Showing papers in "Journal of Rural Health in 1985"

A Prognosis for the Rural Hospital: Part II: Are Rural Hospitals Economically Viable?

Abstract: This is the second of a two part series that summarizes what is known about the operation and performance of the rural hospital and discusses potential options and strategies for strengthening the viability of these institutions. In Part II, we focus on the economic viability of the rural hospital and examine external factors that influence the environment within which the rural hospital operates. We conclude that the future will remain precarious for rural hospitals and that they can hope to improve their economic viability only if they are able to determine where they fit as part of the large health care system.

A prognosis for the rural hospital. Part I: What is the role of the rural hospital?

Abstract: The rural hospital is a vital component of the rural health care delivery system and an important institution in rural communities. In recent years, considerable concern has been expressed over the future of these institutions, many of which have experienced serious difficulties in maintaining financial viability. The problems facing many rural hospitals today result from a number of interrelated factors, both internal and external, that determine the environment within which the rural hospital operates and affect its performance. This is the first of a two-part series that: (1) provides an objective review and critical analysis of what is known and what is not known from the existing body of research on the performance of rural hospitals; (2) identifies and examines the influence of the major external factors which affect viability; and (3) outlines potential options and strategies for strengthening the viability of these institutions. Part I addresses the issues of scope of services and quality of care in rural hospitals.

Improved follow-up care of hypertensive patients by a nurse practitioner in a rural clinic.

Abstract: The usefulness of nurse practitioners in the care of hypertension has been demonstrated in a variety of settings. In a randomized prospective comparison between physicians and nurse practitioner care, observations are extended to rural ambulatory hypertensives. Data indicate that for patients who remain actively in follow-up, blood pressure control was the same when treated by either physicians or the nurse practitioner. However, patients treated by the nurse practitioner had a significantly better follow-up adherence rate than did those treated by physicians. The data presented support the use of nurse practitioners in the care of hypertension, particularly in rural populations where a need for intermediate level practitioners is likely to persist despite an expanding supply of physicians.

Characteristics of rural communities and the changing geographic distribution of physicians.

Abstract: This research paper presents the results of a comparison of the characteristics of rural counties which attracted and failed to attract young physicians during the past decade. The data utilized in this research were from the Area Resource File which contains data on physicians for 1975 and 1979 and which permitted the examination of flows of physicians in counties over this period. Characteristics of rural counties examined included demographic and economic characteristics, population density, physical characteristics, health status measures, and the availability of health resources. Results from this preliminary analysis indicate that counties with at least 25,000 population were more likely to have gained a young physician and that, of all counties which added young physicians, the majority gained only one or two. Characteristics which best distinguished counties gained or lost physicians included population and population growth rate, health resources, growth rate of per capita income, and the proportion of the population agriculture.

Solutions to the Problems of Chronic Disease Management in Rural Settings

Abstract: Recent changes in disease patterns in the United States from acute to chronic disorders and the maldistribution of medical manpower have disproportionately affected rural residents. Programmatic attempts to alter the medical care system in rural areas have traditionally centered on increasing the number of primary providers. In central Mississippi, two innovative alternative models of chronic disease management have been evaluated. The disease focus was high blood pressure and the two management models emphasized: the use of local residents as health facilitators or health counselors, and the use of self-help groups in family and church settings. Eighteen months of outcome data indicated that the health facilitator model was controlling 80 percent of the hypertensives participating; the family-based self-help groups were controlling 90 percent; and, the church-based self-help groups were controlling 79.9 percent. These community-based models of chronic disease management have broad implications for other geographic areas and other chronic disorders.

The Ability of Aggregate Data to Predict Self‐Sufficiency Levels in Subsidized Rural Primary Care Practices

Abstract: American rural health policy has as its long-term goal the reallocation of health facilities and manpower to permit equitable access to primary care for all citizens. Rural health centers subsidized by governmental and philanthropic programs frequently have been placed in places of high need for their services. Yet both government and philanthropic policymakers expect these primary care practices to become economically self-sufficient within a few years of practice. The problem is how to assign rural practices to communities with a planning process that will enhance the likelihood that these conflicting goals of serving need and financial self-sufficiency will be achieved. This study uses actual 1980 self-sufficiency data from 167 randomly selected rural primary care clinics as the dependent variable. Independent variables for the corresponding communities five or more years earlier were taken from a database often used by policymakers to make site evaluations. These data tend to be selected from aggregate county level measures. Regression analysis were used to determine how well these data could predict actual self-sufficiency in later years. The result of the analysis is that these aggregate level data have little capacity to predict the ability of rural primary care practices to achieve self-sufficiency. Much better predictions can be made on the basis of local, practice-specific variables. Therefore, planning for economically viable rural practices calls for a much different forecasting approach.

A Practical Guide for Avoiding Disaster When Computerizing the Small Rural Health Clinic

Abstract: With the advent of the small, personal and affordable microcomputer, the opportunity for purchasing and operating automated data processing equipment in the rural health clinic for medical, administrative and financial functions has become both pragmatic and increasingly popular. Some practical guidelines for clinic administrators seriously considering introducing the computer revolution into their clinic's current methods of operating are discussed. Suggestions are offered for priorities in clinic functional automation, equipment purchasing strategies, and how to evaluate prospective vendors and their products. Some of the potential impacts of computerization on clinic personnel and operation are identified.