ijerph-logo

Journal Browser

Journal Browser

Special Issue "Rural Health Care"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (25 April 2019).

Special Issue Editors

Prof. Dr. Geetha Ranmuthugala
E-Mail Website
Guest Editor
University of New England, Armidale, Australia
Interests: rural health, epidemiology, chronic disease management, health workforce
Dr. Stuart Wark
E-Mail Website
Guest Editor
University of New England Australia, Armidale, Australia
Interests: intellectual disability, ageing/gerontology, palliative/end of life care, rurality, mental health

Special Issue Information

Dear Colleagues,

Rural populations experience poor health status compared with their urban living counterparts, not helped by inequitable access to health care. Addressing this inequity requires a multifaceted approach to recruit and retain health and medical workforce equipped to deliver quality health care that is responsive to need.

This issues of IJERPH will focus on research to inform the delivery of quality health care to rural populations. To encourage an integrated approach to identifying sustainable solutions, submissions are being invited on research that informs the six dimensions of quality health care—accessible, effective, efficient, patient centred, safe and equitable. This may include research on recruitment and retention of rural health workforce, systems thinking approach to providing quality rural health care, model of health care for rural populations, digital technology for healthcare, or any other aspect of health care that would inform the delivery of sustainable quality health care for rural populations [1].

Reference

1. World Health Organization (WHO). Quality of Care: A Process for Making Strategic Choices in Health Systems; WHO: Geneva, Switzerland, 2006.

Prof. Dr. Geetha Ranmuthugala
Dr. Stuart Wark
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Access to health services
  • Health workforce
  • Recruitment and retention of rural health workforce
  • Models of care
  • Digital technology for healthcare
  • Systems thinking
  • Health of rural populations

Published Papers (9 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

Article
The Dilemma of Medical Reimbursement Policy in Rural China: Spatial Variability between Reimbursement Region and Medical Catchment Area
Int. J. Environ. Res. Public Health 2019, 16(16), 2867; https://doi.org/10.3390/ijerph16162867 - 10 Aug 2019
Cited by 2 | Viewed by 1228
Abstract
Since the initiation of the New Rural Cooperative Medical Scheme (NCMS) in 2003 in China, medical reimbursement plays an increasingly important role in reducing the familial burden of critical illness healthcare in rural China. However, the current medical reimbursement system is operated based [...] Read more.
Since the initiation of the New Rural Cooperative Medical Scheme (NCMS) in 2003 in China, medical reimbursement plays an increasingly important role in reducing the familial burden of critical illness healthcare in rural China. However, the current medical reimbursement system is operated based on prefecture-level administrative boundaries, which may prevent some residents from accessing higher-quality medical resources. Using a reliable and high-accuracy geographic information system (GIS) dataset, this study investigates whether this reimbursement system restricts rural residents from freely seeking out medical services in the Hubei Province by employing a two-step floating catchment area (2SFCA). Results show that there are spatial differences between the catchment area of different graded medical centers and prefecture-level administrative boundaries. Spatial reimbursement boundaries should be readjusted so that most rural residents receive equitable coverage by the system and reimburse their medical expenses in a more convenient way. Therefore, we argue that the local government should delineate the spatial region of the medical reimbursement for rural residents according to an assessment of their spatial accessibility to different graded medical centers beyond prefecture-level boundaries. We also discuss potential methods for designing reimbursement boundaries and reimbursement management strategies that the Chinese central government could adopt. Full article
(This article belongs to the Special Issue Rural Health Care)
Show Figures

Figure 1

Article
Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study
Int. J. Environ. Res. Public Health 2019, 16(9), 1532; https://doi.org/10.3390/ijerph16091532 - 30 Apr 2019
Cited by 5 | Viewed by 1696
Abstract
The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted [...] Read more.
The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted using a retrospective analysis based on the medical records of patients provided by the HEMS crew, who were present for the emergencies in rural areas in the period from January 2011 to December 2018. The final analysis included 37,085 cases of intervention by HEMS crews, which accounted for 54.91% of all the missions carried out in the study period. The majority (67.4%) of patients rescued were male, and just under a quarter of those rescued were aged between 50–64 years. Injuries (51.04%) and cardiovascular diseases (36.49%) were the main diagnoses found in the study group. Whereas injuries were significantly higher in the male group and patients below 64 years of age, cardiovascular diseases were higher in women and elderly patients (p < 0.001). Moreover, in the group of women myocardial infarction was significantly more frequent (30.95%) than men, while in the group of men head injuries (27.10%), multiple and multi-organ injuries (25.93%), sudden cardiac arrest (14.52%), stroke (12.19%), and epilepsy (4.95%) was significantly higher. Factors that are associated with the most common health problems of rural patients are: gender and age, as well as the seasons of the year and the values of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and National Advisory Committee for Aeronautics (NACA) used to assess the clinical status of patients. Full article
(This article belongs to the Special Issue Rural Health Care)
Article
Use of a Modified DANP-mV Model to Improve Quality of Life in Rural Residents: The Empirical Case of Xingshisi Village, China
Int. J. Environ. Res. Public Health 2019, 16(1), 153; https://doi.org/10.3390/ijerph16010153 - 08 Jan 2019
Cited by 19 | Viewed by 2216
Abstract
Climate change-related anomalies have increased public concern regarding environmental protection. This has opened newer rural development avenues. In this regard, livability of villages is crucial; it can be evaluated based on the villagers’ quality of life (QoL). The WHOQOL-BREF, a comprehensive cross-cultural and [...] Read more.
Climate change-related anomalies have increased public concern regarding environmental protection. This has opened newer rural development avenues. In this regard, livability of villages is crucial; it can be evaluated based on the villagers’ quality of life (QoL). The WHOQOL-BREF, a comprehensive cross-cultural and cross-disciplinary scale proposed by the World Health Organization to assess QoL, has aided in assessing and improving QoL in different regions. However, the factors of this instrument are mutually influential, necessitating an improvement strategy considering the entire system. This problem may be resolved using the DANP-mV model. However, the traditional DANP-mV model includes many items and responding to all of them is difficult for experts. Therefore, by using the case of Xingshisi Village in China, this study proposed a modified DANP-mV model to provide additional suggestions for systematic improvement of the QoL and livability in the village. Xingshisi is a model village built according to an aspirational benchmark; however, different from the traditional definition of a benchmark, this village exhibits room for improvement. Although the modified model reduces the number of questions from 650 to 168, its effect remains similar to that of the traditional model. Moreover, in the modified model, physical capacity (D1) presented the largest dimensional gap. The interaction among the factors indicated that considering the effect of the environment (D4) and developing a systematic improvement strategy are necessary to improve the livability of villages facing limited resources. Full article
(This article belongs to the Special Issue Rural Health Care)
Show Figures

Figure 1

Article
Exploring Medical Expenditure Clustering and the Determinants of High-Cost Populations from the Family Perspective: A Population-Based Retrospective Study from Rural China
Int. J. Environ. Res. Public Health 2018, 15(12), 2673; https://doi.org/10.3390/ijerph15122673 - 27 Nov 2018
Cited by 5 | Viewed by 1384
Abstract
The costliest 5% of the population (identified as the “high-cost” population) accounts for 50% of healthcare spending. Understanding the high-cost population in rural China from the family perspective is essential for health insurers, governments, and families. Using the health insurance database, we tallied [...] Read more.
The costliest 5% of the population (identified as the “high-cost” population) accounts for 50% of healthcare spending. Understanding the high-cost population in rural China from the family perspective is essential for health insurers, governments, and families. Using the health insurance database, we tallied 202,482 families that generated medical expenditure in 2014. The Lorentz curve and the Gini coefficient were adopted to describe the medical expenditure clustering, and a logistic regression model was used to identify the determinants of high-cost families. Household medical expenditure showed an extremely uneven distribution, with a Gini coefficient of 0.76. High-cost families spent 54.0% of the total expenditure. The values for family size, average age, and distance from and arrival time to the county hospital of high-cost families were 4.05, 43.18 years, 29.67 km, and 45.09 min, respectively, which differed from the values of the remaining families (3.68, 42.46 years, 30.47 km, and 46.29 min, respectively). More high-cost families live in towns with low-capacity township hospitals and better traffic conditions than the remaining families (28.98% vs. 12.99%, and 71.19% vs. 69.6%, respectively). The logistic regression model indicated that family size, average age, children, time to county hospital, capacity of township hospital, traffic conditions, economic status, healthcare utilizations, and the utilization level were associated with high household medical expenditure. Primary care and health insurance policy should be improved to guide the behaviors of rural residents, reduce their economic burden, and minimize healthcare spending. Full article
(This article belongs to the Special Issue Rural Health Care)
Show Figures

Figure 1

Article
Caregiving, Employment and Social Isolation: Challenges for Rural Carers in Australia
Int. J. Environ. Res. Public Health 2018, 15(10), 2267; https://doi.org/10.3390/ijerph15102267 - 16 Oct 2018
Cited by 8 | Viewed by 2024
Abstract
Australia has one of the world’s highest life expectancy rates, and there is a rapidly growing need for informal caregivers to support individuals who are ageing, have chronic illness or a lifelong disability. These informal carers themselves face numerous physical and psychological stressors [...] Read more.
Australia has one of the world’s highest life expectancy rates, and there is a rapidly growing need for informal caregivers to support individuals who are ageing, have chronic illness or a lifelong disability. These informal carers themselves face numerous physical and psychological stressors in attempting to balance the provision of care with their personal life, their work commitments and family responsibilities. However, little is known about the specific challenges facing rural carers and the barriers that limit their capacity to provide ongoing support. A cross-sectional survey composed of open-ended responses and demographic/socioeconomic measures used routinely by the Australian Bureau of Statistics (ABS) and the Australian Institute of Health & Welfare (AIHW) was used with a cohort of 225 rurally-based carers within New South Wales, Australia. Demographic questions specified the respondents’ age, gender, employment, caregiving status, condition of and relationship to the care recipient, postcode, residency status, and distance and frequency travelled to provide care. Open-ended comments sections were provided to allow participants to describe any issues and problems associated with caregiving including employment, travel, residency, carer support groups and any other general information. The results show that most rural carers were middle-aged women supporting a spouse or a child. Unpredictability associated with providing care exacerbated demands on carers’ time, with many reporting significant employment consequences associated with inflexibility and limited job options in rural locations. Specific issues associated with travel requirements to assist with care were reported, as were the impacts of care provision on the respondents’ own personal health. The majority of carers were aware of the social supports available in their local rural community, but did not access them, leaving the carers vulnerable to marginalisation. Problems associated with employment were noted as resulting in financial pressures and associated personal stress and anxiety for the caregivers. While this issue is not necessarily limited to rural areas, it would appear that the lack of opportunity and flexibility evident in rural areas would exacerbate this problem for non-metropolitan residents. The participants also identified specific barriers to the provision of care in rural areas, including the significant impact of travel. Access to support services, such as carer groups, were rarely accessed due to a mix of factors including inaccessibility, poor timing and a lack of anonymity. Financially, there was considerable evidence of hardship, and there is an urgent need for a comprehensive review of government and community-based support to better meet the needs of rural carers. Full article
(This article belongs to the Special Issue Rural Health Care)
Article
Nurses’ Attitudes toward, and Needs for Online Learning: Differences between Rural and Urban Hospitals in Shanghai, East China
Int. J. Environ. Res. Public Health 2018, 15(7), 1495; https://doi.org/10.3390/ijerph15071495 - 15 Jul 2018
Cited by 8 | Viewed by 2393
Abstract
Health professionals need continuing education to maintain their qualifications and competency. Online learning increases the accessibility and flexibility of continuing education. Assessment of nurses’ attitudes toward, and needs for, online learning can provide suggestions regarding learning program design and delivery. This study aimed [...] Read more.
Health professionals need continuing education to maintain their qualifications and competency. Online learning increases the accessibility and flexibility of continuing education. Assessment of nurses’ attitudes toward, and needs for, online learning can provide suggestions regarding learning program design and delivery. This study aimed to evaluate Chinese nurses’ attitudes toward, and needs for, online learning, and to explore the differences in attitudes and needs between nurses working in rural and urban hospitals. This work is a secondary analysis of a multicenter cross-sectional study conducted in Shanghai in 2015 (n = 550). Multiple regression techniques were used to determine the factors associated with nurses’ attitudes toward, and needs for, online learning. Results showed that nurses in rural hospitals had more positive attitudes toward online learning (102.7 ± 14.2) than those in urban hospitals (98.3 ± 12.9) (p < 0.001). For rural hospitals, nurses who could use computers and access the internet in their workplace reported more positive attitudes than those who could not. For urban hospitals, nurse educators showed significantly more positive attitudes than others. Communication skills (86.5%) and patient education (86.3%) were the most commonly-reported learning needs for nurses regardless of their working settings. Chinese nurses were willing to adopt online learning as a continuing education method. Nurses working in rural hospitals displayed more positive attitudes toward, and needs for, online learning than those working in urban hospitals. Nursing educators and managers should develop online learning programs and provide appropriate support to fulfill nurses’ learning needs, especially for those working in rural healthcare settings. Full article
(This article belongs to the Special Issue Rural Health Care)
Article
Who and Where: A Socio-Spatial Integrated Approach for Community-Based Health Research
Int. J. Environ. Res. Public Health 2018, 15(7), 1375; https://doi.org/10.3390/ijerph15071375 - 30 Jun 2018
Cited by 3 | Viewed by 2695
Abstract
Social and spatial characteristics of a population often interact to influence health outcomes, suggesting a need to jointly analyze both to offer useful insights in community health. However, researchers have used either social or spatial analyses to examine community-based health issues and inform [...] Read more.
Social and spatial characteristics of a population often interact to influence health outcomes, suggesting a need to jointly analyze both to offer useful insights in community health. However, researchers have used either social or spatial analyses to examine community-based health issues and inform intervention programs. We propose a combined socio-spatial analytic approach to develop a social network with spatial weights and a spatial statistic with social weights, and apply them to an ongoing study of mental and physical well-being of rural Latino immigrants in North Florida, USA. We demonstrate how this approach can be used to calculate measures, such as social network centrality, support contact dyads, and spatial kernel density based on a health survey data. Findings reveal that the integrated approach accurately reflected interactions between social and spatial elements, and identified community members (who) and locations (where) that should be prioritized for community-based health interventions. Full article
(This article belongs to the Special Issue Rural Health Care)
Show Figures

Figure 1

Review

Jump to: Research

Review
Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review
Int. J. Environ. Res. Public Health 2019, 16(10), 1728; https://doi.org/10.3390/ijerph16101728 - 16 May 2019
Cited by 11 | Viewed by 1957
Abstract
The goal of this systematic review was to examine the existing literature base regarding the factors impacting patient outcomes associated with use of emergency medical services (EMS) operating in urban versus rural areas. A specific subfocus on low and lower-middle-income countries was planned [...] Read more.
The goal of this systematic review was to examine the existing literature base regarding the factors impacting patient outcomes associated with use of emergency medical services (EMS) operating in urban versus rural areas. A specific subfocus on low and lower-middle-income countries was planned but acknowledged in advance as being potentially limited by a lack of available data. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed during the preparation of this systematic review. A comprehensive literature search of PubMed, EBSCO (Elton B. Stephens Company) host, Web of Science, ProQuest, Embase, and Scopus was conducted through May 2018. To appraise the quality of the included papers, the Critical Appraisal Skills Programme Checklists (CASP) were used. Thirty-one relevant and appropriate studies were identified; however, only one study from a low or lower-middle-income country was located. The research indicated that EMS in urban areas are more likely to have shorter prehospital times, response times, on-scene times, and transport times when compared to EMS operating in rural areas. Additionally, urban patients with out-of-hospital cardiac arrest or trauma were found to have higher survival rates than rural patients. EMS in urban areas were generally associated with improved performance measures in key areas and associated higher survival rates than those in rural areas. These findings indicate that reducing key differences between rural and urban settings is a key factor in improving trauma patient survival rates. More research in rural areas is required to better understand the factors which can predict these differences and underpin improvements. The lack of research in this area is particularly evident in low- and lower-middle-income countries. Full article
(This article belongs to the Special Issue Rural Health Care)
Show Figures

Figure 1

Review
Social Determinants of Rural Health Workforce Retention: A Scoping Review
Int. J. Environ. Res. Public Health 2019, 16(3), 314; https://doi.org/10.3390/ijerph16030314 - 24 Jan 2019
Cited by 28 | Viewed by 4235
Abstract
Residents of rural and remote Australia have poorer health outcomes than their metropolitan counterparts. A major contributor to these health disparities is chronic and severe health workforce shortages outside of metropolitan areas—a global phenomenon. Despite emerging recognition of the important influence of place-based [...] Read more.
Residents of rural and remote Australia have poorer health outcomes than their metropolitan counterparts. A major contributor to these health disparities is chronic and severe health workforce shortages outside of metropolitan areas—a global phenomenon. Despite emerging recognition of the important influence of place-based social processes on retention, much of the political attention and research is directed elsewhere. A structured scoping review was undertaken to describe the range of research addressing the influence of place-based social processes on turnover or retention of rural health professionals, to identify current gaps in the literature, and to formulate a guide for future rural health workforce retention research. A systematic search of the literature was performed. In total, 21 articles were included, and a thematic analysis was undertaken. The themes identified were (1) rural familiarity and/or interest, (2) social connection and place integration, (3) community participation and satisfaction, and (4) fulfillment of life aspirations. Findings suggest place-based social processes affect and influence the retention of rural health workforces. However, these processes are not well understood. Thus, research is urgently needed to build robust understandings of the social determinants of rural workforce retention. It is contended that future research needs to identify which place-based social processes are amenable to change. Full article
(This article belongs to the Special Issue Rural Health Care)
Show Figures

Figure 1

Back to TopTop