Rural Health Policy Research Articles

Community responses and adaptations following the closure of a rural pharmacy and primary care facility.

This study investigates the experiences of one rural community in Central Pennsylvania following the closure of its singular pharmacy and primary health care facility. It aims to understand community members' responses and adaptations to declining health care accessibility and broader implications for rural health policy and practice. Employing a qualitative case study design, researchers conducted 26 in-depth interviews from May to December 2022. Interviews were grounded in a phenomenological approach and focused on participants' perceptions of their community and experiences accessing health care. Data were analyzed thematically following a coding reliability approach. The closure of the health care facilities resulted in significant social and economic impacts, particularly among vulnerable groups, such as older adults, people with disabilities, and working-class families. Participants reported increased reliance on their social support networks to access care, delays in seeking care due to the strain from longer travel distances, and loss of familiar and trusted care providers. We also found an over-reliance on local emergency medical services for routine care. Although the community demonstrated resilience through the use of social networks, some adaptations carried health risks, including delayed care and unmonitored use of alternative remedies. This study highligths theneed for health care policies that address the immediate loss of services and support the social networks and economic stability that rural communities rely on in the absence of local health care facilities. This research contributes insights for policymakers, health care providers, and community leaders working to support rural communities facing similar health care losses.

The impact of rural health insurance on vulnerability to chronic poverty among rural residents in China: analysis using Probit and IVprobit models.

Poverty is a global problem, and combating it is a major governance issue worldwide. In China, poverty management efforts have shifted from eliminating absolute poverty to managing relative poverty. One of the most important tasks in managing relative poverty in the post-poverty reduction era is to prevent recurring poverty due to illness. Rural health insurance is an important method of preventing and mitigating disease risk and a key part of China's poverty reduction policy, including among rural residents. However, the mechanism by which basic health insurance alleviates vulnerability to poverty, the causal effect of rural health insurance on vulnerability to poverty, and differences based on having a second health insurance policy and by age and income have not been sufficiently explored. Therefore, this study examined the impact of rural health insurance on vulnerability to long-term poverty among rural residents in China. In addition, this study evaluated the impact of having a second health insurance policy and differences in the effects of rural health insurance by age and income. This study used data from the 2014, 2016, 2018, and 2020 China Family Panel Studies. Household-related characteristics, such as finance, education, and healthcare, were retrieved from the household database; while data on healthcare expenditures, healthcare insurance, and personal-related characteristics were retrieved from the adult database. Robustness tests were conducted with Probit models, and endogeneity tests were conducted with IVprobit models. Vulnerability to poverty was significantly lower among residents with rural health insurance than those without any health insurance coverage, and this difference was observed across age and income groups. These findings were consistently robust and significant after controlling for endogeneity, considering sample selectivity, and eliminating measurement bias in the core variables. The findings indicate that rural health insurance is an important tool for poverty alleviation. The current results could effectively reduce the economic vulnerability of rural households facing health risks, ensuring broader economic security. Moreover, these findings provide policy references for managing relative poverty in China.

STRATEGIES FOR THE PREVENTION AND CONTROL OF HYPERTENSION IN RURAL COMMUNITIES

Hypertension is a prevalent chronic condition that can lead to serious complications such as cardiovascular disease, stroke and kidney failure. The prevalence of hypertension is especially high in rural communities, where factors such as limited access to health care, lack of health information and socioeconomic conditions can contribute to a lack of control of the disease. Prevention and control strategies tailored to these communities are crucial to reducing the burden of hypertension and improving the overall health of the rural population. This brief explores effective strategies for the prevention and control of hypertension in rural communities, highlighting innovative approaches and associated challenges. The aim of this paper is to review and analyze strategies for the prevention and control of hypertension in rural communities. It aims to identify the main interventions that have proved effective, discuss approaches adapted to the needs and resources of rural communities, and address the challenges faced in implementing these strategies. This is a literature review, using qualitative and quantitative assumptions, using the PubMed, Scopus and Google Scholar databases. The health descriptors “Hypertension”, “Hypertension Management in Rural Areas”, “Telemedicine”, “Community Interventions” and “Rural Health Policies” were used to refine the research. The time frame covers the years 2018 to 2022. The focus is to promote a comprehensive understanding of best practices and areas that need more attention to improve the management of hypertension in rural contexts. Preventing and controlling hypertension in rural communities requires a multifaceted approach that takes into account the particularities of these areas, including barriers to accessing healthcare, resource limitations and specific cultural needs. Education is key to preventing hypertension. Awareness programs about risk factors, the importance of regular blood pressure monitoring and lifestyle changes can have a significant impact. Community initiatives such as workshops, lectures and local media campaigns can help raise awareness of hypertension and promote healthy habits. Improving access to healthcare is crucial for hypertension control in rural areas. This can include the implementation of mobile health units, telemedicine and partnerships with health organizations to provide regular medical services and blood pressure monitoring. Community screening programs and regular consultations can help identify and treat cases of hypertension early. Interventions that encourage a healthy diet, rich in fruit, vegetables and low in sodium, as well as regular physical activity, are essential for the prevention and control of hypertension. Nutritional education programs and the promotion of community physical activities, such as walking groups or sports, can be effective in promoting a healthy lifestyle. Thus, many people with hypertension also have other health conditions, such as diabetes or obesity. Integrated strategies that address hypertension alongside other health conditions can improve overall outcomes. This includes chronic disease management programs that provide support for managing multiple health conditions simultaneously. Involving the community in the planning and implementation of prevention and control strategies can increase the acceptance and effectiveness of interventions. Community groups, local leaders and non-governmental organizations can play an important role in promoting health programs and mobilizing resources. The effective implementation of hypertension control strategies in rural communities faces several challenges. Barriers can include a lack of adequate health infrastructure, a shortage of health professionals, limited access to medicines and treatments, and cultural factors that can affect the acceptance of interventions. In addition, logistical and financial difficulties can limit the ability to implement and maintain health programs in remote areas. Therefore, the approach to preventing and controlling hypertension in rural communities must be adapted to the specific needs and characteristics of these areas. Effective strategies include community education and awareness, improving access to health care, promoting a healthy lifestyle and integrated management of comorbidities. Involving the community and overcoming challenges related to infrastructure and resources are critical aspects for the success of these strategies. With a multifaceted and collaborative approach, it is possible to reduce the prevalence and impact of hypertension in rural communities, promoting better health and an improved quality of life for their inhabitants.

Association between summertime emergency department visits and maximum daily heat index in rural and non-rural areas of Virginia (2015–2022)

There is growing evidence that high ambient temperatures are associated with a range of adverse health outcomes. Further evidence suggests differences in rural versus non-rural populations' vulnerability to heat-related adverse health outcomes. The current project aims to 1) refine estimated associations between maximum daily heat index (HI) and emergency department (ED) visits in regions of Virginia, and 2) compare associations between maximum daily HI and ED visits in rural versus non-rural areas of Virginia and within those areas, for persons 65 years of age and older versus those younger than 65 years. Our study utilized 16,873,213 healthcare visits from Virginia facilities reporting to the Virginia Department of Health syndromic surveillance system between May and September 2015–2022. Federal Office of Rural Health Policy defined rural areas were assigned to patient home ZIP code. The estimated daily maximum HI at which ED visits begin to rise varies between 25 °C and 33 °C across climate zones and regions of Virginia. Across all regions, estimated ED visits attributable to days with maximum HI above 25.7 °C were higher in rural areas (3.7%, 95% CI: 3.5%, 3.9%) versus in non-rural areas (3.1%, 95% CIs: 3.0%, 3.2%). Patients aged 0–64 years had a higher estimated heat attributable fraction of ED visits (4.2%, 95% CI: 4.0%, 4.3%) than patients 65 years and older (3.1%, 95% CI: 2.9%, 3.4%). Rural patients older than 65 have a higher estimated fraction of heat attributable ED visits (2.7%, 95% CI: 2.2%, 3.1%) compared to non-rural patients 65 years and older (1.5%, 95% CI: 1.3%, 1.8%). State-level syndromic surveillance data can be used to optimize heat warning messaging based on expected changes in healthcare visits given a set of meteorological variables, and can be further refined based on climate, rurality and age.

Current Status, Problems and Optimization Suggestions of Financing Mechanism for Urban and Rural Residents' Health Insurance in China

The financing mechanism for urban and rural residents' health insurance has continued to develop, with the financing method further refined on the basis of quota financing, the financing level raised year by year in line with individual contributions and financial subsidies, and the financing responsibility shared by the government and gradually strengthened in terms of individual responsibility. However, the current financing mechanism for urban and rural residents' health insurance is faced with the dilemmas of irrational financing method, insufficient financing level, and unbalanced financing responsibility. In light of this situation, it is recommended that the fixed-ratio financing reform be promoted step by step, that a sound mechanism be established for scientifically determining the financing level, that the sense of individual responsibility be strengthened and the financing responsibility be gradually equalized.

Health insurance and subjective well-being: evidence from integrating medical insurance across urban and rural areas in China.

Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.

Does the increase in health insurance benefits have different effects on the health of middle-aged and older people individuals in rural areas? Analysis based on quantile difference-in-differences method.

In the context of healthy aging, enhancing health performance is an intrinsic requirement for the development and reform of the health insurance system. This paper mainly discusses the health effects of increasing medical insurance benefits on people with different levels of health. So this paper utilizes multiple rounds of data from the China Health and Retirement Longitudinal Study (CHARLS) and employs the quantile difference-in-differences method to systematically investigate the impact effects of the integration of urban and rural residents' health insurance on the frailty levels of rural middle-aged and older people individuals. The research findings are as follows: Firstly, the integration of urban and rural resident health insurance has mitigated the frailty level of rural older people individuals, with a more pronounced impact on those with poorer health statuses. Secondly, in terms of heterogeneity analysis, the health performance effects of the urban-rural health insurance integration policy are more significant among the older people population and in the western regions. Thirdly, the integration of urban and rural resident health insurance primarily improves health by reducing the burden of medical expenses, with a greater impact on the older people population with poorer health statuses. Based on the research findings, we recommend addressing the disparities in healthcare benefits across various insurance systems, alleviating the financial burden of healthcare for impoverished individuals, and consistently improving the coordination of healthcare insurance policies for both urban and rural residents.

Risk perceptions and behaviors concerning rural tourism and economic-political drivers of COVID-19 policy in 2020.

When COVID-19 was first introduced to the United States, state and local governments enacted a variety of policies intended to mitigate the virulence of the epidemic. At the time, the most effective measures to prevent the spread of COVID-19 included stay-at-home orders, closing of nonessential businesses, and mask mandates. Although it was well known that regions with high population density and cold climates were at the highest risk for disease spread, rural counties that are economically reliant on tourism were incentivized to enact fewer precautions against COVID-19. The uncertainty of the COVID-19 pandemic, the multiple policies to reduce transmission, and the changes in outdoor recreation behavior had a significant impact on rural tourism destinations and management of protected spaces. We utilize fine-scale incidence and demographic data to study the relationship between local economic and political concerns, COVID-19 mitigation measures, and the subsequent severity of outbreaks throughout the continental United States. We also present results from an online survey that measured travel behavior, health risk perceptions, knowledge and experience with COVID-19, and evaluation of destination attributes by 407 out-of-state visitors who traveled to Maine from 2020 to 2021. We synthesize this research to present a narrative on how perceptions of COVID-19 risk and public perceptions of rural tourism put certain communities at greater risk of illness throughout 2020. This research could inform future rural destination management and public health policies to help reduce negative socioeconomic, health and environmental impacts of pandemic-derived changes in travel and outdoor recreation behavior.

Ten-Year Outcomes: Community Health Center/Academic Medicine Partnership for Rural Family Medicine Training.

The widening gap between urban and rural health outcomes is exacerbated by physician shortages that disproportionately affect rural communities. Rural residencies are an effective mechanism to increase physician placement in rural and medically underserved areas yet are limited in number due to funding. Community health center/academic medicine partnerships (CHAMPs) can serve as a collaborative framework for expansion of academic primary care residencies outside of traditional funding models. This report describes 10-year outcomes of a rural training pathway developed as part of a CHAMP collaboration. Using data from internal registries and public sources, our retrospective study examined demographic and postgraduation practice characteristics for rural pathway graduates. We identified the rates of postgraduation placement in rural (Federal Office of Rural Health Policy grant-eligible) and federally designated Medically Underserved Areas/Populations (MUA/Ps). We assessed current placement for graduates >3 years from program completion. Over a 10-year period, 25 trainees graduated from the two residency expansion sites. Immediately postgraduation, 84% (21) were in primary care Health Professional Shortage Areas (HPSAs), 80% (20) in MUA/Ps, and 60% (15) in rural locations. Sixteen graduates were >3 years from program completion, including 69% (11) in primary care HPSAs, 69% (11) in MUA/Ps, and 50% (5) in rural locations. This CHAMP collaboration supported development of a rural pathway that embedded family medicine residents in community health centers and effectively increased placement in rural and MUA/Ps. This report adds to national research on rural workforce development, highlighting the role of academic-community partnerships in expanding rural residency training outside of traditional funding models.

Survival disparities in rural versus urban patients with pancreatic neuroendocrine tumor: A multi-institutional study from the US neuroendocrine tumor study group

BackgroundPancreatic Neuroendocrine Tumors (PNETs) are indolent malignancies that often have a prolonged clinical course. This study assesses disparities in outcomes between PNET patients who live in urban (UA) and rural areas (RA). MethodsA retrospective cohort study was performed using the US Neuroendocrine Tumor Study Group database. PNET patients with a home zip code recorded were included and categorized as RA or UA according to the Federal Office of Rural Health Policy. Overall survival (OS) was analyzed by Kaplan-Meier method, log-rank test, and logistical regression. ResultsOf the 1176 PNET patients in the database, 1126 (96%) had zip code recorded. While 837 (74%) lived in UA, 289 (26%) lived in RA. RA patients had significantly shorter median OS following primary PNET resection (122 vs 149 months, p ​= ​0.01). After controlling for income, local healthcare access, distance from treatment center, ASA class, BMI, and T/N/M stage, living in a RA remained significantly associated with worse OS (HR 1.60, 95%CI 1.08–2.39, p ​= ​0.02). ConclusionRural patients have significantly shorter OS following PNET resection compared to their urban counterparts.

Villages SDG's response to mental health: Better late than never

Purpose: This article presents village-based mental health policies in response to sustainable development goals. Research methodology: A qualitative research approach was used in conjunction with library research. Results: According to the findings of this study, the focus of development goals, namely living a healthy and affluent life, has not been on mental health. Furthermore, there are findings on advocacy, research and innovation, partnership, and integration of mental health and other SDGs. Contribution: Based on the findings of this study, several recommendations were made, including developing wise mental health policies in rural areas, increasing mental health commitments and budgets, mobilizing communities to respond to rural mental health policies, and improving treatment facilities and mental health response services. Novelty: Although the goals of sustainable development place a special emphasis on healthy and prosperous lives, insufficient data on mental health have been collected, and mental health policies based on village wisdom have not become a theme that many central and regional governments have implemented.

NO PENSION, NO HAPPINESS?—FINANCIAL SUPPORT EXPECTATION IN THE OLDEST-OLD AGE AND DEPRESSIVE SYMPTOMS

Abstract Objective This paper aims to explore the effect of financial support expectation on depressive symptoms among the oldest-elderly. Method. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) 2018. The analytical sample included 10641 respondents who were older than 45. Financial support expectations refer to whom they would reply on when they cannot work, which includes four categories: children, themselves (savings or commercial life insurance), pensions, and others. Linear regression models were employed after controlling for pension, health insurance and urban-rural household registration (hukou). Results More than half of the sample reported that they would rely on their children when they became too old to work. Those who reported that they would rely on themselves (b=-1.72, p=0.000) or pensions (b=-1.23, p=0.000) reported lower levels of depressive symptoms compared to those who would rely on their children. When pension and health insurance were controlled for, only those who would rely on themselves presented lower level of depressive symptoms. Pension and health insurance (except rural health insurance) mediated the association between the financial support expectation and depressive symptoms. However, the hukou status inhibited the mediating effect of pension and health insurance. Conclusion Financial uncertainty is a potential threat in the oldest-old age. Reducing the urban-rural inequality in pension and health insurance would help reduce the negative effects of financial uncertainty.

RURAL HEALTH, FAMILY CAREGIVING, AND DEMENTIA: CHARACTERISTICS AND NEEDS ACROSS POPULATIONS

Abstract The rural population in the US is aging faster, more likely to live alone, and has more comorbidities than the overall aging population. Despite the greater need for long-term care services, rural residents may experience the most barriers to formal services (hospital, home health) and availability of family caregivers. Unfortunately, there is a dearth of research on aging and end-of-life care in rural areas. This symposium includes 4 presentations focused on rural health, family caregiving and dementia and the characteristics and needs across these diverse populations. The first presentation examines rural disparities in use of family and formal caregiving for older adults with disabilities using data from the Health and Retirement Study. The second presentation describes the unmet services needs among people with dementia and their caregivers living in rural Appalachia, and highlights contextual factors that shape service access and utilization. The last two presentations use data from the Utah Population Caregiving Database to examine the characteristics of families of nursing home (NH) residents who die with dementia and of those who die in rural NHs. Understanding the unique characteristics and needs of these underserved populations will help inform rural health practice and policy considerations to better serve this population, especially as we continue to see changes in the hospital and NH landscape across the US. Moreover, it is critical that even as federal and state policies rebalance long-term care from institutional settings to home- and community-based settings, the unique needs of those living in more rural areas are considered.

Optimizing rural healthcare through improved team function: a case study of the Rural Surgical Obstetrical Networks programme

ABSTRACT We explored enablers and mechanisms of optimal team function within rural hospital teams, and the impact of these factors on health service sustainability in British Columbia. The data were drawn from interviews and focus groups with healthcare providers and administrators (n = 169) who participated in the Rural Surgical Obstetrical Networks (RSON) initiative to support low-volume rural surgical and obstetrical services in British Columbia, Canada. The 5-year programme (2018–2022) provided evidence-based system interventions across eight rural sites with the objective of providing sustainable, quality health services to meet population needs. To explore the impact of RSON interventions on local team function, we performed a scoping review, to assess the current literature surrounding enablers of effective rural hospital teamwork. Through inductive thematic analysis of interview data, we identified five enablers of good team function at RSON sites, including emphasis on local leadership, shared direction, commitment to sustainability, respect and solidarity among colleagues, and meaningful communication. The RSON project led to a shift in team culture in participating sites, improved team function, and contributed to improved clinical processes and patient outcomes. The findings have implications for rural health policy and practice in British Columbia and other jurisdictions with similar health service delivery models and geographic contexts.

Abstract B002: Clinical Trial Diversity: Outcomes for US patients with advanced cancer in Phase 1 clinical trials at a major cancer center

Abstract Background: Clinical trials should be equally accessible; however, multiple populations continue to be underrepresented in all phases of cancer clinical research due to interrelated economic, cultural, social, and medical barriers. Insight into how residing in rural areas, geographic distance to trial sites, race, and gender each affect patient enrollment and outcomes in early phase cancer trials will inform addressing these barriers. Methods: Reviewed EMR data for all patients with advanced cancer (> 18 years of age) who consented to at least one clinical trial at a single institution phase 1 unit from 4/1/2014 to 8/1/2022. International patients and those without provided addresses were excluded. Bing geocode data for patient’s home zip codes was used with the haversine distance formula to determine geographic distance to the cancer center. Rural-Urban Commuting Area codes, which classify U.S. 2010 census tracts by zip codes were used to determine rural vs urban areas based on the Rural Health Research Center Categorization A and the Federal Office of Rural Health Policy definitions. Overall survival (OS) was defined as the date of first phase 1 trial cycle 1 day 1 (C1D1) to last contact or death. Results: 8110 patients consented to ≥ 1 early phase clinical trial. 5264 patients had ≥ 1 C1D1 and were included for OS analysis. OS for the 4525 (85.9%) patients from urban areas vs. 740 (14.1%) from rural areas with a hazard ratio (HR) of 0.92 and confidence internal (CI) 0.83 to 1.01 (p: 0.07). In terms of patient travel, 2315 (44.0%) travelled ≥ 250miles for clinical trial participation. OS for patients who traveled ≥ 250miles to those that traveled <250 was HR 0.99 (CI: 0.92, 1.05, p=0.67). Patient race demographics were: 4077 White/Caucasian (77.5%), 478 Black/African American (9.1%), 329 Other/Unknown (6.3%), 277 Asian (5.3%), 82 Hispanic/Latino (1.6%), 12 American Indian/Alaska Native (0.2%) and 9 Native Hawaiian/Pacific Islander (0.2%). The OS HRs compared to Caucasian race patients were: American Indian/Alaskan Native American (HR 1.33 CI: 0.64,2.80 p=0.45), Asian (HR 1.01 CI: 0.86,1.16 p=0.99), Black/African American (HR 1.05 CI: 0.94,1.18 p=0.36), Hispanic/Latino (HR 0.68 CI: 0.53,0.88 p=0.004), Native Hawaiian/Pacific Islander (HR 0.73 CI: 0.30,1.75 p=0.48) and Other/Unknown (HR 0.90 CI: 0.77,1.05 p=0.17). For gender, OS was slightly worse for the 47.2% (2482) male patients with a HR of 1.08 (CI 1.01,1.15 p=0.022). Conclusion: The largest enrolled single institution Phase 1 oncology trial cohort of patients with advanced cancer reveals multiple insights. Disparities were clear for U.S. rural vs. urban and race enrollment without affecting clinical outcomes (except for significantly improved outcomes for Hispanic/Latino race). Similar OS outcomes for these historically marginalized phase 1 clinical trial populations supports pushing broader enrollment despite barriers. Citation Format: Tara M. Davidson, Jason Roszik, Lei Kang, Hung Le, Erick Campbell, Cherri Ozenne, Ecatarina Cathy Dumbrava, Siquing Fu, David S. Hong, Daniel D. Karp, Aung Naing, Sarina A. Piha-Paul, Jordi Rodon, Apostolia M. Tsimberidou, Timothy A. Yap, Funda Meric-Bernstam, Vivek Subbiah. Clinical Trial Diversity: Outcomes for US patients with advanced cancer in Phase 1 clinical trials at a major cancer center [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B002.

Comparative Analysis of Influencing Factors of Health Service Utilization Among Urban and Rural Residents in Tibet

To examine the differences and commonalities of factors influencing the utilization of health services among urban and rural residents in Tibet and to identify vulnerable populations in the utilization of health services, thereby providing references for the formulation of local health policies and the allocation of health resources. Using the Tibetan area data from the Sixth National Health Service Survey, we conducted statistical analysis of the health service utilization status of 8 297 residents of agro-pastoral areas and 2 179 residents of urban areas with χ 2 test and logistic regression model. The two-week outpatient visit rates of residents in agro-pastoral areas and that of the urban residents were 65.3% and 57.1%, respectively, and the one-year hospitalization rates were 8.3% and 8.9%, respectively. The influencing factors of two-week outpatient visits for rural and pastoral residents included urban and rural health insurance coverage, Three Guarantees in One coverage, distance to medical facilities, chronic disease status, physical examination, family doctor contract status, employment status, and health status self-assessment. The influencing factors of two-week outpatient visit for urban residents included chronic disease status, urban and rural medical insurance coverage, health status self-assessment, health records, and physical examination. The factors influencing hospitalization for agro-pastoral residents were sex, age, marital status, urban and rural medical insurance coverage, Three Guarantees in One coverage, critical illness insurance, health self-assessment, mobility, health records, physical examination, and chronic disease status. The factors influencing the hospitalization of urban residents were sex, marital status, health status self-assessment, health records, urban employee medical insurance coverage, and chronic disease status. The factors influencing the hospitalization of urban residents were sex, marital status, health status self-assessment, health records, urban employee medical insurance coverage, and chronic disease status. The urban and rural residents in Tibet have relatively poor health and their awareness of seeking early medical help after they fall ill is relatively weak. The health institutions concerned should dedicate more attention to the vulnerable populations who have difficulty accessing health services, focus on the commonly shared influencing factors of health service utilization among urban and rural residents, take into account the differences, rationally allocate health resources, and improve the effective utilization rate of health services among residents in Tibet.

Rural Location of Residence is Not Associated With Use of Telemedicine for Initial Medical Contact for Gender-Related Healthcare

PurposeThere is very little information available regarding the health needs of transgender and gender diverse adolescents and young adults with gender dysphoria who reside in rural areas of the United States. This study aims to determine if residing in a rural area is associated with the use of telemedicine services, such as synchronous voice-video appointments, for initial contact for medical interventions for gender-related reasons in adolescents and young adults with gender incongruence. MethodsThis study is a retrospective chart review of patients (N = 176) ages 10–24 years who had an initial medical appointment for gender-related concerns between July 1, 2020 and June 30, 2022. Participants were determined to be rural or not based on address eligibility for rural-related health care services by the Centers for Medicare and Medicaid Services Rural Health Clinics Program or the Federal Office of Rural Health Policy grant programs. The use of telemedicine versus in-person appointments were compared, as were initial medical prescriptions (hormones, psychotropic medications, contraceptives, etc.) and recommendations for medical follow-ups made at this initial appointment. ResultsMost participants did not reside in a rural location (N = 130). There was no statistically significant difference in the use of telemedicine versus in-person care in rural patients (22% vs. 78%) as compared to nonrural patients (21% vs. 79%), nor any statistically significant differences in the medical decisions made at the initial appointment with respect to rurality or modality of care. DiscussionResiding in a rural area is not associated with either choice of in-person care versus telemedicine services for initial medical appointments or medical decision-making.

'We country women need advocacy': Birthing narratives from the Western Australian Wheatbelt region.

This study describes the experiences of eight mothers from the Wheatbelt region of Western Australia who shared their stories of travelling and/or temporarily relocating for birth. The aim of this study was to describe rural and remote Western Australian mothers' experiences of travelling long distances and/or relocating to give birth. This study was based on Crotty's four elements of qualitative research. This study was underpinned by a constructivist epistemology, a feminist theoretical lens and a narrative approach using semistructured, story-based interviews. Participants narrated their stories of birthing away from home by telephone interview. Five major themes were identified utilising thematic analysis. These were (1) feeling forgotten in the system, (2) accessibility and choice, (3) compounded social isolation, (4) doing it hard: financial and logistical challenges and (5) building strength: advocating for myself and baby. Mothers' stories were reflective of current and historical failures of rural maternal health policy, including widespread closures of rural birthing hospitals. Mothers described the logistical barriers they faced with little support and suggested multiple solutions that would improve their experiences. Mothers faced significant obstacles which impeded their access to equitable maternal healthcare. This study highlights the complexities of birthing as a rural mother and the need to address maternal health inequities between rural and metropolitan women.

1087-P: Managing Diabetes in the Delta—Effect of Access to Endocrinology Services in an Underserved Area

Background: The Mississippi Delta has one of the highest rates of diabetes in the nation, but patients in these rural, minority-majority counties have lower access to specialty care. At the start of a hybrid diabetes management program at two rural health clinics in the Delta, 53.1% of patients with diabetes had uncontrolled HbA1c levels. We analyze the specific effect of integrating endocrinology specialists into this intervention. Patients could access this care via telemedicine or in-person. Methods: We conducted a quasi-experimental study with clinical data from electronic health records for patients diagnosed with diabetes or prediabetes (aged ≥ 18). We followed two cohorts of the same patients over time for the first 18 months of the program, each matched on elevated HbA1c levels (≥8% at baseline). The treatment group comprised program participants; the control group comprised general clinic patients at-risk of diabetes. We also followed patients in the treatment group who received endocrine services in addition to other program benefits. Results: Among the control group, HbA1c increased an average of 0.04 points; the treatment group saw an average decrease of 0.42 points. The treatment group's endocrinology subset saw an even greater decrease of 0.85 points. The average HbA1c score for this group went down three points in a two-year period (7/20-7/22). Conclusions: The study results indicate that receiving coordinated endocrinology services has been especially effective in reducing HbA1c levels among program participants. As care continuity is associated with better glycemic control for diabetic patients, sustained program participation will likely help the patient population best manage their diabetes and avoid further adverse health outcomes. Additionally, as this diabetes program takes place in a rural, low-income minority area with low access to specialty care, the results demonstrate promising practices for strengthening the rural health care system. Disclosure C.Brindley: None. W.James: None. J.R.Bennett: None. K.F.Matthews: None. Funding Health Resources and Services Administration, Federal Office of Rural Health Policy (HRSA-20-025, D06RH37500)

Expanding rural access to phase I clinical trials.

e18525 Background: Rural cancer patients (RCPs) represent 15-20% of those diagnosed with cancer in the United States (US). RCPs experience decreased access to oncology specialists, increased travel burden, and limited access to clinical trials, as well as unique socioeconomic factors that adversely impact their cancer outcomes. Phase I clinical trials often require complex coordination, frequent follow-up visits, and specialized support staff traditionally limiting access to larger, urban centers. Inclusion of RCPs on these trials can broaden understanding of these therapeutics early in their development. Methods: Starting in 2015, our community oncology program initiated a phase I center dedicated to improving access to RCPs. We evaluated enrollments, patient characteristics, residential location (metro vs. non-metro) as defined by the US Federal Office of Rural Health Policy (FORHP), medically underserved area (MUA) status as defined by the US Health Resources & Services Administration (HRSA), and clinical trial characteristics from April 2015-January 2023. Trials included were phase I, phase IB, or phase I/II trials with safety and/or dosing as the primary endpoint, as well as pharmacokinetic and/or pharmacodynamic secondary endpoints. Our primary outcome was the proportion of FORHP-defined rural participants enrolled. Secondary outcomes included treatment-related deaths and percentage of participants lost to follow-up. Descriptive analysis of patient and clinical trial characteristics was performed. Results: During the analysis period, 21 clinical trials meeting the inclusion criteria were opened. 218 participants were enrolled. Of these participants, 114 (52.3%) resided in FORHP-defined rural locations (89.5% non-metro and 10.5% metro). 23.9% resided in HRSA MUAs. Average distance traveled to our center was 76.1 miles (range 0.4-483 miles). Of these participants, there were no treatment-related deaths. 5 patients (2.3%) were lost to follow-up on study, all during long-term follow-up. Median age of participants was 62 years (range 33-85). 59.2% were male and 40.8% female. Races represented in the studies included: 95% White non-Latino, 2.3% Native American, 0.9% White Latino, 0.5% African American, 1.4% declined/not reported. Common disease sites treated included: 39.9% head and neck, 17.4% non-small cell lung, 11% pancreas, 5.5% melanoma, 5% colorectal, 4.6% breast, and 3.7% ovarian. Of the 21 clinical trials, 38.1% were phase I, 19% were phase IB, and 2.9% were phase I/II. Conclusions: Our center successfully and safely implemented a community-based phase I program with over half the participants enrolled from rural areas. Despite long distances traveled and high rates of rural residency, there were no treatment-related deaths and excellent follow-up rates. These findings support efforts to expand access to phase I trials in a rural setting.