Providing Healthcare Workers in Medically Underserved Areas: A Case Study

Introduction: Demographic trends forecast an increasing population of aging, chronically ill patents in rural areas of the Southeastern United States. Most healthcare professionals opt to practice in or near urban areas because of higher incomes and nearness to desirable facilities. This leaves a chronic shortage of healthcare providers in rural areas where they are critically needed. A university located in one of the critically underserved areas started a program to train physician assistants with the idea that most of the students would be residents of the area and tend to stay in the area to practice after graduation.Purpose of study: This study will examine if the students graduating from the physician assistant training program in a medically underserved area of the Southeastern United States practiced in the area after graduation.Materials and methods: A survey was done to determine if the students who graduated in the first year of the physician assistant training program were practicing in a medically underserved area. Results and discussions: The survey revealed that 58.8% of the students who responded to the survey were employed as a primary care provider, 100% of the students completed their required clerkship in the medically underserved area after graduation and 65.6% are practicing in the area two years after graduation from the program. Conclusion: From this case study, it can be inferred that one option for community leaders and concerned citizens interested in increasing the number of healthcare providers in medically underserved areas is to implement programs to offer training for local residents to become primary healthcare providers. The programs will train residents who will tend to remain in the area to practice and provide critically needed primary healthcare providers

SARS-CoV-2 testing in North Carolina: Racial, ethnic, and geographic disparities

SARS-CoV-2 testing data in North Carolina during the first three months of the state's COVID-19 pandemic were analyzed to determine if there were disparities among intersecting axes of identity including race, Latinx ethnicity, age, urban-rural residence, and residence in a medically underserved area. Demographic and residential data were used to reconstruct patterns of testing metrics (including tests per capita, positive tests per capita, and test positivity rate which is an indicator of sufficient testing) across race-ethnicity groups and urban-rural populations separately. Across the entire sample, 13.1% (38,750 of 295,642) of tests were positive. Within racial-ethnic groups, 11.5% of all tests were positive among non-Latinx (NL) Whites, 22.0% for NL Blacks, and 66.5% for people of Latinx ethnicity. The test positivity rate was higher among people living in rural areas across all racial-ethnic groups. These results suggest that in the first three months of the COVID-19 pandemic, access to COVID-19 testing in North Carolina was not evenly distributed across racial-ethnic groups, especially in Latinx, NL Black and other historically marginalized populations, and further disparities existed within these groups by gender, age, urban-rural status, and residence in a medically underserved area

Applying the Plan-Do-Study-Act (PDSA) approach to Community Health Worker Job Satisfaction: Local and Global Perspectives

Community Health Workers (CHW) have been a continuing presence in the world health care arena for several decades. While the work they do is diverse, all abide by local social and cultural “norms” and are stakeholders within the population they serve. [1] While much literature is available on the importance of community health workers in the provision of care in regions with limited access to health care, there is little known on what inspires someone to engage in the role. The World Health Organization purports that building value for these lay health care providers within their community via training, support, and recognition is critical to the success of any program. An inter-professional team from Texas Tech University Health Sciences Center in Lubbock, Texas works with community health workers in both an urban medically underserved area in our city and in a rural medically underserved area in Nicaragua. The purpose of the quality improvement project was to explore traits and characteristics that motivate community health workers to provide services in these medically underserved regions in Nicaragua and west Texas. Knowledge about motivation can assist community health worker programs to tailor processes to promote better hiring, retention, training, and improved job satisfaction, leading to a higher quality of patient care

Measuring Primary Care Engagement in Emergency Department Patients in a Medically Underserved Area

The purpose of this study was to evaluate primary care engagement in an emergency department population of adults with diabetes and multiple chronic conditions (MCC) within the medically underserved Whitehaven community of Memphis, TN. Using a self-report survey, primary care characteristics of the population and the validity of the local hospital registrar\u27s assessment of primary care engagement were evaluated using descriptive statistics, independent sample t-tests, one-way ANOVA, and bivariate correlations. 83% of patients reported having a primary care provider. There was no effect of age, gender, or race on continuity of care or chronic illness care; however, insurance status did influence continuity of care. There was discordance between hospital registrar data and self-reports of primary care status. Facilitation of community programs that emphasize health coaching, combined with primary care, may help to improve coordination of care, reduce the high prevalence of people with diabetes and MCC, and improve quality of life

Solving the Healthcare Employee Shortage: The Effectiveness of Incentive Programs in Enticing Young Health Professionals to Appalachian Kentucky Communities

Kentucky’s Appalachian counties have long been recognized as medically underserved areas, with access to care being limited by a shortage of healthcare professionals in the region. This issue, specifically as it pertains to primary care physicians, has been the focus of many programs hoping to improve access to care in these communities for many years. Is the ongoing effort to recruit and retain primary care physicians in Appalachian Kentucky counties effective? Hypotheses The mean number of people per physician in Appalachian Kentucky counties reported in 2013 is equal to the mean number of people per physician in Appalachian Kentucky counties reported in 2023. The mean number of people per physician in Appalachian Kentucky counties reported in 2013 is greater than the mean number of people per physician in Appalachian Kentucky counties reported in 2023. A two-sample t-test will compare the mean population per 1 physician in Appalachian Kentucky counties at two data points spanning over the past decade. The test will be evaluated at a significance level of .05. The two-sample t-test fails to reject the null hypothesis, reflecting that there has not been a significant change in the average population per 1 physician over the past decade. Kentucky’s 4 physician education programs are a highly valuable resource for the Appalachian region and consistently produce graduates who become Appalachian Kentucky resident physicians. Appalachian Kentucky communities and stakeholders should focus on bolstering efforts in selection, post-vocational training, and financial incentive programs. Continued research into the individual interventions in the region and their effectiveness on a more detailed level is also warranted. This project’s findings demonstrate some slight movement toward a lower regional average population-to-physician ratio, a measurable percentage of graduating physicians remaining in the region for their first years of practice, and the potential for Appalachian Kentucky to continue moving toward a more robust healthcare workforce in the future

Promoting Teen Contraceptive Use by Intervention with Their Mothers

Introduction: The purpose of this pilot study was to test a community outreach model designed to help mothers in a rural, medically underserved area navigate their teen daughters to health department services for long-acting reversible contraception (LARC) or alternative contraception. Methods: The pilot study used a single-group, post-test only design. Mothers of teen daughters (N=142) received a 1-hour, one-to-one intervention session (in outreach settings) from Community Liaisons. Mothers received training on how to communicate with their daughters about LARC and other contraceptive methods. Data were collected from June through October 2014, and analyzed in September 2015. Results: The authors re-contacted 104 of 142 mothers enrolled in the study, achieving a 73.2% retention rate. Of these, 12.5% had daughters receiving LARC. An additional 11.0% had daughters with health department–verified initiation of birth control pills. Only one correlate—whether a mother believed her daughter was having sex—was associated with receiving either LARC or birth control pills. Among those indicating they knew their daughters were having sex, 31.7% of the daughters received LARC/birth control pills. By contrast, among mothers not indicating they knew their daughters were having sex, only 2.9% had daughters receiving LARC or birth control pills. Conclusions: Findings suggest that an outreach-based program delivered directly to mothers of teen daughters may be a highly effective method for enhancing service utilization of LARC and the initiation of birth control pill use in a rural, medically underserved area

Health Care Shortage Designations: HPSA, MUA, and TBD

A wide variety of federal programs designed to improve access to health care services rely on specific criteria to designate areas and populations eligible for funding and other types of aid. Two related yet distinct designations, the Health Professional Shortage Area (HPSA) and the Medically Underserved Area (MUA), are most commonly used to identify underserved people or places. This background paper reviews the methodologies currently utilized in these designations, identifies the federal programs that use these designations to allocate resources, describes proposals that have been advanced to consolidate and improve these designations, and discusses key issues and challenges for future effort

Designing financial-incentive programmes for return of medical service in underserved areas of sub-Saharan Africa

In many countries in sub-Saharan Africa health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practice for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through two mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentive from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. While financial-incentive programmes are an attractive option to increase the supply of health workers to medically underserved areas – they offer students who otherwise would not have the means to finance a health care education an opportunity to do so, establish legally enforceable commitments to work in underserved areas, and work without compulsion – these programmes may be difficult to implement.Disease, control, global health, financial-incentive programs, Africa.

Critique [of The Ethnic Matrix: Implications for Human Service Practitioners by Jesse M. Vazquez]

Vazquez\u27s psychosocial model for understanding ethnicity and the ethnic process in American society and how this model could be used by practitioners and researchers to further expand their own work is noble. Vazquez fulfilled his purpose. However, the underlying assumption is somewhat misleading, i.e., practitioners and researchers, generally, are not employing the ethnic matrix model. Vazquez states that the absence of ethnic content and concern with ethnic issues in professional training programs was seriously questioned

Wearable Sensors For Continuous Pregnancy Health And Environmental Monitoring: From A Patient And Provider Perspective

Mobile health (mHealth) is an emerging field that uses mobile technology (i.e., mobile phones and various wireless technologies) to track and monitor a patient’s medical health. Few studies have examined the perception of providers and patients with in the use of mHealth technology, particularly among pregnant women. This study evaluated the perception of both patients’ and providers’ attitudes towards mHealth and wearable technologies. Perception was gauged through a survey distributed November 15 through December 31, 2016 at Mountain Area Health Education Center (MAHEC) in western North Carolina in a rural, medically underserved area. Very few providers were currently using mHealth in their clinical practice. Results  found that patients had a positive perception towards mHealth and welcomed its implementation into clinical practice while providers were more  positive with regards to mHealth’s potential in the future