice to incorporate periods of time in both settings may be effective (Ray, et.. al., 2018).
Conclusion
The rural community experiences a lack of healthcare access due to the remoteness nature involved in it. Explored further, the research indicates a large issue is lack of interest in rural healthcare practice by providers while interviews with personnel in the field point more towards transportation issues. A combination of these two demonstrates they are interrelated. Since there are less providers in the rural area, residents of these areas are forced to go where the care is at. If they are unable to do so, they are forced to go without the care that they need. At the time of this writing, large scale research in correlating the pandemic with the rurally underserved medical community is sparse. However, articles and blogs are readily available that provide some insight to the plight this population experiences. One from the Leonard Davis Health Institute of Health Economics out of the University of Pennsylvania points out that communities that have lost their hospitals over the years now lack even more care in this pandemic. This leads to a population that is already older and having more chronic illnesses as having even less access to care. Additionally, people who only show mild symptoms in this region may not recognize the deadly disease they’re carrying and spreading to others within their community. If the critical access hospitals existed in their communities, this may be averted as they would have better access to testing and screening (Levins, 2020). Lastly, others at risk include tribal members on reservations that typically exist in rural areas. They too have traditionally experienced disproportionate healthcare and are at further risk from this deadly pandemic due to this discriminatory history (Le, et. al. 2020). It can be deduced that a significant number of the rural community is underserved due to inadequate transportation and access to medical equipment and interventions, available specialists, and timely medical diagnostic testing. These issues have only been compounded further due to the COVID-19 pandemic. However, upon digging further this is largely the result of a lack of interest to work in the rural setting. Simply put, the rural community provides less financial incentive, less resources, a more difficult population to treat due to comorbidities, and overall less upside, to name a few reasons. To alleviate this, more incentives need to be implemented in order to attract more healthcare professionals to these regions. Though better training has been and continues to be developed that specializes in the care of these individuals, this training is only somewhat effective if the members of this community cannot reach the providers to receive the treatment this training prepares the provider for. Though the rural community is often out of sight of the urban community and the large number of providers who work in the urban setting, the patients in this community cannot be allowed to be forgotten, or out of mind.
References
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