Rural Health Clinics Research Articles

'Most nurses in the rural or remote health clinics run away from their job due to no remote allowances and poor working equipment and environment'. Health professional leaders' perception of shortages in the nursing workforce in underserved areas in Vanuatu.

Health professional leaders are key informants working at senior levels in various health facilities in the areas of policies and planning processes, and human resources. This study explores the factors affecting the nursing shortage in Vanuatu and recommends measures and interventions to resolve the shortage. A qualitative study was used to collect data from 12 health professional leaders using focus group discussion in three randomly selected hospitals in Vanuatu. The qualitative data were collected using a semi-structured, open-ended questionnaire and were audio-recorded. The data were translated and transcribed, and then analysed using thematic analysis. Four themes were identified: inadequate planning, increased population growth, nurse turnover and proposed strategies to resolve nursing shortages. Subthemes for inadequate planning were inadequate policy and human resources planning, and inadequate enrolment. Subthemes for increased population growth were demographics and burden of disease. Subthemes for nurse turnover were job dissatisfaction, absenteeism and increased medical problems. Subthemes for proposed strategies to resolve the nursing shortage were increased enrolment, infrastructure and capacity building. The present study identified key factors affecting current nursing workforce shortages and the recommended measures and interventions to resolve nursing shortages. The findings will assist policymakers to refine and develop relevant policies to address and strengthen the Vanuatu Ministry of Health nursing workforce.

Self-efficacy mediates the associations of diabetes distress and depressive symptoms with type 2 diabetes management and glycemic control

BackgroundAdults with type 2 diabetes (T2D) often experience two common diabetes-related psychological distress: diabetes distress and depressive symptoms. Both are associated with adverse diabetes outcomes including poor self-management and glycemic control. However, diabetes distress and depressive symptoms differ in their associations with diabetes outcomes in T2D patients. ObjectiveThis study proposes a hypothetical model to examine whether self-efficacy mediates the adverse effects of depressive symptoms and/or diabetes distress on self-care behaviors and glycemic control. Additionally, we examined the bi-directional relationships between diabetes distress and depressive symptoms to identify potential underlying mechanisms. MethodsThis study conducted in 15 rural health clinics in Jiangsu province China. 900 adults with T2D participated in the prospective cohort study. The data Diabetes distress (the 17-item Diabetes Distress Scale, DDS17), depressive symptoms(the 10-item Center for Epidemiologic Studies Depression Scale, CESD-10), self-efficacy, self-care behaviors (diet and physical activity), metabolic variables (fasting plasma glucose, FPG) and demographic characteristics were assessed at baseline. Subsequent 12-month Hemoglobin A1C (HbA1c) were measured after baseline. Hierarchical multiple regression and bootstrap mediation analysis were used to test the effects and pathways among these associations. ResultsOf 843 participants (93.67%) of total cohort with available subsequent 12-month HbA1c levels, mean age was 66.08 years and 66.55% were women, 25.15% of them had depressive symptoms (CES-D ≥ 10), 12.20% had moderate diabetes distress (mean DDS ≥2) and 4.98% had the both two psychological distress. Hierarchical multiple regression showed higher DDS score significantly predicted unhealthy diet(β = −1.10, P < 0.001) but not physical activities, while CESD score was negatively associated with physical activity (β = −0.06, P < 0.001) but not diet. No independent effects of the two psychological distress variables on subsequent 12-month HbA1c were observed. Mediation analysis supported that elevated self-efficacy solely mediated the negative effect of both diabetes distress and depressive symptoms on diet (DDS score: β = −0.238, 95 BCE% CI [−0.350, −0.141]; CESD score: β = −0.010, 95 BCE% CI [−0.016, −0.005]), physical activities (DDS score: β = −0.446, 95 BCE% CI [−0.630, −0.283]; CESD score: β = −0.019, 95 BCE% CI [−0.030, −0.010]) and subsequent 12-month HbA1c (DDS score: β = 0.105, 95 BCE% CI [0.030,0.189]; CESD score: β = 0.004, 95 BCE% CI [0.001,0.009]). Additionally, the interplay of diabetes distress and depressive symptoms exerts their effects on diabetes outcomes directly and indirectly via self-efficacy. ConclusionsSelf-efficacy may contribute to better diabetes outcomes and ameliorate negative effects of diabetes distress and depressive symptoms.

Personalized Approach in Smoking Cessation of a Rural Community Health Clinic in Malaysia

Chronic smoking is well known to be associated with many medical disorders in the community. If smoking cessation program can be implemented early in the community it can prevent many non-communicable disease and reduce overall healthcare cost in managing these smoking related complications. The aim of this report is to highlight an organized personalized approach used in smoking cessation clinic in a rural community health clinic in Malaysia. The concept, process, follow up and defaulter tracing system are clearly defined in the clinic. Smoking cessation clinic serves both as treatment and education center for the community people. It can be implemented successfully even in a remote community health care clinic.

Accountable Care Organizations and Health Disparities of Rural Latinos: A Longitudinal Analysis.

The purpose of this study was 2-fold: (1) to analyze the change in diabetes-related hospitalization rates of rural Latino older adult patients as compared with their White counterparts and (2) to determine what factors, including rural health clinic (RHC) participation in accountable care organizations (ACOs), are related to reduced disparities in diabetes-related hospitalization rates. Data for Latino Medicare beneficiaries who were served by RHCs over an 8-year period were analyzed. First, a difference-of-means test was conducted to determine whether there was a change in disparity from the pre-ACO period (2008-2011) to the post-ACO period (2012-2015). A statistically significant decrease in disparity over time was found (t = -7.6899, df = 115, P < 0.001.) Second, multiple regression analyses of 3 separate models were conducted to determine whether ACO participation contributed to reducing disparities in diabetes-related hospitalization rates between Latinos and Whites. The analyses indicated moderate evidence that consistent ACO participation is associated with lower health disparities (t = -1.947, P = 0.0525). However, this association is not significant after balancing covariates, and no causal relationship can be established. Latinos compose one of the fastest growing groups in rural as well as urban areas of the United States. It is critical that ACOs, with their emphasis on care coordination, health care quality, and value, monitor their provision of services to Latinos, rural, and other vulnerable populations.

Rapid adaptation of cancer screening practices during COVID-19: A multi-state qualitative study.

Context: The COVID-19 pandemic required primary care practices to rapidly adapt cancer screening procedures to comply with changing guidelines and policies. Objective: This study sought to: 1) identify cancer screening barriers and facilitators during the COVID-19 pandemic; 2) describe cancer screening adaptations; and 3) provide recommendations. Study design: A qualitative study was conducted (n= 42) with primary care staff. Individual interviews were conducted through videoconference from August 2020 - April 2021 and recorded, transcribed, and analyzed for themes using NVivo 12 Plus. Setting: Primary care practices included federally qualified health centers, tribal health centers, rural health clinics, hospital/health system-owned, and academic medical centers located across ten states including urban (55%) and rural (45%) sites. Population studied: Primary care staff included physicians (n=13), residents (n=10), advanced practice providers (n=9), and administrators (n=10). Outcome measures: The interviews assessed perceptions about cancer screening barriers and facilitators, necessary adaptations, and future recommendations. Results: Barriers to cancer screening included delays in primary and specialty care, staff shortages, lack of personal protective equipment, patient hesitancy to receive in-person care, postal service delays for mail-home testing, COVID-19 travel restrictions (for Mexico-US border-crossing patients) and organizational policies (e.g., required COVID-19 testing prior to screening). Facilitators included better care coordination and collaboration due to the pandemic and more time during telehealth visits to discuss cancer screening compared to in-person visits. Adaptations included delayed screening, patient triage (e.g., prioritizing patients overdue for screening), telehealth visits to discuss cancer screening, mail-home testing, coordinating cancer screenings (e.g., providing fecal immunochemical test materials during cervical cancer screening) and same-day cancer screening. Recommendations included more public health education about the importance of cancer screening during COVID-19, more mail-home testing, and expanded healthcare access (e.g., weekend clinic) to address patient backlogs for cancer screening. Conclusions: Primary care staff developed innovative strategies to adapt cancer screening during the COVID-19 pandemic. Unresolved challenges (e.g., patient backlogs) will require additional implementation stra.

Trends in Health Disparities of Rural Latinos Pre- and Post-Accountable Care Organization Implementation.

We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts. A pre-post design was implemented treating Medicare Accountable Care Organization (ACO) participation by Rural Health Clinics (RHCs) as an intervention, and using diabetes-related hospitalizations to measure disparities. Data for a nationwide panel of 2,683 RHCs were analyzed for a study period of eight years: 2008 - 2015. In addition, data were analyzed for a subset of 116 RHCs located in Florida, Texas, and California that participated in a Medicare ACO in one or more years of the study period. Two broad findings resulted from this investigation. First, for both the nationwide panel of RHCs and the three-state sample of "ACO RHCs," there was a decrease in the mean disparities in diabetes-related hospitalization rates over the eight-year study period. Second, in comparing a three-year time period after Medicare ACO implementation in 2012 to a four-year period before the implementation, a statistically significant difference in mean disparities was found for the nationwide panel. There are a number of factors that may contribute to the decrease in diabetes-related hospitalization rates for Latinos in more recent years. Future research will identify specific contributors to reducing diabetes-related hospitalization disparities between Latinos and the general population, including the possible influence of ACO participation by RHCs. This paper presents original research conducted using data related to rural Latino older adults. The data represent multiple states and an eight-year time period. The U.S. Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes, the complications of which are serious and costly to the patient and the U.S. healthcare system. With the continued growth of the Latino population, it is critical that their health disparities be monitored, and that factors that contribute to their health and well-being be identified and promoted.

Qualitative evaluation of the pre-implementation phase of a rural dental clinic co-located within a health center in the Pacific Northwest of the United States.

The development of a dental clinic within an existing Rural Health Clinic (RHC) was proposed to improve access to dental care for Medicaid enrollees in Washington. This qualitative study assessed the implementation of a co-located dental clinic in a rural community during the pre-implementation phase. Additionally, we sought to determine the needs and expectations of community members living in this rural Washington county. This study took place in Jefferson County, Washington, aDental Health Professional Shortage Area.Semi-structured interviews were conducted with 42 participants, consisting of administrators (n=9), health providers (n=9) and community members (n=24). Administrators and health providers were interviewed by phone. Community members were interviewed in-person at Jefferson Healthcare primary care clinics or by phone. Interview data were deductively coded, and thematic analysis with a hybrid inductive-deductive approach was used to analyse coded data. Five themes were identified regarding local needs and expectations: dental care as a major need in the community, persisting barriers to dental care access, expecting more than a 'Medicaid experience', visions for a clinic that serves the community, and solutions outside the clinic to improve community oral health. By improving access to dental care, a co-located dental clinic is helping to address general dental care needs in rural communities. Policy-level solutions that address housing and food insecurity, improve public transportation, and retain and expand low-income adult Medicaid dental benefits may be needed to overcome persisting barriers to oral health.

Cancer Screening Among Rural and Urban Clinics During COVID-19: A Multistate Qualitative Study.

The effects of COVID-19 have been understudied in rural areas. This study sought to (1) identify cancer screening barriers and facilitators during the pandemic in rural and urban primary care practices, (2) describe implementation strategies to support cancer screening, and (3) provide recommendations. A qualitative study was conducted (N = 42) with primary care staff across 20 sites. Individual interviews were conducted through videoconference from August 2020 to April 2021 and recorded, transcribed, and analyzed using deductive and inductive coding (hybrid approach) in NVivo 12 Plus. Practices included federally qualified health centers, tribal health centers, rural health clinics, hospital/health system-owned clinics, and academic medical centers across 10 states including urban (55%) and rural (45%) sites. Staff included individuals serving in the dual role of health care provider and administrator (21.4%), health care administrator (23.8%), physician (19.0%), advanced practice provider (11.9%), or resident (23.8%). The interviews assessed perceptions about cancer screening barriers and facilitators, implementation strategies, and future recommendations. Participants reported multilevel barriers to cancer screening including policy-level (eg, elective procedure delays), organizational (eg, backlogs), and individual (eg, patient cancellation). Several facilitators to screening were noted, such as home-based testing, using telehealth, and strong partnerships with referral sites. Practices used strategies to encourage screening, such as incentivizing patients and providers and expanding outreach. Rural clinics reported challenges with backlogs, staffing, telehealth implementation, and patient outreach. Primary care staff used innovative strategies during the pandemic to promote cancer screening. Unresolved challenges (eg, backlogs and inability to implement telehealth) disproportionately affected rural clinics.

Review of Publicly Available State Policies for Long-Acting Reversible Contraception Device Reimbursement.

Background: Provider challenges to accessing long-acting reversible contraception (LARC) include level of reimbursement for LARC device acquisition and cost to stock. State-level LARC device reimbursement policies that cover a greater proportion of the cost of the LARC device and enable providers to purchase LARC upfront may improve contraceptive access. Materials and Methods: To summarize state-level policies that include language on LARC device reimbursement in the outpatient setting, we conducted a systematic, web-based review among all 50 states of publicly available LARC device reimbursement policies that include coverage of LARC devices as a medical or pharmacy benefit, the use of the 340B Drug Pricing Program to purchase LARC devices, and separate payment for LARC devices outside of the Medicaid Prospective Payment System (PPS) payment rate for Federally Qualified Health Centers or Rural Health Clinics. Results: Forty-two percent (21/50) of states with publicly available state-level policies included language on LARC device reimbursement. Among the states, 24% (5/21) had coverage policies as a medical benefit, 33% (7/21) as a pharmacy benefit, and 19% (4/21) as both a medical benefit and pharmacy benefit; 38% (8/21) used the 340B Program to purchase LARC devices; and 62% (13/21) indicated separate payment for LARC devices outside of the Medicaid PPS payment rate. Conclusion: State-level policies for LARC device reimbursement vary, highlighting differences in reimbursement strategies across the U.S. Future research could explore how the implementation of these payment methods may impact LARC device reimbursement and whether increased reimbursement may improve access to the full range of contraceptive methods.

Exploration of Vaccination Attitudes Among Parents and Caregivers in a Rural Appalachian Health Clinic.

At a rural Appalachian health clinic in Kentucky, 20% of patients under 18 years were not up to date with the CDC-recommended immunization schedule. Reasons parents or caregivers chose to delay or refuse their child's immunizations were explored using the Caregiver Vaccination Attitude Scale. High levels of trust in the healthcare provider and self-reported vaccine knowledge highlight opportunities for rural healthcare providers to apply evidence-based communication strategies to address vaccine hesitancy and promote the safety and health of the entire community.

Assessment of Chronic Disease Management Strategies Among Health Care Practices in Medically Underserved South Carolina Counties.

Diabetes and heart disease are among the leading causes of death and disability in the United States, and these conditions are especially prevalent in the South. South Carolina's persistent racial and socioeconomic disparities in chronic disease outcomes are well-documented, yet little is known about how health care practices in medically underserved areas are addressing these challenges. Data were collected through a cross-sectional survey as part of two complementary 5-year cooperative agreements between the Centers for Disease Control and Prevention and the Division of Diabetes and Heart Disease Management (the Division) at the South Carolina Department of Health and Environmental Control. The Division fielded a survey to (a) assist in determining which Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) were best poised to implement specific strategies as part of these cooperative agreements and (b) provide data to establish the baseline for performance measures. FQHCs and RHCs in the top 25% of counties with the highest diabetes and heart disease burden were surveyed about eight domains: staffing/services, electronic health records, team-based care policies, lifestyle change programs, medication therapy management, telehealth, quality improvement collaboratives, and patient demographics. Data representing 71 practices revealed contrasts between RHCs and FQHCs and opportunities for improvement. For example, while most practices reported they were not implementing evidence-based lifestyle change programs (e.g., the National Diabetes Prevention Program), most RHCs and FQHCs expressed interest in starting such programs. Findings are being used to guide efforts to improve diabetes and heart disease prevention and management in South Carolina.

Techno-economic evaluation of stand-alone energy supply to a health clinic considering pandemic diseases (COVID-19) challenge

The increase in the number of patients in health care centers boosts electricity consumption. Such a load jump also adversely affects the energy supply, in particular, in rural off-grid systems. To overcome the mentioned challenges, some innovative and practical approaches with available optimization tools should be employed. This study addresses the possibility of developing a challenge prediction-based method for optimizing a reliable and affordable hybrid renewable energy system (HRES) to aid with energy challenges associated with pandemic conditions. The results indicate that the PV/diesel/battery hybrid system with a maximum energy cost of $0.141/kWh and a renewable fraction of more than 50% can meet demand even during the most severe load jumps. Furthermore, the fuel constraints during pandemic years can increase the energy costs up to 2.5 times, and the required photovoltaic installation capacity by about four times. Due to the 20.1% PV output boost, Vertical-axis tracking systems are recommended in areas with limited PV installation space. It is concluded that, by considering the likely effects of pandemics, the supplied energy cost to the rural health clinic equipment and water treatment loads would be between $0.113–0.200/kWh.

Outcome and Impact Assessment Study Development of Community Internet Centre in Kampung Batu Embun Jerantut, Pahang

The outcome and impact assessment study for developing a community internet centre was conducted in Kampung Batu Embun Jerantut, Pahang. Researchers set out to figure out how local communion in internet networks relates to other parameters. This study aims to achieve the objectives listed by researchers on assessing outcomes and impacts of developing a community internet centre in Kampung Batu Embun Jerantut, Pahang. To conduct this study, a total of 30 participants were chosen. A quantitative analysis was carried out using a questionnaire that has become a standard study instrument for researchers' studies. The findings showed that the association between the factors led to internet centre services in the local community. Nevertheless, the proposal for improvement in the use of internet access is to strengthen the use of ICT among rural communities, including the addition of Wifi hotspot locations in rural schools, public halls, health clinics, hospitals and essential locations suitable to enable the community to access the Internet regardless of age. Finally, is anticipated that this study will have a positive impact. On the local community as well as improve a more efficient lifestyle.

Interprofessional Student Perceptions of Planning and Implementing a Student-led, Faculty-guided Rural Health Clinic

Purpose: To develop an interprofessional student-led, faculty-guided clinic in a rural, medically underserved area in Wisconsin through applying an existing innovative clinical education model. A local university provides a system for training and practice of interprofessional students in a rural community increasing access to preventive health care to individuals and families in rural medically underserved communities. The primary aim of the project was to qualitatively describe perceptions of interprofessional students after completing community assessment, planning, and implementation phases and secondarily to understand student learning experiences in adopting and leading a community model within a rural practice setting. Sample: Participants were interprofessional undergraduate and graduate students placed within an interprofessional clinical education model for an assigned clinical, field, or practicum rotation (n=64). Methods: Institutional Review Board approval was obtained prior to implementation of the qualitative evaluation of this project. Open-ended survey questions were distributed via Qualtrics following the student’s experience. Thematic analysis was completed identifying themes of learning and perceptions in rural settings. Findings: Twenty-six anonymous surveys were collected. Major themes identified were cultivating patient outcomes, understanding community as the client, leading through community assessment, and improving self-communication and collaboration. Conclusion: Participants perceived value in learning within rural settings and noted unique learning features of rurality, primarily around access and resources. Participants learned the importance of working together across professions to serve rural areas. Schools of nursing and health sciences can be an advantageous partner with others to support health needs in rural settings. Keywords: Community health, Interprofessional practice, Nurse-led, Rural health, Student-led DOI: https://doi.org/10.14574/ojrnhc.v21i2.674

Abstract 12773: Sources of Health Information and Health-Seeking Patterns of Filipinos in Rural Communities in the Philippines

Background: Rural healthcare delivery and access have various obstacles due to limited infrastructure for health promotion, limited health information sources, reliance on medical advice from multiple sources, and a lack of skilled rural healthcare practitioners. The disparity in access to healthcare is ultimately why healthcare in rural communities is inadequate. Aims: This cross-sectional study describes sources of health information and health-seeking behaviors (e.g., type of healthcare provider, response to illness) of adults (aged ≥ 18) living in rural, largely underserved communities in the Philippines. Methods: Participants completed a survey assessing health information sources and health-seeking habits. Descriptive statistics and χ 2 -tests were used to compare age groups (young vs. old 60]) and sex. Results: Surveys were completed by 1203 persons (65% female, age 50 ±18 years). The preferred source of health information was friends and family (57%), followed by social media (28%) and healthcare providers (15%). Participants said they sought healthcare largely from physicians (60%), herbalists (12%), nurses (5%), and quack doctors (5%) or a combination of providers (12%). When they were ill, the majority (70%) visited a healthcare provider, while 48%, 39%, and 30% self-medicate, sought advice from a rural health clinic, or pray, respectively. There were no variations in the sources of information, care provider preferences, or illness response between the sexes. Younger persons were more inclined to seek health information on social media and from a physician. By contrast, older persons were more likely to seek advice from friends and relatives and contact a herbalist or quack physician. Conclusions: Our results highlight the need for well-structured programs and campaigns to address the population's demands understandably. Additionally, it emphasizes the importance of enhancing the quality of information available to rural communities and integrating friends and relatives, social media, and healthcare providers to provide evidence-based health information. Finally, more research is required to identify why so many people sought medical advice from friends and family members rather than licensed healthcare professionals.

Attitudes and Beliefs of COVID-19 and Vaccine Uptake among Amish Women

The Amish, a Christian religious group living in rural areas with distinct beliefs about remaining separate from the outside world, have communities in 31 states and four Canadian provinces with just over 600 settlements. Their access to health care and technology is often limited. Several studies have noted low vaccination rates for preventable diseases among the Amish, often due to lack of knowledge about efficacy and safety of vaccines. To gain an understanding of beliefs surrounding COVID-19 and attitudes toward vaccine uptake, we surveyed 863 Amish and Mennonite women throughout Ohio who participated in rural mobile health clinics between 2015 and 2019 at two time periods: before and after the 2020 election. We received 372 completed surveys, 252 of which were completed by respondents who identified themselves as Amish. While 100% of the Amish respondents had heard of COVID-19 and 90% reported knowing someone who had contracted the disease, a mere 1.7% (4) indicated a willingness to get vaccinated. In terms of COVID-19 diagnosis, post-election participants were two times more likely to report having a positive test than pre-election respondents (p = .011). Qualitative analyses revealed significant differences in keywords used to describe COVID-19. Post-election respondents were less likely to use words like "evil" and "bad" and associate COVID-19 with the flu. A notable shift in vaccine hesitancy among Amish participants centered on the perceived politicization of the pandemic and safety/efficacy of the vaccines. Public health efforts should center on raising awareness of the severity of COVID-19 and the benefits of vaccine uptake for distinctive subcultures like the Amish.

Graduate Medical Education Enhancement and the Consolidated Appropriations Act, 2021.

Graduate Medical Education Enhancement and the Consolidated Appropriations Act, 2021.

Sexualized drug use and specialist service experience among MSM attending urban and rural sexual health clinics in England and Scotland.

Background: To date, evidence on whether sexualized drug use (SDU) and chemsex occur less frequently in rural compared to urban areas in Britain has been conflicting. This study aimed to better measure and understand whether attending urban versus rural sexual health clinics in the United Kingdom was associated with a difference in men who have sex with men’s (MSM) experience of SDU or their access to SDU support. Methods: Men from 29 sexual health services across England and Scotland were recruited by self-completing a waiting room survey. Results: A total of 2655 men (864 MSM) took part. There was no statistically significant difference in recent SDU or chemsex identified in MSM attending rural compared to urban clinics. Gamma-Hydroxybutyrate/Gamma-Butyrolactone (GHB/GBL) was the most commonly reported chemsex drug used in a sexual setting, with equal prevalence of use in urban and rural MSM attendees. Distance travelled for SDU was not significantly different for rural compared to urban MSM. Rural MSM reported a higher rate of unmet need for SDU specific services, although this difference was not statistically significant. Conclusion: Within this sample of MSM, there were no significant differences in sexualized drug use behaviours between those attending rural compared to urban sexual health settings.

Racial Disparities in Access to Potential COVID‐19 Vaccine Administration Facilities across US States: A Geographic Information Systems Analysis

Research ObjectiveA major challenge in the design of vaccine distribution and administration plans is ensuring equitable access to COVID‐19 vaccines among racial minority populations, who have been disproportionately affected by the pandemic.We calculated driving distance to the closest potential COVID‐19 vaccine administration facility for a representative sample of the US population and estimated whether race was associated with access to healthcare facilities that may serve as COVID‐19 vaccine administration locations.Study DesignWe mapped community pharmacies providing immunization services as of October 1, 2020, federally qualified health centers, rural health clinics, and hospital outpatient departments. For a 1% sample of a US synthetic population, we computed driving distance to the closest facility using ArcGIS Network Analyst and a national transportation dataset. For each state, we calculated the proportion of population with ≥10 miles distance to the closest facility and the odds ratio of having a distance≥10 miles to the closest facility for Black compared to White residents.Population Studied1% sample of the 2010 U.S. Synthetic Population developed by RTI International (n = 2,982,544).Principal FindingsThe mean (median) number of potential COVID‐19 vaccine administration facilities per state was 988 (1335) and ranged from 201 in WY to 6577 in CA. In 21 states, more than 5% of the population had a driving distance ≥10 miles to the closest facility. In ND, SD, MT, WY, NE, and KS, over 10% of the population had a driving distance ≥10 miles.In 17 states, Black residents were more likely to live ≥10 miles to the closest facility than White residents. Among these 17 states showing statistically significant disparities, there were 8 states where Black residents were at least 5 times more likely to have a driving distance ≥10 miles than White residents, including AK, CT, DE, MA, NJ, RI, UT, and DC. Additionally, in CA, NV, and SC, Black patients were 2 to 5 times more likely to have a driving distance ≥10 miles to the closest facility.ConclusionsThere exists large state‐level variation in racial disparities in access to potential COVID‐19 vaccine administration facilities. While states with a greater proportion of the overall population ≥ 10 miles to the closest facility were concentrated in the Midwest, states with significant racial disparities, mostly placed along the coasts, tend to be more populous with highly diverse racial composition.Implications for Policy or PracticeEnsuring an equitable COVID‐19 vaccine administration among the U.S. population is the current public health priority. Our analyses can guide public health officials in the identification of areas that necessitate additional infrastructure for a equitable vaccine distribution. This is of upmost importance to prevent the historical disparities in access to health care from further magnifying disparities in COVID‐19 related outcomes.Primary Funding SourceWest Health Policy Center.

Access to outpatient services in rural communities changes after hospital closure.

Between January 2005 and July 2020, 171 rural hospitals closed across the United States. Little is known about the extent that other providers step in to fill the potential reduction in access from a rural hospital closure. The objective of this analysis is to evaluate the trends of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in rural areas prior to and following hospital closure. We used publicly available data from Centers for Medicare and Medicaid Provider of Services files, Cecil G. Sheps Center rural hospital closures list, and Small Area Income and Poverty Estimates. We described the trends over time in the number of hospitals, hospital closures, FQHC sites, and RHCs in rural and urban ZIP codes, 2006-2018. We used two-way fixed effects and pooled generalized linear models with a logit link to estimate the probabilities of having any RHC and any FQHC within 10 straight-line miles. Not applicable. Compared to hospitals that never closed, the predicted probability of having any FQHC within 10 miles increased post closure by 5.95 and 11.57 percentage points at 1 year and 5 years, respectively (p < 0.05). The predicted probability of having any RHC within 10 miles was not significantly different following rural hospital closure. A percentage point increase in poverty rate was associated with a 1.98 and a 1.29 percentage point increase in probabilities of having an FQHC or RHC, respectively (p < 0.001). In areas previously served by a rural hospital, there is a higher probability of new FQHC service-delivery sites post closure. This suggests that some of the potential reductions in access to essential preventive and diagnostic services may be filled by FQHCs. However, many rural communities may have a persistent unmet need for preventive and therapeutic care.