Dissertations / Theses: 'Rural clinical health'

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Hale, Nathan, Tamar Klaiman, Kate E. Beatty, and Michael Meit. "Rural Health Departments and Clinical Services: Transition to Whom?" Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6845.

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Beatty, Kate E., Nathan Hale, Michael Meit, Paula Masters, and Amal Khoury. "Clinical Service Delivery along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6870.

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Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities. Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting Area codes. Bivariate analysis for clinical services was conducted by rural/urban status. For each service, the proportions of LHDs that directly performed the service, contracted with other organizations to provide the service, or reported provision of the service by independent organizations in the community was compared. Results: Analyses show significant differences in patterns of clinical services offered, contracted, or provided by others, based on rurality. LHDs serving rural communities, especially large rural LHDs, tend to provide more direct services than urban LHDs. Among rural LHDs, larger rural LHDs provided a broader array of services and reported more community capacity for delivery than small rural LHDs- particularly maternal and child health services. Implications: There are capacity differences between large and small rural LHDs. Limited capacity within small rural LHDs may result in providing less services, regardless of the availability of other providers within their communities. These findings provide valuable information on clinical service provision among LHDs, particularly in rural and underserved communities.

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Beatty, Kate, Michael Meit, Tyler Carpenter, Amal Khoury, and Paula Masters. "Clinical Service Delivery Disparities along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6847.

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background: Rural communities face numerous health disparities related to health behaviors, health outcomes, and access to medical care. LHDs serving rural communities have fewer resources to meet their community needs. The number and types of community organizations (hospitals, health clinics, not-for-profits), available to partner with may be limited geographically. These factors may affect availability of clinical services in rural communities. This study will assess LHD clinical service delivery levels based on rurality. data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area (RUCA) Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy. analysis: Bivariate analysis for 25 clinical services offered by rurality . For each service, we compared the proportions of LHDs that: 1) directly performed, 2) contracted with organizations, and 3) reported that the service was provided independently by organizations in the community. principal findings: Analyses show significant differences in patterns of clinical services offered, contracted or provided by third parties based on rurality. LHDs in micropolitan areas provided more services directly than urban and rural LHDs (p≤0.001). Urban LHDs were more likely to contract with other organizations (p≤0.001). conclusions: Rural LHDs are less likely to offer, contract, or have services provided by another organization in the community, whereas larger rural (i.e., micropolitan) jurisdictions are more likely to directly provide these services. implications for public health practice and policy: Lower levels of clinical service delivery by rural LHDs may contribute to the access issues facing rural communities. Health care reform brings threats and opportunities for LHD clinical service delivery. Further analyses to assess impacts on rural LHDs and identify strategies to ensure access to clinical services is encouraged.

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Hale, Nathan, Tamar Klaiman, Kate E. Beatty, and Michael B. Meit. "Local Health Departments as Clinical Safety Net in Rural Communities." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6824.

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Introduction: The appropriate role of local health departments (LHDs) as a clinical service provider remains a salient issue. This study examines differences in clinical service provision among rural/urban LHDs for early periodic screening, diagnosis, and treatment (EPSDT) and prenatal care services. Methods: Data collected from the 2013 National Association of County and City Health Officials Profile of Local Health Departments Survey was used to conduct a cross-sectional analysis of rural/urban differences in clinical service provision by LHDs. Profile data were linked with the 2013 Area Health Resource File to derive other county-level measures. Data analysis was conducted in 2015. Results: Approximately 35% of LHDs in the analysis provided EPSDT services directly and 26% provided prenatal care. LHDs reporting no others providing these services in the community were four times more likely to report providing EPSDT services directly and six times more likely to provide prenatal care services directly. Rural LHDs were more likely to provide EPSDT (OR=1.46, 95% CI=1.07, 2.00) and prenatal care (OR=2.43, 95% CI=1.70, 3.47) services than urban LHDs. The presence of a Federally Qualified Health Center in the county was associated with reduced clinical service provision by LHDs for EPSDT and prenatal care. Conclusions: Findings suggest that many LHDs in rural communities remain a clinical service provider and a critical component of the healthcare safety net. The unique position of rural LHDs should be considered in national policy discussions around the organization and delivery of public health services, particularly as they relate to clinical services.

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Beatty, Kate. "Clinical Service Delivery Disparities along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6853.

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Basley, Anthony A. "Selection of medical laboratory and clinical locations in Ghana using decision modeling." Online version, 2009. http://www.uwstout.edu/lib/thesis/2009/2009basleya.pdf.

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Stidworthy, Jennifer Jane. "The implementation of a portfolio assessment system for a rural clinical school in South Africa : what can be learned from the implementation of portfolios as an assessment system in a rural clinical school." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80389.

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Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: A portfolio assessment system was designed to meet the needs of a Rural Clinical School education platform, hosting final year MB ChB students for the duration of their final year. A study entitled “What can be learned from the implementation of a portfolio assessment system, to be used in the assessment of clinical reasoning of final MB ChB students placed in a Rural Clinical School in South Africa? “ was conducted. The experience of educators and students during this process was explored. The findings are in keeping with the literature. Van Tartwijk & Driessen 2009, Eley et Al 2002, Lake & Ryan 2004, Burch & Seggie 2008 claim that portfolios drive deep student learning and develop clinical reasoning. Burch & Seggie (2008) offer an assessment tool which has proved feasible within the South African setting on which this portfolio assessment system was modelled. The assessment tool design faced a number of challenges within the RCS setting which were addressed during a review process. The portfolio assessment system is viewed as a work in progress requiring further development. Despite the constraints and challenges, both staff and students unanimously supported the development of patient case studies within the design as a valuable learning tool.
AFRIKAANSE OPSOMMING: ‘n Portefeulje assesserings sisteem is ontwerp om die behoeftes van ‘n UKWANDA Landelike Kliniese Skool opvoedings program wat die gasheer van die MB ChB student tydens hul finale jaar is, na te kom. ‘n Studie genaamd “ Wat kan geleer word uit die implementering van ‘n portefeulje assesserings sisteem, wat gebruik gaan word om die kliniese redenering te bepaal van finale jaar MB ChB student wat geplaas is in ‘n Landelike Klinieke Skool in Suid Afrika? ” is uitgeoefen. Die ervaring van die dosent, so wel as die studente, is ondersoek. Die bevinding is in lyn met die literatuur. Van Tartwijk & Driessen 2009, Eley et Al 2002, Lake & Ryan 2004, Burch & Seggie 2008 beweer dat portfeuljes dryf student tot diep studie en ontwikkel kliniese redenasie. Burch & Seggie (2008) bied ‘n assesserings (hulp)middel aan wat toepaslik en uitvoerbaar is in die SA konteks , waarop die portfeulje assessering sisteem gebaseer is. Die ontwerp van die assesserings (hulp)middel het vele uitdagings binne die RCS opset in die oog gestaar. Dit is aangespreek tydens ‘n proses van hersiening. (Lather, 2006).Die portefeulje assesserings sisteem word gesien as ‘n werk onder hande en vereis verdere ontwikkeling. Ten spyte van die beperkinge en uitdagings het beide die staf en die student onomwonde die ontwikkeling van pasiente gevalle studies, binne die ontwerp, as ‘n waardevolle leermiddel gesien.

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Avey, Jaedon P. "Discharge planning from urban psychiatric facilities to rural communities using telehealth." Thesis, University of Alaska Anchorage, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3619191.

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Coordinating care is of particular concern in Alaska due to expansive geography, difficulty of travel, and often limited behavioral health care resources. This study explored how individual, organizational, and systemic factors influence clinicians' use of video teleconferencing to conduct "live" discharge plans from urban psychiatric facilities to rural communities.

Semi-structured key informant interviews were conducted, in person and by telephone, with urban clinical staff (n = 10), urban administrative staff (n = 6), and rural outpatient staff (n = 14). Two researchers analyzed the transcribed interviews in a recursive manner using a grounded theory methodology.

Participants described infrequent, but generally positive experiences with live discharge planning: connecting patients to providers, temporarily joining treatment teams, evaluating patients for appropriate placement, engaging patients in their own care, addressing medication issues, and coordinating with family and village resources. Providers recommended hiring interns or dedicated staff, installing equipment "on unit," or using wireless tablets. Rural participants ascribed a greater value to emergency psychiatric consultations at admissions than coordination at discharge.

Continued selective use of live discharge plans is indicated with patient length of stay being an important consideration in determining feasibility. Future implementation should involve dedicated resources and use video teleconferencing to formally enhance other transitional services. Once issues of organizational readiness are addressed, a Knowledge-Attitudes-Behavior framework may be useful for managing providers' underuse. Future research could evaluate rural, village-based intensive case management supported by consultation with the psychiatric hospital via video teleconferencing.

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Weierbach, Florence M., and Marietta P. Stanton. "Interface of Prelicensure Clinical Education, Case Management and Rural Nurse Theory in Appalachian Primary Care Clinics." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7380.

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Cockrell, Deborah Jane. "Rural clinical placements for dental students : an action research study." University of Sydney, 2005. http://hdl.handle.net/2123/4662.

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Doctor of Philosophy
This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

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Urruty, Kenli A. "Factors Associated with Physical Activity Behaviors Among Rural Adolescents." DigitalCommons@USU, 2009. https://digitalcommons.usu.edu/etd/488.

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The "obesity epidemic" in the United States is a current health concern that has sparked research interest in physical activity as a means of weight management. However, little research has examined the physical activity behaviors of rural adolescents. The goal of the current study was to use a biopsychosocial framework to examine the physical activity behaviors of a sample of rural adolescents, and explore factors associated with physical activity participation. A sample of 162 ninth- and tenth-grade students in a rural, western community were recruited for this study. Generally, the sample reported levels of physical activity for both genders that are higher than the national average. Additionally, a significant difference in physical activity between genders was not found. Results indicated that school-sponsored, low- or no-cost sports are essential to physical activity participation. Psychological factors and parent and peer support were also strongly associated with physical activity.

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Oetinger, Megan. "The decision and rewards of practicing psychology in a rural area." Theological Research Exchange Network (TREN), 2008. http://www.tren.com/search.cfm?p088-0179.

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Russo, Kimberly M. "The Collaborative Role of Psychologists in Rural Pediatric Primary Care Settings." Antioch University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1331307175.

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Briggs, Beth. "Solutions for Recruitment and Retention of Rural Psychologists by Rural Psychologists." Antioch University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1441373640.

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Wise, Jason M. "Farm Resource Center clinical assessment a symptom checklist for rural adults in the midwestern United States /." Online full text .pdf document, available to Fuller patrons only, 2003. http://www.tren.com.

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Jensen, Trey Howard. "Impact of Distance, Diagnosis, and Demographics on Attendance for Rural Outpatient Treatment." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3170.

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Missed psychotherapy appointments inhibit mental health treatment, limit the availability of treatment to those waiting for care, and reduce clinician revenue. Previous research has revealed that the factors that predict missed appointments vary depending on the geographic location in which that research is conducted. There is not a complete understanding of the characteristics of people who miss appointments in a rural context. This study used information from 281 client records to examine the predictive relationships among missed appointments and the distance traveled to the clinic, mental health diagnosis, age, and gender at a rural outpatient mental health clinic. The purpose of this research was to identify the factors that significantly predicted if clients missed 30% or more scheduled psychotherapy appointments. The health belief model was used as the framework. Logistic regression analysis revealed that clients with a diagnosis of depression, bipolar disorder, or anxiety were more likely to miss 30% or more appointments. The distance traveled to the clinic did not predict missed appointments. This finding deviates from results in previous literature which found that long travel distances increase the likelihood of missed appointments. This could be due to the geographic region or how the client records were selected in this study. This study can have a positive impact by informing rural mental health clinics of factors that may predict the likelihood of missed appointments. Clinics could then use the information to develop empirically-supported retention interventions. Retention interventions could promote social change by increasing appointment attendance, which could improve overall patient care and reduce health care waste accrued by missed appointments.

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Lilly, Courtney E. "Technology Use in Rural Appalachia: A Pilot Study of the Implications for Pediatric Behavioral Health." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etd/2295.

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Technology is a promising means for increasing rural individuals’ access to behavioral healthcare. However, the range of technology use in rural areas is currently unknown. The aims of this study were to examine the use of technology in rural areas, the relationship between technology use and willingness to access pediatric mental health services via videoconferencing, and this relationship within the context of other critical variables linked to service uptake. Data were collected at 2 pediatric primary care clinics. While no significant relationship was found between technology use and willingness to use videoconferencing, a significant relationship emerged between previous service seeking and willingness to use videoconferencing. These findings indicate the need for more research examining other variables’ relationships to willingness to seek help via technology, such as general help-seeking attitudes, unfamiliarity with videoconferencing services, or other variables included in previously established models of technology adoption.

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Love, Amithea M. "Rural Clinicians’ Perceived Ethical Dilemmas: Relationships with Clinician Well-Being and Burnout." Antioch University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1421066142.

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Tolliver, Robert M. "Who Done It? Rurality vs. SES as Critical Factors in Evaluating the Prevalence of Child Psychosocial Concerns in Primary Care." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etd/2302.

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The purpose of this study was to evaluate the prevalence of child psychosocial concerns in rural primary care, hypothesized to be greater than national averages due to lacking mental health services in rural areas. This study was an examination of the role of SES, various definitions of “rural,” and the interaction of SES and rurality, in predicting parent-reported child psychosocial concerns in Appalachian primary care clinics. Caregivers presenting with their child at one of 8 pediatric primary care sites (n=2,672) were recruited to complete a measure assessing demographics and the Pediatric Symptom Checklist (PSC). Results showed that while rural status was not associated with PSC scores, higher parental education was associated with lower rates of clinically significant psychosocial concerns. The present study failed to replicate prior preliminary findings that child psychosocial concerns are more prevalent in rural primary care. SES, rather than rurality, appeared to be the primary predictor of such concerns.

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Theunissen, Anna Luttig. "An exploration of the experiences and perceptions of health and allied health care students regarding interprofessional collaboration and education in a rural clinical setting in South Africa." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86617.

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Ransom, Dana M. "Telephone-Delivered, Interpersonal Therapy for HIV-Infected Rural Persons with Depression: A Pilot Randomized Clinical Trial." Ohio : Ohio University, 2007. http://www.ohiolink.edu/etd/view.cgi?ohiou1181761210.

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McCarter, Kayla D. "RURAL PEDIATRIC PRIMARY CARE PRACTICE PATTERNS AS A RESULT OF AN ON-SITE BEHAVIORAL HEALTH CONSULTANT: A RETROSPECTIVE ANALYSIS." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/honors/204.

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Nationally, it has been estimated that 10 to 21% of children with psychosocial concerns are seen in primary care settings (Jellinek et al., 1999; McInerny, Szilagyi, Childs, Wasserman & Kelleher, 2000; Palermo et al., 2002). Often, however, children go undiagnosed with/treated for psychosocial concerns in pediatric primary care due to lack of physician time and poor referral rates to mental health providers. Evaluations of integrated care models, in which a behavioral health consultant is present in primary care practices, has shown to increase the availability of mental health services (Stancin, Perrin, & Ramirez, 2009). Using extant data from patient records extracted by a trained nurse, this study aims to assess practice scheduling habits and seasonal variation in behavioral health consultant (BHC) usage on days when a BHC is present versus non-BHC days in one rural pediatric office over the course of four years. This study aims to evaluate economic efficiency based on the number of patients scheduled per day. It is hypothesized that the presence of an onsite BHC will increase patient volume and, thus, economic efficiency. Information gathered from the clinic’s electronic scheduling system included: 1) the number of patients scheduled on a BHC day and 2) the number of patients scheduled on a non-BHC day for each week of the BHC’s employment. These data—both overall and by year and season—were analyzed using one-way ANOVA and post hoc Tukey testing. There were no significant differences in scheduled patient volume found between the day types overall. However, yearly analysis revealed significant differences between 2010 and 2012, 2013, and 2014 on BHC days and between 2010 and 2014 on non-BHC days. When examined by season, significant differences were found between Fall/Winter and Spring/Summer on both day types in post hoc Tukey testing. These findings have important implications for the trajectory of benefits provided by a BHC in a rural integrated care model.

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Wood, Tamara Michelle. "Nutritional Assessment of Rural Mossi People in Burkina Faso: A Comparison of Pre- and Post-Harvest Status." UNF Digital Commons, 2000. http://digitalcommons.unf.edu/etd/287.

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The purpose of this study was to compare the nutritional status of a rural population of Mossi people in Burkina Faso during the pre- and post-harvest seasons. Comparisons were made between the sample population and the American population, between the pre- and post-harvest seasons, between males and females in the sample population and between the various age groups in the sample population. This nutritional assessment consisted of collecting demographical information, anthropometrical measurements such as weight and height, a clinical assessment to evaluate physiological signs of nutritional deficiencies and a food frequency questionnaire to describe the dietary practices of the population. Due to the potential risks of handling human blood, urine and feces, biochemical analyses were not performed in this study. Special attention was given to the nutritional problems most common in Africa: protein energy malnutrition, vitamin A deficiency, iron deficiency and goiter. Adults in this study had an average body mass index of 19.1, classifying the adult population as "underweight". The population of American adults, however, has a tendency toward a body mass index in the slightly overweight category. The BMI range of adults in the study population was 12.9 to 27.8. A total of 36.9% of the adult population presented with some level of protein energy malnutrition while only 2.7% were slightly obese. Seventy percent of children were below the 50th percentile on the 2000 Centers for Disease Control weight-for-height growth chart. A third of all children were below the 3rd percentile of weight-for-height. The vast majority of children in this study had a weight-for-height below the median, or "average", American child. The mean percent of median body weight-for-height for the child population in the lean season was 85.2% indicating that the median child in this sample population was mildly wasted. The mean percent of median weight-for-height rose to 94.6% in the post-harvest season indicating that the median child of the sample population was "normal" concerning wasting status. The results of this study indicate that this rural population of Mossi people was less well-nourished than their American counterpart and that their nutritional status differed based on season (F=[4,177] 4.77, p=.03 for adults and F=[4,51] 8.56, p=.005 for children) but not gender (F=[ 4,177] .04, p=.83 for adults and chi square= 4.37, p=.22, df=3 for children) or age group for adults (r=.l 0, p=.29). In children, nutritional status was based on age group (but contrary to the expected outcome) with prepubescent children having lower weight-for-height percentiles than the under-five population (chi square = 40.34, p=.02, df=24). Nutritional status improved as predicted during the postharvest, or plentiful, season. Due to the lack of biochemical analyses, the potential vitamin and mineral deficiencies indicated in the brief physical examination were not confirmed. Vitamin A deficiency was the most likely nutrient deficiency; symptoms occurred in 51% of the population, primarily in adults and older children. PEM, although indicated by the anthropometric measures to affect 37.1% of the adult population and 55.4% of the child population, did not greatly manifest itself in clinical symptoms. The incidence of iron deficiency anemia was also relatively low with only 7% of the population presenting with pale conjunctivae, a potential, but non-specific sign of iron deficiency anemia. The goiter rate was also very low with only two cases occurring during the post-harvest season.

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Saulnier, Matthew James. "LINKING THE HOME AND NEIGHBORHOOD FOOD ENVIRONMENTS REGARDING DIETARY INTAKE AMONG RURAL ADOLESCENTS." UKnowledge, 2015. http://uknowledge.uky.edu/foodsci_etds/35.

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Home availability of both healthful and unhealthful foods may influence consumption among rural adolescent populations. In conjunction, the availability of food in an individual’s local food environment has the potential to significantly impact what is procured for the home and eaten away from the home. The purpose of this study was to determine how in-store food availability and parental purchases influences home availability and, ultimately, dietary intake among adolescents. This study measured perceived home availability, using the University of Minnesota Project EAT Survey, and dietary intake, using the NHANES Dietary Screener Questionnaire, of (n=28) adolescent participants in two Kentucky counties during 2013. Availability of food in local stores was measured using the Nutrition Environment Measures Survey in Stores (NEM-S). The results of multiple linear regression analysis suggest that overall store availability does not significantly impact parental purchases. However, in-store availability of specific unhealthy food categories, such as snacks, junk food, candy, and pop, was associated with increased parental purchases of similar unwholesome items and a greater predicted intake of sugar. Therefore, it may be beneficial to develop interventions aimed at decreasing the availability of unhealthy food items in stores in order to improve diet quality among rural adolescents.

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Dronamraj, Saritha. "Electronic Prescribing Management System for Rural Settings of Developing Countries : A Patient Centric System." Thesis, Linköpings universitet, Institutionen för datavetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-80986.

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During the last decade, electronic prescribing has been a point of focus in healthcare industry and is rapidly becoming a standard of practice. It has proven as an important element in improving the quality of patient care, mitigating or eliminating the phone calls back and forth from pharmacies to point of care/health centers. Many e-prescribing systems were developed and marketed but these usually were unsuccessful because of the lack of direct electronic connectivity to local pharmacies and the lack of up-to-date formulary information, clinical guidelines, health plans & services among other reasons. Despite their benefits, the adoption and usage of electronic prescribing systems has been low. In some of the developing countries like Uganda, the problem is even worst. Due to lack of essential resources and manpower, healthcare services have significantly impacted on the productivity and quality of patient care.In an effort to improve, promote and maintain the quality of health services in rural settings of developing countries like Uganda, a high level design for e-prescribing system has been proposed. Design specifications for Electronic Prescribing Management System (EPMS) along with functional prototype are built based on ICT4MPOWER project requirements and previous research and publications in this area.Initially research began with Drug and Stock Management System and EPMS emerged as one of its essential components. In order to strengthen and establish connection between ongoing electronic health record system and drug and stock management development, EPMS component came into lime light. Mare prescription management is not enough to serve patient centric needs. Hence, clinical decision support has been introduced into e- prescribing system to improve the quality of prescribing decisions. In order to develop a patient-centric e-prescribing system that is self-evolving and self sustaining, it is important to update the clinical decision-support system, formularies & guidelines on regular basis. In order to make it usable, it is required to formulate effective health plans and increase associations between pharmacies and other health organizational units. The principal benefit of introducing E-prescribing system into Electronic Health Record (EHR) System is to connect open ended systems to form a strong knowledge base for future.
ICT4MPOWER

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Gretak, Leal Alyssa P. "A Gap Analysis of Reentry Services for Corrections-Involved Populations in Rural East Tennessee." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/etd/3954.

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Returning citizens face a host of barriers when attempting to reintegrate into society; thus, services for these concerns are imperative for successful reintegration. Unfortunately, services are often lacking, particularly in rural communities which tend to be overlooked in reentry research. In order to better determine service need for justice-involved populations in rural communities, the current study completed a gap analysis, both inspired and supplemented, by qualitative information collected from mental health providers (MHPs) in a rural Appalachian region of Tennessee. To complete the gap analysis, an estimation of need was collected via local crime statistics. Using this data, a two-sample t-test revealed that increased rurality was related to a significantly higher percentage of substance use related crimes, but not to crimes against persons or sexual crimes. Service availability data was then collected for local providers in the domains of general mental health, substance abuse, anger management (or anger management aligned), and sex offender treatment. It was found that nine of the ten counties in the identified region are considered mental health professional shortage areas (MHPSAs) for general mental health care. Using average caseload data from local MHPs, a calculation of provider shortfall was completed for specialty services for returning citizens. For the identified 10-county region, provider shortfalls were existent in all treatment domains. The largest gap identified was for anger management aligned services, while the smallest gap identified was for sex offender treatment services. An increase in rurality did not ensure an increased provider shortfall across domains. Overall, MPHs in the area identified similar needs in treatment services via two major qualitative themes and five subthemes. The findings from the current study provide a specific example of what services are missing for rural returning citizens. It is hoped that the results of this study help inform policy and programming efforts in rural communities as they attempt to close the service gap and successfully reintegrate rural returning citizens.

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Richie, Kevin Anthony. "THE IMPACT OF A FRUIT AND VEGETABLE FARMERS' MARKET VOUCHER PRESCRIPTION PROGRAM ON A LOW-INCOME RURAL POPULATION." UKnowledge, 2019. https://uknowledge.uky.edu/foodsci_etds/65.

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Objective: Measures the impact of the Farmers’ Market Voucher program on weight, body mass index, waist circumference, during the 2016 summer on a rural, low-income population residing in Appalachian Kentucky. Background: Rural communities often have limited access to fresh fruits and vegetables (FV) which contributes to low levels of consumption. FV are calorie poor, nutrient dense and are inversely associated with inflammation markers, obesity, hypertension, and high blood glucose levels. Appalachian rural communities have a higher prevalence of obesity, diabetes, strokes, and death by heart attack when compared to the U.S. Farmers’ markets Methods: Pre-experimental intervention design examining FV consumption and variety. T-test used measuring biochemical outcomes, pre and post, participation, and voucher amount. Results: Medical clinic patients (n=308) and household members (n=89) participated in study. Patients had a decrease in blood glucose and waist circumference (p=0.0231, p=0.0014 respectively). Patients had greater blood glucose reductions when compared to household members (p < 0.001). Patients reported consuming more FV with greater variety. Conclusion: The Farmers’ Market Voucher program successfully increased FV consumption and had a positive effect on blood glucose and waist circumference. Future studies should examine cooking methods of this population.

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James, Glynnis Geraldine. "Woven threads : a case study of chemotherapy nursing practice in a rural New Zealand setting : a thesis submitted to the Victoria University of Wellington in partial fulfilment of the requirements for the degree of Master of Nursing (Clinical) /." ResearchArchive@Victoria e-Thesis, 2008. http://hdl.handle.net/10063/637.

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Motswaledi, Mmabotsha. "Cultural issues in the treatment of hospitalised, malnourished children : an exploratory-descriptive study of the attitudes of health professionals and mothers in a rural hospital setting." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/17314.

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Bibliography: p. 100-105.
Culture plays a significant role in the treatment of certain illnesses and in the maintenance of good health in communities. In hospitals, professionals are constantly faced with medication non-compliance and other defaulting behaviour by health consumers or patients due to lack of their sensitivity towards cultural issues. It is true that most Africans are faced with a dilemma of choosing between Western treatment approaches and their own traditional healing. Therefore some may need still to adopt both Western and African approaches. The study examines the attitudes of both the professionals and mothers with malnourished children towards the cultural values linked to the treatment modalities. An exploratory- descriptive method is used as a focus for the study. Because of the illiteracy of the mothers, an interview schedule was used to collect data and get impressions about certain issues. A questionnaire was used to collect data from the professionals; which included nurses, an occupational therapist, a physiotherapist, and people working for the Kwashiorkor Centre. Both the literature review and other studies showed that there is a difference in attitudes regarding cultural issues in the treatment of malnourished children between the health consumers and the health professionals. Findings of this study revealed negative attitude towards mothers who used traditional medicine before coming to hospital. Mothers felt that they were reprimanded regarding their cultural value systems. This study includes recommendations that health professionals need to be sensitive to the cultural belief system of the health consumers for better compliance and service delivery. It is recommended that health care providers be aware of their value systems and above all respect those of the consumers. To facilitate better participation in health education programmes it is important that these programmes are culturally sensitive.

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Austin, Jacob Brendan. "A Phenomenological Investigation of Physician Job Satisfaction in Rural Integrated Primary Care." Antioch University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1346953375.

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Gillespie, Rachel. "CONNECTING SELF-EFFICACY OF DIETARY CHOICES AND THE ASSOCIATION WITH DIETARY INTAKE AMONG RURAL ADOLESCENTS IN NORTH CAROLINA AND KENTUCKY." UKnowledge, 2017. https://uknowledge.uky.edu/foodsci_etds/54.

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Determining the level of belief one has in themselves, or their self-efficacy, can be a key factor to improve certain dietary patterns and choices in the rural youth population. Sugar sweetened food and beverage consumption continues to rise and fruit and vegetable intake remains a struggle in rural areas; addressing both the food environment and adolescents’ self-efficacy could have a lasting impact on changing the nature of a generation of rural student’s food and beverage choices. This study measured self-efficacy levels of (n=425) adolescents in rural Kentucky and North Carolina using the Youth Impact Questionnaire and dietary intake using the NHANES Dietary Screener. Multiple linear regression analysis found that higher levels of self-efficacy resulted in a statistically significant ability to consume more vegetables. Further associations found that higher levels of self-efficacy resulted in increased fruit consumption, and improved added sugar food and beverage selections. These findings suggest that it could be beneficial to target adolescents’ self-efficacy as a way to modify certain health behaviors in a sparse food environment such as these rural Appalachian areas.

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Cosio, David. "A Telephone-Delivered, Motivational Interviewing Intervention to Reduce Risky Sexual Behavior in HIV-Infected Rural Persons: A Pilot Randomized Clinical Trial." Ohio : Ohio University, 2008. http://www.ohiolink.edu/etd/view.cgi?ohiou1218748266.

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Murphy, Caroline E. "Parental Perceptions of Barriers to Care: An Examination of Rural Appalachian Parents' Expectancies of the Availability, Process, and outcome of Mental Health Services for Elementary School-Aged Children." Ohio : Ohio University, 2005. http://www.ohiolink.edu/etd/view.cgi?ohiou1129068871.

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Dalton, William T. III, Karen Schetzina, and Elizabeth Conway-Williams. "A Coordinated School Health Approach to Obesity Prevention among Appalachian Youth: Middle School Student Outcomes from the Winning With Wellness Project." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/ijhse/vol2/iss1/2.

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The Winning With Wellness (WWW) project was a school-based obesity prevention program that was developed to promote healthy eating and physical activity in youth residing in rural Appalachia. The project was based on the Coordinated School Health model (Centers for Disease Control and Prevention (CDC), 2013a) and used a community-based participatory research approach with an emphasis on feasibility and sustainability. The purpose of this study was to examine self-reported health outcomes for middle school students across the course of the intervention. Sixth grade middle school students (N = 149; 52% girls) from four schools in Northeast Tennessee completed a survey assessing demographic factors and health behaviors as well as the Pediatric Quality of Life Inventory (PedsQL, Varni, Seid, & Kurtin, 2001) at baseline and follow-up, approximately 9-months after project implementation. Across the course of the intervention there were no statistically significant changes from baseline to follow-up in fruit and vegetable consumption, physical activity, or screen time. Further, there were no statistically significant changes in health-related quality of life (HRQoL). The lack of change in health behaviors is similar to a recent study also emphasizing sustainability (Neumark-Sztainer, Story, Hannan, & Rex, 2003). Unlike in the current study, Palacio-Vieira and colleagues (2008) found HRQoL to significantly decline with age in a population-based sample of Spanish youth. It will be important to examine whether or not obesity interventions may ameliorate this effect as well as to test the feasibility and school/structural support for sustained intervention implementation at a level that promotes lifestyle change.

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McDonald, Jordan Elizabeth. "FINDING THE LINK BETWEEN SOCIAL CONNECTIVITY AND DIETARY INTAKE AMONG RURAL ADOLESCENTS IN NORTH CAROLINA AND KENTUCKY." UKnowledge, 2017. https://uknowledge.uky.edu/foodsci_etds/53.

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Social networks play a significant role in adolescent decision making, specifically when it comes to dietary outcomes. This study, granted by the United States Department of Agriculture (USDA), assessed the connectivity of these social networks and the impact they have on fruit and vegetable, added sugar and sugar sweetened beverage consumption. Additionally, the relationship between shopping companionship and dietary choices was studied. Positive and negative associations were found among adolescents who shop with parents or friends. It was also found that those adolescents with greater social network cohesion were found to have more negative dietary outcomes. Divulging further into the relationships within adolescent social networks may improve fruit and vegetable and decrease added sugar consumption within rural communities.

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Mitchell, Dana. "Stress, Coping, and Appraisal in an HIV-seropositive Rural Sample: A Test of the Goodness-of-Fit Hypothesis." Ohio University / OhioLINK, 2004. http://www.ohiolink.edu/etd/view.cgi?ohiou1103225821.

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Morrow, Jennifer A. "Technologically Assisted Intervention (TAI): Are Clients Satisfied with Online Therapy?" DigitalCommons@USU, 2008. https://digitalcommons.usu.edu/etd/20.

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This study examined the level of satisfaction reported by participants of a technologically assisted intervention study (TAI). TAI is a type of teletherapy done through online, live video conferencing. Satisfaction was examined at three different time points, post therapy, 3-months post therapy, and 6-months post therapy. Analyses examined if there were any changes in reported satisfaction over the three time periods. Participants received cognitive behavioral therapy (CBT) targeted at reducing symptoms of mild to moderately severe depression. A satisfaction measure was developed for this study, and included quantitative and qualitative items which were analyzed to determine participants' level of satisfaction. Seventeen women residing in the Vernal and Roosevelt, Uintah Basin areas, volunteered to participate in the study that was funded by a CURI and AES grant. This study found that the women experienced a high level of satisfaction with TAI across the various dimension measured. This high level of satisfaction remained consistent across the three time periods examined. Qualitative data offered a depth of understanding regarding what particularly participants were and weren't satisfied with. (106 pages)

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Selvakumar, Divya Lakshmi. "Relationships between a Prenatal Nutrition Education Intervention and Maternal Nutrition in Ethiopia." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1551.

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In Ethiopia, 17% of pregnant women ages 18-49 are malnourished and have low awareness of prenatal nutrition, which may relate to increasingly high rates of maternal and infant mortality. The purpose of this mixed methods research study was to determine the effects of a community-based prenatal nutrition education intervention program on maternal nutrition knowledge and attitudes in the Alaje district of Ethiopia. The theoretical framework was Sen's capability theory of poverty, in which opportunities can lead to well-being and promote economic development. Research questions focused on the relationships among 8 independent variables-age, income source, degree of program implementation, marital status, education, number of pregnancies, number of children, and occupation-with respect to maternal nutrition knowledge and attitudes. Health workers recruited 135 pregnant and non-pregnant women in each of 2 villages: Dejen (control village) and Takha (experimental village), totaling 270 participants. The community intervention program was an add-on to the Ethiopian government's nutrition program and provided information on portion sizes, the importance of eating an extra meal each day, and obtaining adequate rest during pregnancy. Data from customized pretest and posttest focus groups and surveys were collected. Focus groups were analyzed manually and surveys were analyzed using 1-way ANOVAs and descriptive statistical analyses. The key findings were that the women in Takha had significantly greater knowledge of the importance of prenatal health requirements. The implications for positive social change include recommendations for policy makers about proper dietary practices in order to improve pregnancy outcomes related to maternal malnutrition.

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Paguay, Ruiz R. Patricio. "Relation between Internal Parasites with Basic Services and the Nutritional Status of Children Five Years of Age in the Indigenous, Black and Mestizo Communities of the Rural Area, Imbabura Province." BYU ScholarsArchive, 2000. https://scholarsarchive.byu.edu/etd/5415.

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Various studies have been done to determine the prevalence of anemia in our country, but these studies don't reflect the true magnitude of this sickness, considered in Ecuador a problem of public health since these investigations correspond to urban sectors and margins and not to rural places where the care is very deficient and in certain cases useless, mainly because of the difficult access and the lack of economic resources of the government institutions. The current work was realized in coordination with the school of Nutrition and Dietetics and with the help of the Benson Agriculture and Food Institute was applied in rural communities of the Indigenous, "Mixed-Race" and African-American of Imbabura taking into account kids under the age of 5 as being a population group in constant risk of suffering specific deficiencies, such as Iron deficiency and its subsequent evolution towards Anemia. In this investigation we are going to find information about the prevalence of Anemia in the before mentioned groups of kids, their relationship with the deficiency of the consumption of Iron, influence of one of the most common sicknesses in these sectors as are Intestinal Parasitism. I am sure that the content will be of enormous interest to those that desire to know and better the critical situation of health and nutrition which unwinds this people, because of the provision of updated and truthful information will permit a better orientation of the different programs and projects that are implemented in these areas.

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Mensch, Denise Lee. "Rural Montana: mobile health clinics." Thesis, Montana State University, 2011. http://etd.lib.montana.edu/etd/2011/mensch/MenschD0511.pdf.

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Residents of rural areas are faced with many barriers when accessing health care. Fewer health care providers, longer wait times for appointments, availability of employment providing health insurance, weather and road conditions, as well as personality traits including strong wills, independence, and self-sufficiency are some of the barriers rural residents face. This study's purpose was to explore the potential benefits of a mobile health clinic providing primary care to rural residents. The research questions were: (a) how do the people of this rural community meet their health care needs, (b) what health care services are lacking in this community, (c) if a mobile health clinic came to this community, would rural residents utilize the services it will provide, (d) are there any specific health care services rural residents feel should be available through the mobile health clinic, and (e) do rural residents feel a mobile health clinic would be beneficial for them. Penchansky and Thomas' (1981) framework on the five dimensions of access, availability, accessibility, accommodation, affordability, and acceptability, guided the study. Results revealed that, while the participants have access to health care, that access is approximately twenty miles away for basic health care services and approximately seventy miles away for tertiary care. Several participants states that due to the distance, they only sought health care in emergent situations and if they were sick. Eleven of the twelve participants believed that their community was lacking in access to health care. When asked if a mobile health clinic would be beneficial to their community, all twelve participants said yes. All but one participant stated that they would use the services a mobile health clinic would provide if it was available to them. Characteristics of a mobile health clinic that were reported as appealing included personality of the provider and staff, frequency of visits, and dependability. Unappealing or concerning characteristics included financing, inconsistency, and the health care provider's attitude toward patients. Implications and recommendations for practice include the need for further research on the use of mobile health clinics and how to maximize health care delivery in rural areas.

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Shirely, Kaitlyn, Margaret Smith, Kacie Denton, Blair Brandt, Ivy A. Click, and Joseph Gravel. "Social Determinants of Health in Rural Tennessee Clinics." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6383.

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Holmberg, Sara. "Musculoskeletal Disorders among Farmers and Referents, with Special Reference to Occurence, Health Care Utilization and Etiological Factors : A Population-based Study." Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4626.

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Objectives. To study the prevalence of musculoskeletal symptoms among farmers as compared to rural referents and to evaluate the effects of physical work exposures, psychosocial factors, lifestyle and comorbidity.

Material and methods. A cross-sectional population-based survey of 1013 farmers and 769 matched referents was performed. Data on various symptoms, consultations and sick leave and information on primary health care and hospital admissions were obtained along with information on physical workload, psychosocial factors and lifestyle.

Results. The farmers reported higher lifetime prevalence of symptoms from hands and forearms, low back and hips as compared to the referents. However, the farmers did not seek medical advice more often than the referents, and they reported significantly fewer sick leaves. After adjustment for the influence of physical work exposure, farmers still had a excess rate of low back pain (LBP) and hip symptoms as compared with the referents, while a lower rate of neck-shoulder symptoms was revealed. Several of the psychosocial variables were associated with LBP but the difference in LBP prevalence between farmers and referents could only be explained to some extent. LBP was associated with musculoskeletal symptoms other than LBP and with chest discomfort, dyspepsia, symptoms from mucous membranes, skin problems, work-related fever attacks, and primary care for digestive disorders. Presence of both respiratory and digestive disorders doubled the LBP prevalence.

Conclusions. Symptoms from hips and low back were more frequent among farmers than among referents, but farmers did not seek more health care and reported fewer sick leaves than referents. Physical work exposure and psychosocial factors did not explain the differences in low back and hip symptoms between the two groups. Significant associations between LBP and digestive and respiratory disorders might indicate that these disorders may have etiological factors in common.

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Mason, Patricia Lynn. "Diffusion of Electronic Health Records in Rural Primary Care Clinics." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/466.

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By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants' experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs under the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health, and the Patient Protection and Affordable Care Act legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants: (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of transformation at rural medical practices. The implications for positive social change include the potential implementation of EHRs particularly in physician practices in rural communities, which could provide cost-efficient health care services for those communities and a more sustainable future at primary care practices.

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Weber, Amy Judith, Olubunmi Kuku, and Edward Leinaar. "Differences in Access to Contraceptive Services Between Rural and Non-Rural Clinics in South Carolina." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/125.

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Unintended pregnancies, defined as either being unwanted or mistimed, represent a major public health challenge. Roughly half of all pregnancies in the United States are unintended, and have been associated with poor health and economic outcomes for infants, children, women, and families. Modern contraceptives have been proven to be both safe and effective in reducing unintended pregnancy. This is particularly true for long-acting reversible contraceptive (LARC) methods, which are associated with both higher user satisfaction and overall efficacy as compared to short-acting methods. We therefore investigated types of contraceptive services offered among rural and non-rural clinics in South Carolina. A survey was developed; all clinics in South Carolina who offer contraceptive services were invited to participate. Completion of the survey was voluntary and an incentive was provided. The survey was multi-faceted, covering several aspects of contraceptive care including scope of services provided, availability of resources, and training received. Of primary interest to this research, is the extent to which highly effective contraception methods, such as LARCs, are available in both urban and rural clinics. Findings suggest that access to highly effective LARCs is not equitable among rural and urban clinics. Approximately 62% of urban clinics offered LARC methods, compared to 36% among rural clinics (p=0.0015). These data indicate that women who reside in a rural locale have significantly lower access to these more effective contraceptive methods. As nearly 25% of women within the United States reside in a rural locale, the need to address barriers to access to contraceptive care is essential. This work will be a useful tool in understanding barriers to contraceptive care utilization and can lead to the development of novel programs to reduce the rate of unintended pregnancy, births and abortions, and corresponding savings in health care costs.

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McLaughlin, Gayla Diane. "Achieving Glycemic Control in Rural Clinics." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6065.

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Diabetes is the 7th leading cause of death in the United States and is the main cause of chronic kidney failure, nontraumatic limb amputations, blindness, myocardial infarction, and stroke. Many patients with diabetes do not meet goals for at least 1 control measure of blood sugar, blood pressure, or cholesterol. The purpose of the project was to implement a template for documentation--a toolkit for patient care management-to improve blood glucose and blood pressure levels in a rural health clinic in central Texas for 33 patients with diabetes during a 6- to 8-week timeframe. The practice-focused question asked whether management of patients with diabetes would be improved if documentation on a standard template were used by all providers at the site. Models used in this doctoral project included the chronic care model and the Institute for Healthcare Improvement breakthrough series collaborative model. Sources of evidence included published outcomes and research from a systematic review of the literature, archival and operational data collected from the rural health clinic, and evidence from the project. Glycosalated hemoglobin levels improved from a mean of 8.9 mg to 7.6 mg in 31 of 33 participants (t = 2.684, 30 df, p = .012). Systolic and diastolic blood pressures were reduced slightly, but changes were not statistically significant. Potential implications for positive change in nursing practice include improvements in clinical management, implementation of evidence-based practice, and improved outcomes for patients with diabetes. Incorporating evidence-based practice provides scientific justification for actions that will improve clinical outcomes for patients, which leads to healthier patients, families, and communities and contributes to positive social change.

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Billmeyer, Tina W. "Evaluation of a behavioral health integration program in a rural primary care facility." Huntington, WV : [Marshall University Libraries], 2007. http://www.marshall.edu/etd/descript.asp?ref=755.

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Bennett, Jennifer Gay. "Implementing Lipid Screening Guidelines for Children in a Rural Health Clinic." Thesis, University of Louisiana at Lafayette, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10163291.

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During the past three decades, there has been an abundance of research regarding cardiovascular disease and the pathology responsible for it. The incidence of childhood obesity and dyslipidemia are at the highest in history. Evidence exists demonstrating that arterial changes leading to cardiovascular disease begin in childhood. The National Heart, Lung, and Blood Institute (NHLBI), along with the American Academy of Pediatrics (AAP), issued guidelines in 2011 advocating for the screening of all children for dyslipidemia in order to identify children at-risk for development of cardiovascular disease and to implement interventions. The purpose of this synthesis project was to implement an evidence-based quality improvement project to screen lipids in children at the Start Community Clinic (SCC), a rural health clinic in Northeast Louisiana. Statistical Process Control (SPC) was used to evaluate both processes and outcomes. Outcomes measured include the number of children eligible to be screened compared to the number of children screened. Control charts were used to determine the stability and success of the improvement effort in implementing the evidence-based guideline. The guideline implementation using quality management techniques was successful and resulted in lipid screening of 60% of eligible children within the project time frame.

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Hulst, Samantha. "Diabetes Self-Management Education Service at a Rural Minnesota Health Clinic." Diss., North Dakota State University, 2019. https://hdl.handle.net/10365/29399.

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In 2015, there were an estimated 30.3 million Americans living with diabetes, and 95% of them were diagnosed with type 2 diabetes (T2D) (Centers for Disease Control and Prevention, 2017b). Patients living in rural America have an increased prevalence of diabetes, and their participation rates in preventative care practice are lower (Rutledge, Masalovich, Blacher, & Saunders, 2017). The increased prevalence of the T2D in rural communities does not positively correlate with the number of diabetes self-management education (DSME) services in these areas, which poses a gap in healthcare services (Rutledge et al., 2017). Diabetes self-management education can be defined as ?the process of facilitating the knowledge, skill, and ability necessary for diabetes care? (Powers et al., 2015, p. 71). Diabetes self-management education has shown to decrease participant?s A1c by as much as 0.9%, which has been associated with a 25% reduction in microvascular complications, a 10% decline in diabetes-related mortality, and a reduction in all-cause mortality by 6% (Chrvala, Sherr, & Lipman, 2016). The utilization of DSME services in rural health clinics has the potential to improve health outcomes by decreasing complications directly related to diabetes in those patients participating in the service. The practice improvement project established a pilot DSME group service, which was consistent with the Standards of Medical Care in Diabetes - 2019 (ADA, 2018d). The practice improvement project was structured using the Chronic Care Model and Model for Improvement to help provide a functional and sustainable DSME service. The overall goal of the practice improvement project is to have the organization continue the service after the conclusion of the practice improvement project. The practice improvement project yielded positive results. The organization?s surveys indicated strong support for the service and the ability of the DSME service to fill a gap in their current diabetic education. The DSME participant?s skills and confidence increased through completing the curriculum, positively correlated to improved glycemic control. The organization?s stakeholders also felt that the service would be marketable to the organization?s patient population and profitable by increasing quality numbers and providing the opportunity for reimbursement.

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Morgan, Andrew P. "Trip generation characteristics of rural clinics in West Virginia." Morgantown, W. Va. : [West Virginia University Libraries], 2003. http://etd.wvu.edu/templates/showETD.cfm?recnum=2847.

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Thesis (M.S.)--West Virginia University, 2003.
Title from document title page. Document formatted into pages; contains x, 108 p. : ill. (some col.), maps. Vita. Includes abstract. Includes bibliographical references (p. 71-73).

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Hunley, Alacyn Johnson. "Optimizing Prediabetes Screening in a Rural Primary Care Clinic." Thesis, University of Louisiana at Lafayette, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=10981632.

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Purpose: Implement and evaluate a formal evidence-based risk screening protocol in a rural clinic setting to optimize early identification of prediabetes and T2DM in asymptomatic, non-pregnant adults age 18–44.

Significance: Absence of an evidence-based risk screening protocol contributed to under/overutilization in laboratory test referral and inconsistency in prescribed treatments among clinic providers. Early identification of prediabetes and initiation of appropriate treatment plans may assist in preventing T2DM and its associated complications.

Methodology: Quality improvement project utilizing a retrospective, randomized representative sample of charts, n = 30 and a convenience sample of participants, n = 40. The American Diabetes Association Diabetes Risk Test (ADA DRT) served as a prediabetes risk screening tool. Provider adherence to ADA DRT risk screening and laboratory test referral, type of laboratory test ordered, the relationship between demographic characteristics and the ADA DRT score, participant follow-up, and treatment ordered based on risk screening and laboratory results were analyzed using group data.

Results: Thirteen (35.7%) participants had laboratory values in the prediabetes or T2DM range and 100% of treatment ordered are substantiated by ADA guidelines. Using the ADA DRT tool, risk screening was completed in 100% of eligible participants; accordingly, appropriate utilization of laboratory test referral improved by 33.33%.

Recommendation: Incorporation of best-practices for risk screening and laboratory test referral for early identification of prediabetes is needed. APRNs are instrumental in promoting efficacious screening strategies and preventative treatment aimed at improving health outcomes. The benefits of using the ADA DRT as a prediabetes risk screening protocol in primary care should be elucidated in a prospective study.

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Dissertations / Theses on the topic 'Rural clinical health'

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