Should Different Standards of Quality of Care Exist for Rural and Urban
Settings and what Factors Contribute to these Differences?
Jennifer Latta, PA-S; David Day, EdS, MPAS, PA-C
\
Department of Physician Assistant
College of Health Professions, Wichita, Kansas
RESULTS
INTRODUCTION
Rural and urban locations differ from each other
culturally, structurally, economically, and socially.
Because healthcare facilities serve the
surrounding communities, the structural and
cultural make up of these communities plays a
large role in health care delivery. However,
despite the significant difference between urban
and rural communities, quality of healthcare is
determined by one set of generalized standards of
care. This leaves rural areas at a disadvantage,
because they lack many of the elements that
urban facilities possess. To better the quality of
care (QOC) for rural patients, they need to be
recognized as their own entity and specific
standards of care developed that address these
unique traits. By doing so, rural health care can
be recognized for the true specialty that it is
instead of a substandard way of practicing
medicine.
DISCUSSION
Thirty-five articles matched the criteria and were reviewed
using evidence-based methods. Close analysis of the
presented data found a decrease in the QOC, with regards
to AMI and diabetes management, in rural facilites
compared to urban. However, the literature also
demonstrated many factors that contribute to these QOC
differences. Rural areas differ from urban in many ways
including: lack of specialty care, smaller size of the
community, lack of trasportation, isolation of residents,
unique cultural dynamic, interactional community, lack of
autonomy, shortage of healthcare providers, and
technology deficits.
4. Editorial
Differences in
Rural vs.
Urban
Quality of Care (QOC):
Factors that Contribute
MeSH terms: quality of care, rural diabetes,
rural acute myocardial infarction (AMI), rural
nursing, rural social work
CONCLUSIONS
Total articles n=35
METHODS
The purpose of this paper was to perform a
systematic review of the literature and examine
the cumulative data addressing rural QOC, in the
end being able to make a clear distinction
between urban and rural cultures. This should
demonstrate to healthcare providers that these
differences can play a significant role in the
quality of healthcare received. Articles used
included those addressing rural adherence to
acute myocardial infarction (AMI) and diabetes
care treatment guidelines, rural quality of care,
and differences in social work and nursing in rural
areas.
Rural vs. Urban
QOC
n=10
AMI QOC
n=7
Diabetes
Management QOC
n=6
Sociocultural issues play a large role in rural
healthcare. Differences between rural and urban need
to be realized and measures taken to account for these
distinctions. Many suggestions were made on how to
resolve these issues including the use of protocols for
infrequently encountered conditions, forming
partnerships with urban facilities, community
collaboration, utilizing electronic media to decrease
isolation, and increase use of home health care.
Providers should also take into account the unique
characteristics of the rural residents and their
perceptions of healthy behavior and local hospitals.
Without these needed changes it is possible the QOC
guidelines serving rural areas will evolve mainly from
the expansion of urban-based care, completely
avoiding the individual differences that exist between
these two populations.
Rural
Social Work
and Nursing
n=12
Discussion
n=5
By first understanding the factors that influence QOC
measurement in rural communities, we can create a set
of standards that is unique to these rural populations
and, by doing so, improving the quality of healthcare
received as a whole.
REFERENCES
Retrospective
n=5
Retrospective
n=4
Interview
n=2
outcome:
Rural healthcare demonstrated an inferior QOC
compared to urban in regards to management of
diabetes and AMI. Many factors contribute to
these differences.
Questionnaire
n=3
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