RUPRI’s Richgels discusses summertime experiences of rural children

Jocelyn Richgels, director of national policy programs for the Rural Policy Research Institute, was an invited panelist at a National Academies of Sciences, Engineering, and Medicine information gathering session held Sept. 19 in Washington, D.C.

The session was convened by the Committee on Summertime Experiences and Child and Adolescent Education, Health, and Safety. Richgels contributed perspectives on the summertime experiences of children and adolescents in rural communities.

The committee, chaired by Martín Sepúlveda, IBM Fellow, CEO of CLARALUZ, LLC., and long-time member of the College of Public Health Board of Advisors, is studying how summertime experiences affect children across four areas of well-being: 1) academic learning and opportunities for enrichment; 2) social and emotional development; 3) physical and mental health and health-promoting behaviors; and 4) safety, risk-taking, and anti-and pro-social behavior.

Additional information is available at http://sites.nationalacademies.org/dbasse/bcyf/summertime/.

RUPRI examines causes and effects of rural pharmacy closings

A new research brief from the RUPRI Center for Rural Health Policy Analysis outlines the trends and issues surrounding the high rate of closures among independently owned rural pharmacies.

Researchers found that since 2002, more than 1,200 independently owned rural pharmacies in the United States have closed, with the most drastic decline occurring between 2007 and 2009. The report states that 630 rural communities that had at least one retail (independent, chain, or franchise) pharmacy in March 2003 had no retail pharmacy in March 2018. This decline has continued through 2018, although at a slower rate.

Keith Mueller, professor and head of health management and policy at the University of Iowa College of Public Health and director of the RUPRI Center for Rural Health Policy Analysis, is the lead author on the report.

According to Mueller, the spike in rural pharmacy closures can be attributed to the financial challenges posed to these pharmacies by the implementation of Medicare Part D.

“The biggest challenge for these pharmacies is the delayed maximum allowable cost adjustment and remuneration fees that drive up the cost of providing medications when the payments from Medicare Part D and others do not keep pace,” he says.

The report also states that the closing of so many rural pharmacies can pose significant obstacles to residents living in these communities.

“Local pharmacists are part of the health care system who provide essential services such as counseling residents as prescriptions are filled, attending to residents with mild illnesses that can be treated with over-the-counter medications, providing immunizations, and supporting other local providers,” Mueller says. “Their departure creates a big gap in these communities.”

The report was co-authored by program director Fred Ullrich and doctoral student Abiodun Salako, both in the Department of Health Management and Policy at the University of Iowa.

The full brief is available at bit.ly/2Mth3eO and was recently highlighted in The Washington Post’s “The Health: 202” newsletter.

Mueller comments on rural pharmacy closings

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/08/23/the-health-202-here-s-why-rural-independent-pharmacies-are-closing-their-doors/5b7da33e1b326b7234392b05/

Mueller testifies at Senate hearing on rural health care

On May 24, Keith Mueller, interim dean of the University of Iowa College of Public Health and director and chair of RUPRI’s Rural Health Initiatives, testified at a United States Senate Finance Committee Public Hearing on rural health. The hearing focused on challenges and opportunities in rural health care delivery.

CPH hosts Mental Health First Aid Training Course

mental health first aid logoThe College of Public Health recently hosted the Mental Health First Aid Training Course. Julie Baker and Nancy Adrianse, both with the Iowa Primary Care Association in Urbandale, provided the 8-hour training. Diane Rohlman, associate professor of occupational and environmental health, with support from the CPH Diversity Committee, organized the training as part of her Topics in Agricultural and Rural Health course, which focused on mental health in rural areas this semester.

In addition to raising awareness about different types of mental illness, the Mental Health First Aid course provides participants with the key skills and resources necessary to help someone who is developing a mental health problem or experiencing a mental health crisis. These skills and resources include the identification of risk factors and warning signs for a range of mental health problems, as well as a 5-step action plan to help a person in crisis connect with appropriate professional help.

In attendance were 25 University of Iowa faculty, staff, and students who received certification in Mental Health First Aid upon completion of the training. Participants represented the Departments of Occupational and Environmental Health, Epidemiology, Public Health Administration, and Community and Behavioral Health in the College of Public Health, as well as the College of Liberal Arts and Sciences.

According to a post-training survey, 92 percent of respondents said that they found the training useful and 100 percent would recommend the training to others. Some feedback included: “The Mental Health First Aid course was very informative and I suggest it be added to the curriculum for all first-year students,” and “I think the information is useful to those who have no background in any of the mentioned mental health topics. This is useful as a basic primer. Though this should be mandatory for all faculty and staff.”

For more information about Mental Health First Aid, please visit their website at https://www.mentalhealthfirstaid.org/.

 

Paper looks at rural health policy initiatives, future opportunities

A recent paper from the Rural Policy Research Institute (RUPRI) Health Panel examines the progress of national health policy initiatives and the gaps that remain as they affect rural people, places, and providers.

Professor and Interim Dean Keith Mueller.
Keith Mueller

According to Keith Mueller, RUPRI Health Panel Chair, professor of health management and policy, and interim dean at the University of Iowa College of Public Health, the paper lays out clear policy trajectories in seven major subject areas that can enhance access and affordability of high quality services in rural America into the future. The subject areas included are Medicare, Medicaid and CHIP, Insurance Coverage and Affordability, Quality, Health Care Finance and System Transformation, Workforce, and Population Health.

Each chapter begins with a summary of policy opportunities, followed by a background section on rural trends and challenges that summarizes rural-related policy advances and continued gaps. Each chapter concludes with a “Looking Ahead” section that highlights the most pressing issues in today’s rural health care system environment and suggests future policy directions related to each issue.

“We wanted to take a look at national policy initiatives such as Medicare, Medicaid, and insurance reform to take stock of progress made for rural communities and to develop clear statements of remaining challenges,” says Mueller. “Ultimately our goal is to help build a roadmap to achieve a high performance health system in all of rural America.”

A PDF of the paper is available at http://www.rupri.org/wp-content/uploads/TAKING-STOCK-2018.pdf

Co-authors are Charles Alfero, Hidalgo Medical Services (HMS); Dr. Andrew F. Coburn, University of Southern Maine; Dr. Jennifer P. Lundblad, Stratis Health; Dr. A. Clinton MacKinney, University of Iowa; Dr. Timothy D. McBride, Washington University in St. Louis; and Dr. Paula Weigel, University of Iowa.

This report was funded by the by the Leona M. and Harry B. Helmsley Charitable Trust, grant number 2017PG-RHC006.

Telemedicine improves rural ER response time

Emergency department patients at rural hospitals using telemedicine see a clinician six minutes sooner than patients in hospitals that have no such technology, a new study from University of Iowa shows. And if that first clinician assessment is through a telemedicine encounter, the door-to-provider time is shortened by nearly 15 minutes, says study lead author Nicholas Mohr, MD, an emergency physician and associate professor at the Carver College of Medicine at the University of Iowa.
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Additional Media Coverage

UI College of Public Health
https://www.public-health.uiowa.edu/news-items/emergency-department-telemedicine-shortens-patients-time-to-provider/

Becker’s Hospital Review
https://www.beckershospitalreview.com/telehealth/study-telemedicine-reduces-er-patient-wait-times-by-15-minutes-for-rural-hospitals.html

Emergency department telemedicine shortens patients’ time-to-provider

 

Rural hospitals using telemedicine services reduce the time between patients entering the emergency department to receiving physician care by six minutes, according to a new study led by University of Iowa researchers.

The research team, headed by Nicholas Mohr, UI associate professor of emergency medicine and anesthesia, measured the impact of emergency department (ED)-based telemedicine services on timeliness of care in rural hospitals. The study looked at data collected from 14 hospitals in Iowa, Kansas, Nebraska, North Dakota, and South Dakota that subscribe to telemedicine services from a single ED-based telemedicine provider. The team matched 2,857 emergency department cases that used telemedicine services with non-telemedicine controls.

Emergency Signs at Hospital

The results, published online Jan. 2 in Telemedicine and e-Health, showed that telemedicine decreased door-to-provider time by six minutes. This provider could be either a local provider physically assessing the patient or a telemedicine provider—whoever was available first. The first provider seeing the patient was a telemedicine provider in 41.7 percent of telemedicine encounters, and in these cases, telemedicine was 14.7 minutes earlier than local providers.

The researchers also noted that among patients who were transferred to other hospitals, ED length-of-stay at the first hospital was shorter in patients who had telemedicine consulted. The authors suggest that this reduced time may be due to remotely located staff completing administrative and charting tasks, allowing local staff to concentrate on patient care.

The study team included Tracy Young, Karisa Harland, and Marcia Ward from the University of Iowa; and Brian Skow, Amy Wittrock, and Amanda Bell from Avera eCare.

The project was supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services and the analysis was conducted by the Rural Telehealth Research Center at the University of Iowa.

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