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At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Country living, city income for rural practitioners by implementing the Rural Health Clinics Act.

Rural medical practices have historically faced lower reimbursement than their urban counterparts. The relatively little-known Rural Health Clinics Act of 1976 permits a higher level of payment from Medicare and Medicaid through cost-based reimbursement. This article discusses the specifics and requirements of the Act and how practices can qualify and implement the change to rural health clinic participation.

Ambulatory Care Facilities↗
PubMedDate not supplied

Experience of the Checkerboard Area Health System in planning for rural health care.

The design of rural health care delivery systems often is based on concepts obtained from urban models. The implicit planning premises of successful urban models, however, may be inappropriate for many rural systems. An alternative model planned and implemented in the checkerboard region of rural northwest New Mexico has proved to be successful. This experience may be helpful to health care policymakers and planners confronted with environments that are not congruent with typical urban settings. The checkerboard region presented a challenging health planning environment characterized by formidable geographic, population, economic, and health behavior constraints. The Checkerboard Area Health System (CAHS), designed to provide comprehensive services in an area dominated by these constraints, was formed around a central diagnostic and treatment facility with six satellite clinics. The CAHS used an innovative administrative structure, extended the productivity of traditional providers by extensive use of mid-level and ancillary personnel, and created an effective referral network. These features are distinctly different from those of urban health care models. Overall, the CAHS attained a high rate of inpatient use. Additionally, the performance of the outpatient program indicates that traditional ambulatory care can be integrated with other health services that are more oriented toward health promotion and disease prevention. Finally, the emergency room at the central facility has attained an impressive record that, like the inpatient and outpatient areas, is responsive to the needs of the target population.

Adolescent↗
PubMed1997

Relationship of C-reactive protein to risk of cardiovascular disease in the elderly. Results from the Cardiovascular Health Study and the Rural Health Promotion Project.

Markers of inflammation, such as C-reactive protein (CRP), are related to risk of cardiovascular disease (CVD) events in those with angina, but little is known about individuals without prevalent clinical CVD. We performed a prospective, nested case-control study in the Cardiovascular Health Study (CHS; 5201 healthy elderly men and women). Case subjects (n = 146 men and women with incident CVD events including angina, myocardial infarction, and death) and control subjects (n = 146) were matched on the basis of sex and the presence or absence of significant subclinical CVD at baseline (average follow-up, 2.4 years). In women but not men, the mean CRP level was higher for case subjects than for control subjects (P < or = .05). In general, CRP was higher in those with subclinical disease. Most of the association of CRP with female case subjects versus control subjects was in the subgroup with subclinical disease; 3.33 versus 1.90 mg/L, P < .05, adjusted for age and time of follow-up. Case-control differences were greatest when the time between baseline and the CVD event was shortest. The strongest associations were with myocardial infarction, and there was an overall odds ratio for incident myocardial infarction for men and women with subclinical disease (upper quartile versus lower three quartiles) of 2.67 (confidence interval [CI] = 1.04 to 6.81), with the relationship being stronger in women (4.50 [CI = 0.97 to 20.8]) than in men (1.75 [CI = 0.51 to 5.98]). We performed a similar study in the Rural Health Promotion Project, in which mean values of CRP were higher for female case subjects than for female control subjects, but no differences were apparent for men. Comparing the upper quintile with the lower four, the odds ratio for CVD case subjects was 2.7 (CI = 1.10 to 6.60). In conclusion, CRP was associated with incident events in the elderly, especially in those with subclinical disease at baseline.

Aged↗
PubMed2000

Rural health research in Canada: at the crossroads.

Rural health research in Canada is at the crossroads. Jolted by the establishment of the Canadian Institutes of Health Research, rural health researchers are trying hard to overcome past benign neglect and the lack of cohesion and collaboration within the rural health research community. Although there is considerable catching-up to do, rural health research in Canada has a firm foundation. Backed by a growing network of rural health research centres, researchers are searching for ways to work together in order to advance rural health research and the health and wellbeing of rural Canadians.

Canada↗
PubMed1991

Hospital-sponsored rural health clinics: an effective diversification alternative for rural hospitals.

Changes in rural health care are resulting in new challenges for the administrators of rural hospitals. The lack of available care, economic deterioration, and demographic changes in rural America are contributing factors to rural health care problems and are detrimental to the financial well-being of rural hospitals. Diversification is becoming commonplace in these hospitals as administrators seek strategies to gain financial viability for their facilities. The concept of hospital-sponsored rural health clinics is more than a decade old, yet there are fewer than 30 such clinics nationwide. Reasons for the underutilization of such clinics may include the lack of knowledge that such clinics exist as well as inadequate information describing the establishment, operation, and financial feasibility of the clinics. The hospital-sponsored rural health clinic "concept" will be introduced, including potential benefits of such clinics to both the hospital and the communities they serve, factors to be considered in developing such a system, and problems that may arise in this development. This article presents a case study of how one rural hospital incorporated such clinics into its long-range plans.

Community Health Centers↗
PubMedDate not supplied

The cost of sustaining the Ghana's "Cash and Carry" system of health care financing at a rural health centre.

This paper investigates the sudden fall in clinic attendance at a rural health centre. The pressure to sustain the cash and carry system of procuring drugs is being blamed for over prescription, inconsistent pricing of prescriptions and subsequent fall in clinic attendance. The clinic attendance which was dropping since the introduction of fee-for-service (1985) has now dropped sharply to about 25% after the implementation of the Cash and Carry system (1990). Yet, the average revenue generated per patient has jumped from 201 cedis in 1990 to 348 cedis in 1992. Analysis of the prescription pattern for malaria infection showed that 56% and 89% of patients received injections or were given three or more drugs in the free health service period and in the fee-for-service period respectively. Prescriptions which contained injections or more than three items yielded between 120% and 200% profit to the Health Centre compared to a profit of 60% if only chloroquine and analgesics were prescribed. Consumptions of drugs by staff and non paying patients amounted to about 10% of the revenue generated from the paying patients. It is suggested that, at the health centre level, mechanism for pricing of prescriptions to patients must be reviewed, since motivation for profit could influence the management of diseases and also the use of health facilities. Secondly, refund for drugs consumed by staff and non-paying patients must be recovered in order to remove undue pressure to make profit.

Community Health Centers↗
PubMed1996

Integrated pathways for managing rural health services.

Rural providers must redefine their role in the changing health care system to include a more integrated approach to health care delivery. The rural provider must develop integrated pathways to coordinate all medical, behavior, and social services to ensure that appropriate services are available, locally or through linkages with other providers, for the population. The integrated pathway must manage care across the continuum of services and coordinate decisions occurring at the point of service.

Community-Institutional Relations↗
PubMed1977

A controlled trial of the impact of the family practice nurse on volume, quality, and cost of rural health services.

Rural Newfoundland communities with and without expanded role nurses were compared on a before and after basis. The rural communities are located in a geographically isolated area served by a 40-bed hospital staffed by salaried physicians. Primary care visits within the community increased by 186 per cent after establishment of the family practice nurse community clinic and attendance at the hospital decreased by 35 per cent. Acute care days in hospital decreased 5 per cent in the experimental group and increased by 39 per cent in the control group. A major portion of the community based visits provided to the experimental group were classed as preventive. The total annual health service cost per 1,000 persons in the experimental group increased slightly more than in the control group (26 versus 21 per cent). Adequate management of certain indicator conditions and drugs was maintained by the family practice nurse when compared to the adequacy rating for the physician during the same time period.

Community Health Nursing↗
PubMed1991

The potential of the academic medical center to shape policy-oriented rural health research.

Rural communities continue to have problems in gaining access to basic health care services, a problem exacerbated by persistent shortages of physicians, financially threatened rural hospitals, and weak local economies. Academic health centers can help to address these issues, not only by increasing the flow of their graduates to rural areas, but also by supporting health services research designed to shape public policy that affects the rural United States. Examples of such research include experiments designed to influence the locational decisions of medical students and residents, studies of the quality and cost-effectiveness of care in rural hospitals, and the testing of new ways to provide emergency medical care in rural areas. Such policy-oriented research is compatible with both the intellectual and the service missions of most medical schools; in addition, lessons learned in rural areas may be relevant in more urbanized areas.

Academic Medical Centers↗