Hospitals on wheels and Skyping your doctor: how to improve rural healthcare

Three ways regional areas are coping with shortages of doctors

Almost one in every six people in the United States lives in a non-metropolitan county. Spread across vast rural areas, caring for their health is a serious challenge.

Yet overcoming the challenge is essential. Rural Americans suffer consistently worse health outcomes. They tend to be older, and face broader social difficulties — like a lack of access to healthy food — which make their health needs more serious.

Rural communities’ needs can be addressed through less traditional approaches. Innovative rural healthcare is a rapidly shifting space, with plenty of new and overlapping ideas. Here are three of the most important developments that are helping look after patients outside the big city.

The problem

It’s easy to underestimate the importance of the urban-rural age split for healthcare.

Data from the Rural Health Information Hub shows striking disparities in health outcomes between metropolitan and non-metropolitan counties.

More than one in nine rural Americans have been diagnosed with diabetes — almost two percentage points higher than the urban rate.

They also lag on the important socioeconomic outcomes which have major health effects. Median household incomes are lower. And according to the US Department of Agriculture, more than 60% of households have limited access to healthy food in rural parts of seven states, including Kansas and New Mexico.

That leads to differences in life expectancy of nearly two years nationwide, and more than three years in some states.

Those gaps are exacerbated by much more limited availability of healthcare. Across the country, there are more than twice as many physicians per head in metro areas than rural ones.

And the problem may only be getting worse. Just under a fifth of doctors in urban areas are under 35, with long careers ahead of them. The proportion in rural America is barely 8%. In California and Florida it’s less than 4%.

That poses problems for hospitals, which can find it difficult to employ specialists when they may serve very few patients in a year. Some 120 rural hospitals closed from 2005 to 2016, according to research from the Rural Policy Research Institute at the University of Iowa.

So rural areas are finding new ways to deliver for patients’ health needs.

1. Telemedicine

More and more projects using communications technology for healthcare are coming online.

In its most straightforward form, telemedicine involves patients consulting directly with doctors by phone or video. The Portland Veterans Affairs Medical Center, for example, provides mental health services to military veterans across three states.An evaluation found that the program saved more than a million miles of travel in 2013.

But there are other important types of telemedicine. One is remote monitoring, which saves patients from repeat appointments for tests.

Partners Healthcare in Massachusetts uses telemonitoring to enable nurses to remotely assess patients’ health, and contact them to intervene before any issue requires re-hospitalisation. It estimates that as much as $10 million in costs has been saved, and readmission rates cut by 50%.

2. Coordinating care

Another approach is to increase how many patients each trained physician can care for.

In Colorado, the High Plains Health Center implemented a new system which gave each doctor three medical assistants who dealt with non-clinical tasks, such as making and updating medical records. The centre also employed “health coaches” to help patients make plans for managing their health after seeing a doctor.

The result was annual savings of half a million dollars and higher productivity, with doctors able to see more patients per hour.

In Georgia, the Stratus partnership of hospitals collaborates to make savings on infrastructure like IT systems, and shares resources and expertise between hospitals.

More novel is Project ECHO, an initiative started in New Mexico to help primary healthcare providers tackle chronic, complex conditions like hepatitis C. The program gives primary doctors the opportunity to consult with specialists on treatment plans for their patients.

That involves group conversations, with a number of doctors describing cases they’re encountering and getting specialist advice, which build the knowledge needed for effective treatment.

3. Mobile healthcare

Another answer to the problem of patients living far from healthcare facilities is straightforward: take the facilities to them.

That makes it easier for patients to access care, and also delivers savings by reducing the number of different locations in need of expensive equipment. In 2011, for example, a group of hospitals in rural Idaho clubbed together to purchase a mobile MRI unit built into a truck.

The unit visits two hospitals a day, meaning it’s available multiple times per week at each participating site.

Even more ambitious is the kind of service delivered in New Zealand, which need not even be attached to an existing hospital. Mobile units offer breast cancer screening in rural areas on a rotating basis, enabling important early intervention even for people in remote areas.

A program in New Mexico combines mobile screening units with telemedicine capability to help tackle respiratory problems for miners. An initial check using x-ray or audiometry in the unit itself is followed up, if necessary, by remote consultation with a specialist.

The Mobile Health Map in the US includes about 700 mobile providers, and its makers estimate there are more than 2000 across the country. — Fergus Peace

This piece has been updated to remove an inaccurate description of Project ECHO’s activity.

(Picture credit: U.S. Army/Reese Brown)

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