Wonderment Wednesday: The South Carolina Rural Health Research Center Is Going STAR WARS

We don't know about you, but we here at the South Carolina Rural Health Research Center IS PUMPED for this Thursday. After sitting on the edge of our seats for the past year, Star Wars: The Force Awakens finally opens in theaters. We're not pumped because of all the lightsaber fights we have been recreating at the South Carolina Rural Health Research Center.

Rather, it means we can finally stop hearing everyone and their parents talk about Star Wars and how much nostalgia the trailers bring them. Before we change our profile pictures to have lightsabers, listen to the Notorious B.I.G. Star Wars mix, and fully engross ourselves in the Star Wars hype, let me pose this important question:

Will a galaxy far far away that has all this futuristic equipment include health information technology (IT)? Would it even have something called Wonderment Wednesday that talks about.......

4 Facts On Health IT
1. Health IT makes a difference
In a study that was published by Chaudry and friends, it looked at different studies that looked at the impact of health IT. In short, the study found that health IT did indeed help improve quality and efficiency of care.

2. Health IT isn't some fancy operation
Many times when people think of health IT, they think of large expensive operations requiring futuristic new machines and special suits to operate.

No,

However, that isn't always the case. In this paper written by Dr. Kevin J. Bennett, it looked at the effects of just improving the paperwork associated with health IT work. Essentially, the paperwork was customized to the needs of the academic center. The result? A 5% increase in completed charts.

3. Rural residents are less likely to have internet
Since we are the South Carolina Rural Health Research Center, we couldn't get too far without talking about rural at least once. One problem facing rural residents is the distance they need to drive, which is why the internet is important. In this study, written by Dr. Jong-Yi Wang, it found that people living in rural areas were less likely to have internet than people in urban areas. Most importantly, minorities and people with medical conditions were less likely to use the internet.

4. Rural health providers need a lot of help
This is not just a patient level problem when it comes to health information technology, it is also an organization problem. In a study published Dr. Amy Martin, it looked at the differences between rural hospitals and rural primary care providers in South Carolina on: a. telemedicine adoption, b. telemedicine training needs c. current use of technology for patient care, In all three metrics, rural hospitals were more likely to fare better than their rural primary care providers. Unfortunately, this highlights the overwhelming need in rural areas for a stronger primary care workforce.


In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center.We will be taking the next few weeks off, so until next time, take care!

-Matt

Wonderment Wednesday: It's National Pastry Day!

It's National Pastry Day folks!

Like any good unofficial national day of celebration it gives us a good excuse to eat poorly. So get out your favorite pies, eclairs, macaroons, pecan pies, or chomp down on a bevy of pastry options in the celebration of this fine day.

But before you do, the South Carolina Rural Health Research Center insists that you practice good oral hygiene. With all the extra sugar you will be chomping down it causes you to be prone to cavities. Since we're already on the topic of oral hygiene how about we talk about

5 Facts About Rural Oral Health

1. 80% of cavities are found in 25% of children
Okay, this is not really a rural oral health fact, but it is a fact from the National Institutes of Health. This means that only a small group of children are making up a HUGE amount of the cavities. Let's dig into this a little more.

2. Rural children are less likely to have excellent teeth
In a report published by Dr. Amy Martin, it asked  the parents of both rural and urban children the condition of their children's teeth. Guess what? Like all our Wonderment Wednesday posts rural children once again got the short end of the stick.

It found that rural children were less likely to report having teeth in "excellent" condition than urban children. But what are the causes of this?

3. Rural children are less likely to have dental insurance than urban children

In a paper written by Dr. Jihong Liu, found that rural children were more likely to be uninsured than urban children. What does this mean? Going deeper into the results, children who lacked dental insurance were less likely to receive preventative care. Less preventative care means a higher chance of dental problems. A possible reason why this occurs according to the study? I'll let you take a gander:

Talking about preventative care...

4. Preventative care helps, but not as much if you don't live in urban areas

According to this study by Dr. Amy Martin, it looked personal health provider status and how often children received preventive dental care. Based on the results, personal health providers for children were more likely to receive preventive care then people who did not personal health providers. However, if the child lived in a rural area, they were less likely to receive preventive care. But not all the news is bad for rural

5. Dental sealants are about the same for both rural and urban children
Dental sealants are used as to prevent tooth decay. Based on this report, urban and rural children have about the same amount of dental sealants. Huzzah!

In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center. See you next week, same place, same time.
-Matt

Wonderment Wednesday: HIV Awareness

Folks,
We are tired at the South Carolina Rural Health Research Center.

 Why? It isn't because we partook in the post-Thanksgiving marathon of themed days (Black Friday, Small Business Saturday, Still Needs a Name Sundays, Cyber Monday, and Giving Tuesday). No. It's not even because we ate too much. It's because we are so fed up with HIV Awareness Day being put on the back burner that we are tired.

That is right, lost in the hustle and bustle of these post-Thanksgiving themed days was HIV Awareness Day. HIV or Human Immunodeficiency Virus that causes Acquired Immunodeficiency Syndrome or AIDS. Click here for more information on HIV. Many of you may remember the times of HIV/AIDS was a regular news story. While HIV is not as prevalent of a news story as it used to, it still shows up in everyday pop culture.

Other places it might show up? You guessed it, rural areas.

5 Facts About HIV/AIDS In Rural Areas

1. Prevalence of HIV/AIDS is higher in urban areas

In a report written by Dr. Medha Iyer (nee Vyavaharker) that looked at 28 states, HIV/AIDS were higher in urban counties than rural counties. Going deeper into the numbers,  HIV/AIDS tended to decrease as counties became more rural. FINALLY, some good news for people living in rural areas.

Don't worry, we were just as shocked as you are. But all this good news comes with a tidbit.

2. There are less HIV/AIDS services available in rural areas

The same study looked at HIV/AIDS services available to HIV/AIDS patients. In particular, Ryan White medical providers which provide HIV services to people lacking the resources for HIV care. Of the counties analyzed, 69% of urban counties do not have Ryan White clinics, while 95% of rural counties do not have Ryan White clinics. Unfortunately, it also found a higher proportion (78%) of rural residents with HIV/AIDS did not have a Ryan White clinic supporting them compared to urban (11%) of residents.  

.

3. South Carolina HIV infected adults are not accessing HIV care.

In this study written by Dr. Bankole Olatosi it looked at current HIV positive patients in South Carolina. What it found was that up to 40% of South Carolina HIV patients were not receiving care. But why? The paper pointed to several reasons which may include fear, stigmatization, denial of care, and stage of disease.

4. HIV isn't just a physical struggle, it is a mental struggle
In a study published by Dr. Kenneth Phillips, they reviewed home visits by peer counselors in rural women. What they found gives a very detailed insight of people who are infected with HIV/AIDS. During their study they found 4 themes in HIV/AIDS patients: 1. Stigma of their HIV status 2. Depression  3. Struggling Life 4. An uncomfortable dependence on others.

5. It is important to get HIV screenings if you are sexually active
Let me take the time to underline the importance of this point. Despite all the HIV awareness out there, 130,000 new people a year are infected by HIV in the United States.  The spread of HIV can be prevented. If you are sexually active here are local testing centers, please get tested often. If you are a person currently infected with HIV or AIDS, remember there is plenty of support and help out there for you. Please get in contact with your local public health department if you need it.

In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center. See you next week, same place, same time.
-Matt

Wonderment Wednesday: Thanksgiving and Obesity

It's Wednesday!
Let's cut to the chase folks, tomorrow is Thanksgiving and we at the South Carolina Rural Health Research Center have begun wearing the only appropriate headgear for tomorrow.

Thanksgiving marks the beginning of the holidays where there is much to be excited and unexcited for. For instance, being unexcited about that one uncle who takes a certain joy out of bringing everyone down at the dinner table. To prepare you for your uncle, let us be the buzz kill to the start of your holiday season. According to research, the average weight gain during the holiday is a little more than one pound. The problem is that we don't lose that gained weight over the year, which contributes to the obesity epidemic.

While most of you reading this are likely feeling bad for yourself and mentally preparing for the weight gain. You should feel even worse for people in rural areas. Based on these

4 Facts About Rural Obesity 

1. Rural children are heavier than urban children

According to this study published by Jihong Liu et al. in 2010, when comparing rural to urban children, rural children had higher rates of obesity than urban children. What made the rural children heavier than urban children? The major takeaway from the study was rural children were taking in more unhealthy food than their urban counterparts:

• Younger rural children consumed more fat than urban children (62.7 v 56.9)
• Younger rural children consumed more sweetened beverages than urban (13.5% v 7.9%)

But is it because rural children exercise less? Not really. 

2. Rural children did not exercise less than urban children 

According to the report, there was no real difference between rural and urban children in terms of exercise. Which likely means the weight difference is caused by the diet differences. However, the report did note, to the surprise of no one, 64%-74% of children (depending on age groups) spent 2+ hours in front of a TV or computer screen.

I heard it helps improve grip strength!

3. Rural adults had higher rates of obesity than urban adults

According to Tushar Trivedi et al,, this isn't just a rural children problem, because it effects rural adults as well. Rural adults had a higher rate of obesity than urban residents (35.6% v 30.4%). Similar to young children, rural adults were less likely to eat healthy food and drink more sweetened drinks. So it is just a diet problem right? Nope.

4. Rural adults reported less physical activity than their urban adults

 Unlike rural children, rural adults reported doing less physical activity than their urban counterparts. While the paper did not go into why rural adults would likely report less physical activity than urban adults a search of current research finds:

1. Not enough physical gyms/locations to exercise

2. Not enough sidewalks

3. Extreme conditions making it too cold/hot to exercise

And this too.

While all this information about rural obesity may put a cramp on you while you shove that cranberry covered stuffing down tomorrow. Look on the bright side! You've gained some excellent conversation starters at the dinner table tomorrow. 

As for preventing that 1 pound weight gain? We suggest smaller proportion sizes and finishing it off with a vigorous night of Black Friday shopping. 

In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center. See you next week, same place, same time. Make sure to have a safe Thanksgiving!
-Matt

Wonderment Wednesday: IT'S NATIONAL RURAL HEALTH DAY.....tomorrow!

Happy Wednesday folks!
We don't know if you know, but tomorrow is National Rural Health Day! At the South Carolina Rural Health Research Center we are so excited for tomorrow we can hardly contain ourselves.

We understand National Rural Health Day is a fairly new industry holiday day of celebration, which is why you should click on this link to get great ideas on how to celebrate National Rural Health Day. While it isn't a federal holiday just yet, keep holding your breathes, because we're in the process of lobbying for it to become a federal holiday. Like any good holiday, we here at the South Carolina Rural Health Research Center believe we give you a gift....as in a gift of rural health knowledge on

5 New Things About Rural That We Have Learned About In This Past Year Illustrated With GIFs To Celebrate National Rural Health Day

1. Free Clinics Are Much Rarer In Rural Counties 

Free clinics are incredibly helpful for populations that are disadvantaged and lack health insurance. Rural populations typically lack health insurance, which leads to poor health outcomes. For this reason, free clinics are quite an asset for disadvantaged populations. The problem is, as this link shows, only 22% of free clinics are located in rural areas. Obviously, this does not bode well for America's rural population.

2. 30 Day Readmission Rates Are Higher Among Dual Eligibles. But There Is A Silver Lining For Rural Dual Eligibles. 

If you are an elderly person living in with Medicare and Medicaid as your insurance, then you are a dual eligible. It also means that the odds are in your favor. According to this link, you are less likely to have a 30 day readmission than Medicare only rural residents. All this means that while rural residents are less healthy, a dual eligible resident is less likely to go back to the hospital if they do end up going.

3. Rural Medicare Residents were less likely to receive post-discharge inpatient rehabilitation care after stroke because they live too far

One of the things that is constantly highlighted by the South Carolina Rural Health Research Center is the lack of healthcare access for rural residents. This is due in large part to the amount of driving that a rural resident needs to do to reach a healthcare facility. According to this link, rural medicare residents were less likely to receive post-discharge rehabilitation care after a stroke because they lived too far. When they did receive care, rural residents drove an average of 18.6 miles versus 8-12.6 of an urban resident. 

4. Not All Deprived Rural Counties Are

In a study looking at looking at health outcomes among children, it was found that while many rural counties were sicker than other counties. It suggested that not all rural counties were sick. According to  this link some counties are actually better off than urban counties when looking at health outcomes. 

5. But When A Rural County Is Deprived, It Is Much Worse Off

This good news come with a tidbit. When looking further into the same evidence that produced the previous point, this policy brief revealed a major detail. When comparing a deprived urban county with similar characteristics to a deprived rural county with similar characteristics, the rural county was impacted worse than the urban county.

As you can see, most of the news from rural health is bad news. This only marks the need for more help in rural areas. Only you can make a difference for people in rural by writing to your legislature for policy change.

In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center. See you next week, same place, same time.
-Matt

It's A Wonderment Wednesday! Diabetes Awareness

Good Morning!
Before we begin, we at SCRHRC want to remember and thank all the veterans that have served for our country.  

On a totally different subject, I don't know about you, but I've finally put away all my pink based Breast Cancer Awareness items and updated my my entire wardrobe for Diabetes Awareness Month. That's right, the same diabetes that effects over 29 million Americans currently. Diabetes doesn't play around. Diabetes can lead to blindness, kidney disease, cardiovascular damage, and a slew of other problems. So make sure you wear a grey or a blue circle pin and promote Diabetes awareness this November 14th (Saturday) and for the rest of the month! 

Remember it's a blue circle pin, not a blue pin.
 Blue pins are for colon cancer in March. 

Because we are slightly fond of rural health at SCRHRC, let's put on our research caps to see the difference between urban vs. rural for diabetes. According to a research brief written in 2009 by Dr. Kevin J. Bennett et al. at SCRHRC:

• Rural adults were more likely to report having diabetes than were urban adults (9.6% versus 8.4%).  

• The proportion of adults with diabetes who reported receiving at least two hemoglobin A1c tests within the past year was lower among rural  (33.1%) residents  than urban (35.0%) residents

• Rural black adults were nearly 20% more likely to report having diabetes than were urban black residents. 
• 

If you would like to read the full report you can click here. Don't believe the results here? In this paper, written by Dr. Nathan Hale et al. in 2010, reported similar results of higher prevalence of diabetes and poorer access to care by rural residents. In addition, they are more likely to report retinopathy and foot sores. That's right, people in rural areas are more likely to have diabetes, less likely to receive quality care, and have worse health outcomes! Can you say.....mind blown?

In the meantime, remember to give a nice tap on that subscribe button to the very bottom or top left hand side of this page to read more about the South Carolina Rural Health Research Center. See you next week, same place, same time.

Matt

Rural Healthy People 2020

Researchers at the Southwest Rural Health Research Center have just published the results of their Rural Healthy People 2020 survey in The Journal of Rural Health.  

The study found that, just as when the study was first conducted a decade ago (as the Rural Healthy People 2010 study), “access to quality health services” was considered to be the single most important health priority for rural Americans. While lack of sufficient access to health care unsurprisingly remains the most salient hurdle to better health for rural residents, the survey also found that the Top 10 issues facing rural residents for the decade going forward have changed from a decade ago.  

Specifically, while issues of “nutrition and overweight” were not even listed in as a “Top 10” priority ten years ago, while it has moved into the second highest priority in the most recent survey.

 Another interesting finding is that while stakeholders responding to the survey a decade ago did not list “older adults” as a healthy priority to be addressed within rural America, in this latest survey, the majority of stakeholders ranked issues facing “older adults” in the top ten highest-priority issues. 

These are issues we all need to be aware of as important to rural practitioners and policy makers, and ensure that they do not get lost in the ongoing struggle for improved access.

Community Paramedicine

The SC Rural Health Research Center has a history of working with community partners, providers, and systems to analyze, evaluate, and otherwise aid in their operations. One such project is the Abbeville Area Medical Center's Community Paramedicine Project.  This pilot, spearheaded by David Porter (Director of Abbeville's EMS), utilizes paramedics to conduct home visits for medically indigent patients.  The two videos below summarize the program, introduce you to the EMTs and a couple patients, and discuss some of the outcomes from this innovative project.

King v. Burwell: Rural Implications?

Unless you live under the proverbial health policy rock, you know that today the Supreme Court will hear arguments on King v. Burwell (a brief history is here).  If the SCOTUS strikes down the subsidies provided in federally run exchanges, the impact will be significant:

• Approximately 7.2 million with insurance losing access to subsidized premiums; in other words, about 87% of those who obtained insurance via the exchanges
•  Substantial increase in the number of uninsured (due to the loss of subsidies, it is anticipated many would not be able to afford the full premium)
• Premiums (in the non-group market) would increase substantially, upwards of 35%

These changes have the potential to impact rural residents to a greater degree.  Rural residents have, on average:

• lower incomes
• reduced access to employer sponsored coverage
• more likely to live in a non-Medicaid expansion state
• have fewer enrollment options (plan and/or network choices) and higher premiums within the exchanges

If these subsidies are removed, it will further distance rural residents from the rest of the country in regards to insurance coverage, access to care, and equity in treatment.