Access to Health Care Services for Adults in Maine [Policy Brief]

This data brief by researchers at the Maine Health Access Foundation and the University of Southern Maine\u27s Maine Rural Health Research Center found ongoing inequality in the ability of people in Maine to get quality health care. The report examines data from 2014-2016 and shows that Maine people, of all income groups, report difficulties in paying medical costs. Research has also found the ability to seek timely and appropriate health care is impacted by income levels, educational background, race and ethnicity. This brief provides an update to the 2016 study (available in Digital Commons: https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1038&context=insurance) For more information, 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]

Preventive Health Service Use among Rural Women

Preventive health services and screenings are an important component in the continuum of care provided to individuals across all ages. Yet, research has shown that rural residents generally use fewer preventive health services and screenings. This study used the National Health Interview Survey to examine receipt of preventive health services (cholesterol check, fasting blood sugar test, mammogram, pap smear, and receipt of the HPV vaccine) by rural and urban women over the age of 18. Findings indicate that rural women were less likely than their urban peers to receive preventive health services, and that some of the differences may be explained by rural-urban differences in sociodemographic characteristics. However, even when controlling for these characteristics, lower use of mammogram or HPV vaccine among rural remained. Outreach efforts targeted to rural women, along with policies and programs designed to improve access to rural women’s cancer screening and HPV participation, are needed

Substance Use among Rural and Urban Youth and Young Adults

Rural youth and young adults have historically had higher use rates of alcohol and other substances than their urban counterparts. Recent research suggests that rates of youth and young adult alcohol and other substance use have declined over the past two decades, but we have limited knowledge of whether and how current rural and urban substance use patterns may differ. As national substance use rates decline, it is important to re-assess differences in use among rural versus urban youth and young adults. This study uses data from the National Survey of Drug Use and Health (NSDUH) to examine rural-urban differences in the rates of substance use among youth and young adults. Findings can help inform rural-specific prevention strategies and research targeting rural communities. FMI: Erika Ziller, PhD, [email protected]

Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas

Analyzing the Medicare Current Beneficiary Survey, authors from the Maine Rural Health Research Center found that compared to their urban counterparts, rural Medicare beneficiaries had higher odds of nursing home use after controlling for beneficiary characteristics and contextual factors including nursing home bed supply

Rural-Urban Differences in the Decline of Adolescent Cigarette Smoking.

OBJECTIVES: To examine change over time in cigarette smoking among rural and urban adolescents and to test whether rates of change differ by rural versus urban residence. METHODS: We used the 2008 through 2010 and 2014 through 2016 US National Survey of Drug Use and Health to estimate prevalence and adjusted odds of current cigarette smoking among rural and urban adolescents aged 12 to 17 years in each period. To test for rural-urban differences in the change between periods, we included an interaction between residence and time. RESULTS: Between 2008 to 2010 and 2014 to 2016, cigarette smoking rates declined for rural and urban adolescents; however, rural reductions lagged behind urban reductions. Controlling for socioeconomic characteristics, rural versus urban odds of cigarette smoking did not differ in 2008 through 2010; however, in 2014 through 2016, rural youths had 50% higher odds of smoking than did their urban peers. CONCLUSIONS: Differential reductions in rural youth cigarette smoking have widened the rural-urban gap in current smoking rates for adolescents. Public Health Implications. To continue gains in adolescent cigarette abstinence and reduce rural-urban disparities, prevention efforts should target rural adolescents. (Am J Public Health. Published online ahead of print March 21, 2019: e1-e3. doi:10.2105/AJPH.2019.304995)

Telebehavioral health (TBH) use among rural medicaid beneficiaries: Relationships with telehealth policies

The authors examined associations between state Medicaid telehealth policies and telebehavioral health (TBH) use among rural fee-for-service (FFS) beneficiaries with behavioral health needs and assessed relationships between beneficiary characteristics and TBH use. They concluded that in the FFS Medicaid environment, engaging patients through informed consent within provider settings that receive facility fees may facilitate access to TBH services. FMI: Yvonne C. Jonk, PhD, Deputy Director, Maine Rural Health Research Center, [email protected]

Patterns of Telehealth Use Among Rural Medicaid Beneficiaries

[Abstract from the Journal of Rural Health] Purpose: Few studies have examined telehealth use among rural Medicaid beneficiaries. This study produced a descriptive overview of telehealth use in 2011, including the prevalence of telehealth use among rural and urban Medicaid beneficiaries, characteristics of telehealth users, types of telehealth services provided, and diagnoses associated with telehealth use. Methods: Using data from the 2011 Medicaid Analytic eXtract (MAX), we conducted bivariate analyses to test the associations between rurality and prevalence and patterns of telehealth use among Medicaid beneficiaries. Findings: Rural Medicaid beneficiaries were more likely to use telehealth services than their urban counterparts, but absolute rates of telehealth use were low—0.26% of rural nondual Medicaid beneficiaries used telehealth in 2011. Psychotropic medication management was the most prevalent use of telehealth for both rural and urban Medicaid beneficiaries, but the proportion of users who accessed nonbehavioral health services through telehealth was significantly greater as rurality increased. Regardless of telehealth users’ residence, mood disorders were the most common reason for obtaining telehealth services. As rurality increased, significantly higher proportions of telehealth users received services to address attention‐deficit/hyperactivity disorder (ADHD) and other behavioral health problems usually diagnosed in childhood. Conclusions: These findings provide a baseline for further policy‐relevant investigations including examinations of changes in telehealth use rates in Medicaid since 2011. Reimbursement policies and unique rural service needs may account for the observed differences in rural‐urban Medicaid telehealth use rates

Advancing Tobacco Prevention and Control in Rural America: Executive Summary

The objectives of the comprehensive report were to: examine rates and patterns of commercial tobacco use across rural subpopulations; explore aspects of the rural context that may affect tobacco prevention and control efforts; provide an overview of rural tobacco control activities over the past ten years; suggest directions for future research; and offer recommendations for advancing rural tobacco control initiatives. Public health professionals, health department leaders, elected officials, and tobacco control advocates are encouraged read the full report to understand the unique challenges tobacco control programs face in rural communities, identify strategies and interventions that have worked, and review recommendations to improve tobacco control efforts in rural communities across the country

Advancing Tobacco Prevention and Control in Rural America

Commercial tobacco use is the leading cause of preventable disease, disability, and death in the United States. Rural communities continue to bear a disproportionate burden of tobacco-related health harms. In this comprehensive report, the lead authors—members of the Maine Rural Health Research Center and the Muskie School of Public Service at the University of Southern Maine—examine rates and patterns of commercial tobacco use across rural subpopulations; explore aspects of the rural context that may affect tobacco prevention and control efforts; provide an overview of rural tobacco control activities over the past ten years; suggest directions for future research; and offer recommendations for advancing rural tobacco control initiatives. The report also highlights a variety of examples of tobacco prevention and control efforts underway in rural communities across America that can be replicated and scaled to reduce the prevalence of commercial tobacco use and improve public health