Use of Electronic Health Records to Manage Tobacco Screening and Treatment in Rural Primary Care

Researchers at the Maine Rural Health Research Center, University of Southern Maine examined whether the use of electronic health records by rural primary care physicians facilitates their use of best practices in addressing tobacco dependence. The study used the National Ambulatory Medicare Care Survey (2012-2015) to explore how rurality and use of tobacco-related electronic health record functions were related to smoking status documentation and cessation treatment at adult primary care visits. Rural-urban comparisons were also examined. The authors conclude that rural primary care physicians were at least as successful as their urban counterparts in leveraging electronic health records to enhance tobacco-related services, and that opportunities exist to expand cessation treatment in rural primary care. FMI: Jean Talbot, [email protected]

Adverse Childhood Experiences in Rural and Urban Contexts

Recent research shows that rural children are more likely than urban children to experience certain kinds of adversity. Researchers at the Maine Rural Health Research Center looked at how adverse childhood experiences (ACEs) have affected rural and urban adults. Using data from the Behavioral Risk Factor Surveillance System Assessment, this study found that, while the prevalence of ACEs was comparable in rural and urban adults, over half of rural adults surveyed reported having ACE exposure.Among those with any ACE history, about one quarter experienced four or more ACEs. Policy implications and strategies are highlighted in this brief. Key Findings: Past research has shown that adverse childhood experiences (ACEs) have long-term, negative implications for health and well-being: as the number of ACEs increases, the risk for health problems in adulthood rises. Adverse childhood experiences (ACEs) are a significant problem among rural adults. Over half of rural residents reported some ACE exposure, and over one in ten reported high levels of exposure (four or more ACEs). After adjustment for demographics, rural and urban populations showed similar odds of experiencing high-level ACE exposure. Rural primary care providers can play a leadership role in forging community partnerships to raise public awareness about ACEs, conduct ACE-focused community needs assessments, and launch initiatives to create new services geared toward building resilience in families

Implications of rurality and psychiatric status for diabetic care use among adults with diabetes

This research examined patterns of diabetic preventive care use among adults with diabetes, to determine whether these patterns varied according to respondents’ rural/urban residence or psychiatric status (i.e., the presence/absence of a mental health diagnosis). Specifically, we considered whether rural people with diabetes are less likely than urban peers to use diabetic preventive services; whether having a mental health diagnosis affects preventive service use among diabetics; and, whether rural/ urban differences in service use vary depending on the presence or absence of a mental health diagnosis

Fact Sheet #1: How Family-Centered is MaineCare?

Parent reports on family experiences of care can provide health plans, systems and providers with crucial information on their performance in the domain of family-centeredness. The Maine Department of Health and Human Services (DHHS) conducts an annual survey to gather this kind of information for MaineCare, the state of Maine’s Medicaid and Child Health Insurance (CHIP) program

CO-OP Health Plans: Can They Help Fix Rural America\u27s Health Insurance Markets?

Consumer-Operated and Oriented Plan (CO-OP) programs are intended to create nonprofit health insurance issuers that would offer health plans to individual and small group markets. Part of the Affordable Care Act, CO-OPs could have a substantial effect on rural healthcare delivery systems. In this Brief, authors Jean Talbot and Andy Coburn of the Maine Rural Health Research Center at the University of Southern Maine provide an overview of the CO-OP program legislation from the Affordable Care Act; identify the challenges to obtaining private health insurance in rural areas; and assess the opportunities and challenges of using the CO-OP program to address the limitations of the rural private health insurance market. Dr. Coburn participated in a webinar on this topic co-hosted by the Rural Assistance Center (RAC) with the State Health Access Reform Evaluation (SHARE)

Fact Sheet #2: How Do MaineCare Providers Perform on Childhood Screening and Prevention?

The annual Survey of Children Served by MaineCare, which collects a wealth of data on the experiences of MaineCare families, examines the extent to which MaineCare providers follow Bright Futures guidelines during well-child visits. This fact sheet presents findings on Bright Futures adherence from the 2013 survey

Opioid-Related Visits to Rural Emergency Departments

Increased rates of acute opioid poisoning and related emergency department (ED) visits in the United States have occurred at the same time as rural EDs face a number of resource constraints. Researchers at the Maine Rural Health Research Center conducted this study to gain insight about rural ED visits for acute opioid poisoning and how they compare with urban ED visits. The authors used data from the 2006 and 2013 Nationwide Emergency Department Sample to examine rural and urban opioid-related visits (ORVs) to EDs, including rate change over time, and the outcomes of these ED visits (treatment and release, inpatient admission, transfer, and death). Study findings showed that ORVs as a proportion of total visits increased in rural and urban EDs between 2006 and 2013; rural ORV rates were lower than urban rates in both time periods, however this difference narrowed because of somewhat higher rural increases. Additionally, rural ORVs were more likely than those in urban areas to be by patients 65 and older and to involve concurrent use of benzodiazepines. One fifth of ORVs by rural residents occurred in urban EDs and rural EDs were more likely to transfer patients to another hospital. More research is needed to understand the impact of rural residents’ treatment in urban EDs or other facilities on short- and long-term outcomes for patients who experience an ORV. For more information on this study, please contact Dr. Erika ZIller, [email protected]

Residential Settings and Healthcare Use of the Rural Oldest-Old Medicare Population

The aging of the baby boom generation is projected to dramatically increase the population aged 65 and older in the coming decades. In particular, those aged 85 and older (the ‘oldest old’) are expanding at a faster rate than any other age group and by 2050 are expected to make up 4.5 percent of the population, compared to 1.9 percent in 2012. Faster growth in the percentage of older people (65+) in rural than in urban areas is likely to challenge the healthcare and long term services and supports (LTSS) capacity in many rural communities. This study used Medicare Current Beneficiary Survey data to profile rural and urban Medicare beneficiaries aged 85+ with respect to their demographic and socioeconomic characteristics, the residential settings in which they live, their health and functional status, and their healthcare use. In addition to some demographic and socio-economic differences, rural beneficiaries aged 85+ had greater functional limitations, were more likely to live alone in the community or in nursing homes, and less likely to reside in assisted living facilities. The greater proportion of rural individuals relying on nursing homes to meet their LTSS needs has financial implications for consumers and for state Medicaid programs that are the primary source of public financing for LTSS. The reliance on nursing homes in rural areas may partly be due to a scarcity of home and community based services (HCBS) options. The growing evidence of increased cost-effectiveness of HCBS suggests the importance of federal and state policies that support expanded access to and use of these services in rural communities. For more information on this study, please contact Jean Talbot, PhD at [email protected]

Mental Health Services

This chapter provides an overview of the challenges rural areas face in providing mental health services, particularly to older adults. The authors posits several service delivery models and alternatives to improve rural mental health access and quality for older adults. These models include telemedicine referral models and task-sharing models that address shortages of rural specialty care providers. The author notes that further research is needed to better understand the factors that influence the effectiveness, cost, feasibility, and sustainability of these models for rural areas. FMI: Jean Talbot, PhD. [email protected]