Rural Lifelines, Part 2: Bringing Care to People
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Between 2013 and 2020, about 4% of rural hospitals closed, resulting in people in these areas having to travel about 20 additional miles to reach inpatient care, and 40 miles farther for specialty care. Since then, closures have accelerated, further isolating rural communities from essential services.
Rural health in America is at a critical juncture, and states must map how they strengthen quality and access to care to better serve communities. In this series, JSI draws on its over 30-year history to bring some of the most important interventions to light. In the last article, we focused on supporting providers. This time, we turn our attention to patients.
Bringing Care to People
Transportation is one of the greatest challenges to rural communities’ access to health care. What if, instead, health services are brought to the people who need them most?
Telehealth
Innovations in telehealth have expanded patient and provider options, making it more accessible for people to receive timely, convenient, quality care. We’ve used telehealth effectively in support of specialty care, such as HIV and behavioral health and have seen measureable, impactful results. The successful implementation of these efforts can be expanded to broader initiatives aimed at reducing barriers to care in rural communities.
The JSI Telehealth Strategies to Maximize HIV Care project used implementation science to identify and scale effective telehealth coordination strategies for five distinct Ryan White HIV/AIDS Program clinics, spanning across urban and rural settings. Patients from these clinics reported that telehealth effectively mitigated challenges related to transportation, work-life scheduling, and privacy. These improvements in care yielded compelling clinical results: nearly 60% of previously unsuppressed patients achieved HIV viral suppression, and almost 89% of those without a prior prescription successfully initiated antiretroviral therapy.
As Gretchen Weiss, the initiative’s project director, explained, “By removing geographic and logistical barriers to accessing care, telehealth proved to be a transformative driver of clinical success and patient satisfaction.”
We’ve also seen how telehealth can transform behavioral outcomes among youth through our evaluation of the School-Based Telebehavioral Health Pilot program at the Brookline Center for Community Mental Health. This model connects students across Massachusetts to a licensed telehealth clinician, providing individualized behavioral health care even in the context of the ongoing provider shortage and barriers to access in rural settings.
“Telebehavioral Health is all about accessibility – making it easier for young people most in need of care to get the support they need in a safe environment,” says Amanda Parrish, senior associate at JSI. “We’ve heard so many success stories about the transformative effect this program has had for students across the state.”
Mobile Care
In addition to virtual care options, mobile health can bring essential care to people where they are. JSI Senior Technical Associate, Kate Lena notes the success of mobile care in offering preventative and wraparound substance use services to individuals not well-connected to health care. JSI supported Tapestry Health and Everest Recovery in mapping workflows to expand access to hepatitis C care in Massachusetts using mobile vans. Mobile vans are able to park in central community locations and at partner care sites. “When initiatives like these take the time to understand how to offer care that meets needs, they strengthen trust in medical providers and achieve better health outcomes,” says Lena.
Integrating Service Delivery
In addition to remote and mobile services, service integration can effectively bring care to people by offering more services from a single point of access. In rural settings, this can reduce delays in accessing services associated with visiting separate facilities for specialty care. JSI has worked on integrating care for co-existing conditions for over 30 years. Recently, JSI began an initiative that uses an implementation science approach to study interventions across 10 Ryan White HIV/AIDS Program-funded clinics across the country that integrate care for commonly co-occurring mental health conditions into routine HIV services. This integration can reduce barriers such as stigma to accessing both HIV and mental health services, ultimately improving retention in medical care, especially for people who are not yet virally suppressed.
A Foundation for the Future of Rural Health
The challenges facing rural health systems are deeply entrenched, but they are not insurmountable. Person-centered care offered virtually, close to home, or co-located with other essential services closes gaps in access and quality.
In Part Three of this series, we will explore the next set of strategies that build health systems capable of delivering the highest quality of care for rural communities.