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Rural Hospitals Focus on Social Determinants of Health, Transportation

One hundred percent of the rural hospitals included in the study addressed transportation as a social determinant of health blocking patient care access.

Rural healthcare organizations excel at addressing social determinants of health despite the barriers blocking patient care access, a new University of Missouri study found.

Overall, hospitals and health systems serving rural Missouri are addressing SDOH like transportation access, mental healthcare access, food security, housing security, and dental access, the researchers said.

These findings come amidst a backdrop of poor healthcare access in rural areas. Travel distances have long beleaguered individuals living in rural settings, with longer distances standing in the way of accessing in-person medical care. Workforce shortages, too, can stand in the way of healthcare access for rural Missourians, the researchers said.

But it’s not just geography and person power that gets in the way; folks in rural areas also face SDOH that can keep them from getting medical care.

This latest MU study looked at how care coordinators at Missouri’s rural healthcare organizations address social and other healthcare needs for patients and found that those needs are relatively well addressed.

Every organization included in the assessment did something to address transportation, while 86 percent provided referrals for mental healthcare, 79 percent provided food assistance, 71 percent provided housing assistance, and 50 percent provided dental assistance.

That transportation aid was especially important because it helps get to one of the core barriers to healthcare access in rural settings, according to Julie Kapp, an associated professor in the MU College of Health Sciences and a lead author on the study.

“Transportation was the most commonly reported barrier addressed, particularly in rural areas where you have to travel farther distances, especially if you need specialized care, and the physician shortages in rural areas have made this barrier even worse,” Kapp said in a press release.

“Some families might just have one car that everyone shares, the car might not be reliable, or if families are working long hours while juggling household responsibilities, missing work to drive long distances might not be possible.”

Although organizations serving rural regions are pushing to address key SDOH, Kapp pointed out that it’ll be critical for them to assess how they can tailor interventions to patient needs. Stepping up in food security or offering more than just telehealth access will be key.

“Doctors often recommend prescription medications be taken on a full stomach, but for someone struggling with food insecurity, that might not always be an option,” Kapp said. “Telehealth is often marketed as a possible solution in rural areas, and it can definitely be a convenient option, but lack of broadband internet access can be a challenge, although MU and the UM System have made great strides to help in this area.”

Because the study was interview-based, Kapp said she and the research team were able to uncover innovative strategies for addressing SDOH. Much of that innovation was sparked by the COVID-19 pandemic, she said, as lockdown restrictions limited access to key resources and hamstrung social services that traditionally filled those gaps.

“One organization we interviewed talked about partnering with a local food bank and dropping off the food at the patients’ door with contactless delivery,” Kapp recalled. “Another created their own transportation system when the one in their area shut down during the beginning of the pandemic. There was also an organization that would proactively call patients in between appointments and ask how they were doing or if they needed anything, which decreased the likelihood of missed appointments.”

In addition to assessing which SDOH care coordinators addressed, the study also revealed how well organizations adhered to care coordination best practices, using the American Medical Association’s ten essential characteristics of care coordination.

Most organizations said they proactively plan for transitions of care. However, there’s room for improvement in terms of using electronic health information systems to support communication during care coordination, the researchers said.

Fundamentally, these findings underscore the fact that rural healthcare is about more than just getting patients in the door and delivering good care; there are complex social needs that need to be considered too, Beau Underwood, a doctoral student in the MU College of Arts and Science’s Truman School of Government and Public Affairs.

“One of the main takeaways of this research is that health care is much more broad today than before, and it incorporates basic social services that are often not thought of as health care related,” Underwood, who collaborated with Kapp on the study, said in a statement. “We need to think beyond just what happens in the doctor’s office, and part of that is thinking about if patients have transportation to get to the doctor’s office in the first place, or if there is even a physician in the patient’s area.”

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