Across America, healthcare is retreating from rural communities. Rural hospitals are closing at alarming rates, and nearly two-thirds of the Primary Care Health Professional Shortage Areas deemed by the Health Resources and Services Administration (HRSA) are in rural communities.
Specialists are even fewer and farther between, meaning that PCPs in rural areas are often burdened with health needs outside their realm of expertise and capacity.
The demanding health needs of populations in rural communities necessitate quality healthcare all the more. These communities face more chronic illness requiring ongoing care, are home to greater numbers of elderly patients, and have been hit harder than urban areas by the opioid crisis.
The biggest challenge in rural healthcare is access. Rural Americans are more likely to be poor and without health insurance, creating a financial barrier to high quality healthcare. And, as residents are more spread out in rural areas, many lack the resources needed to travel long distances to receive care.
Access issues, coupled with persistent health challenges, make care coordination a must for rural healthcare providers to not only survive, but thrive in providing healthcare tailored to the nuanced needs of rural communities.
Health officials in Wyoming found particular problems with readmissions and care transitions in its rural communities, and developed a targeted program for rural seniors with chronic, complex health conditions. The Wyoming Rural Care Transition Program assigns care transition nurse coaches to help patients keep up with medical records, medication management and follow-up visits. The program also creates “medical neighborhoods” by sharing data and aligning providers at all facilities to help its rural seniors move seamlessly between them.
To target chronic conditions in its own neighborhood, North Carolina leveraged technology to develop care coordination initiatives for diabetes patients in rural areas. A program funded by HRSA used telemedicine with type 2 diabetes patients in remote areas to help educate them on self-management. The program also looped pharmacists into the patients’ medical history and virtual visits to help boost medication adherence. In the first 2.5 years of the program, patients averaged just three to four interdisciplinary telemedicine visits that successfully improved weight, A1c levels, and even symptoms of depression.
As evidenced by Wyoming and North Carolina, approaches to rural care coordination are never one-size-fits-all. But common threads between these successful models are collaboration and information sharing. Whether it’s linking care facilities or getting interdisciplinary teams on a video call, no one health entity can tackle rural healthcare alone—it takes a village.