Harrington RA, Califf RM, Balamurugan A, Brown N, Benjamin RM, Braund WE, Hipp J, Konig M, Sanchez E, Joynt Maddox KE. Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association. Circulation.:CIR–0000000000000753.
An interesting read from American Heart and Stroke Associations. Key points below – some of which will sound familiar, although in a vastly different health and political (thank goodness) environment!
- There is no single definition of rural in the United States.
- Rural population: older, lower population growth, more impoverished, less ethnic diverse, but higher percentage of indigenous populations (living close to or on their homelands)
- Health outcomes significantly worse (and worsening) cf. urban areas
- 40% higher prevalence heart disease
- 30% increased stroke
- higher maternal mortality rates
y axis = deaths; rural = orange line
- Hospital care is increasing more difficult and further away (10.5miles cf. 4.4 miles)
- Worsening as hospitals close (>100 rural hospitals closed since 2010; especially if state did not extend Affordable Health Care act (Obama Care))
- Harder to access ambulance services
- Some evidence of worse cardiovascular outcomes in rural v urban hospitals (evidence in NZ coming soon)
“In addition, it is hard to measure and track outcomes of rural hospitals for many conditions because volumes are often sufficiently low so as to preclude any conclusions from being drawn about performance for any individual site.”
- Patient satisfaction higher cf. urban hospitals’
- 9% of US physicians practice in rural area (despite 20% of population)
- 77% of rural areas = Primary Care Health Professional Shortage Areas
Solutions
- Supply of clinicians need to be addressed
- Rural specific team based care models
- Scope of Practice Laws facilitate rural workforce development
- Telehealth and digitally enabled health care
- Rural-specific care delivery sites
- Regionalisation fo care
- Sustainable funding
- Flexible payment models
- Improvement health insurance coverage
- Broader economic development in rural areas
- Research!
“The AHA is committed to leveraging our reach and assets and to working with strategic partners to develop solutions to improve rural health in America.”
Abstract
Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association’s pursuit of a world with longer, healthier lives. Improving the health of rural populations is consistent with the American Heart Association’s commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health.
Thanks to Mayanna Lund (Cardiologist @ Middlemore Hospital) for passing on this paper