Author Interviews, Diabetes, Duke, Telemedicine / 15.06.2020

MedicalResearch.com Interview with: Matthew J. Crowley, MD Core Investigator, Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Affiliated Investigator, VA Office of Rural Health Staff Physician, Endocrinology Section, Durham VA Health Care System Elizabeth Kobe, BS Medical Student Durham VA Health Care System Duke University School of Medicine MedicalResearch.com: What is the background for this study? With whom were the telehealth sessions performed? (MDs, PAs, Dieticians etc). Response: Diabetes management in rural populations is especially challenging due to limited access to specialty care and self-management programs. Telehealth is a potential strategy for extending high-quality diabetes care to rural areas. The Veterans Health Administration (VHA) has a robust Home Telehealth (HT) system that is currently used for telemonitoring patient blood glucose values. In order to address the challenges of managing diabetes in rural areas in a clinically feasible manner, we strategically designed an intensive diabetes management intervention – Advanced Comprehensive Diabetes Care (ACDC) – for delivery using existing VHA HT infrastructure and clinical staffing. ACDC is a 6-month telehealth intervention that combines telemonitoring with module-based self-management support and medication management. ACDC is delivered entirely by existing clinical staff (a clinical HT nurse and a medication manager (typically a PharmD)) through bimonthly, 30-minute calls. Our initial randomized controlled trial found that ACDC improved HbA1c by a clinically and statistically significant  -1.0% relative to usual care at 6 months, while also improving blood pressure and diabetes self-care. Our goal with the present work was to improve diabetes care in clinical practice for rural Veterans whose type 2 diabetes remained uncontrolled despite receiving available services. To this end, we partnered with the VA Office of Rural Health to implement ACDC into VA sites across the country with large rural populations.  (more…)
Author Interviews, Health Care Systems, University of Pittsburgh / 10.12.2019

MedicalResearch.com Interview with: Hayley Drew Germack PhD Assistant Professor of Acute and Tertiary Care University of Pittsburgh School of Nursing MedicalResearch.com: What is the background for this study? Response: The rate of rural hospital closures has been increasing over the last ten years. Rural hospitals close for a number of reasons including poor hospital economic health tied to uncompensated care and community factors, like a local aging population. Rural hospital and unit closures have been tied to decreased access to emergency and specialty care for patients including decreased access to obstetric-gynecological services and increase travel time for appointments. A recent paper also found a 6% increase in mortality in conditions needing emergent attention after rural hospital closures. We examined the impact of hospital closures in rural counties on the counties’ supply of physicians. (more…)
Author Interviews, BMC, Cost of Health Care, Diabetes, Yale / 28.09.2019

MedicalResearch.com Interview with: Phoebe Tran Doctoral Student Department of Chronic Disease Epidemiology Yale School of MedicinePhoebe Tran Doctoral Student Department of Chronic Disease Epidemiology Yale School of Medicine  MedicalResearch.com: What is the background for this study? Response: As the prevalence of diabetes risk factors such as obesity, high blood pressure, high cholesterol, and physical inactivity are considerably higher in US individuals residing in rural areas compared to their urban counterparts, rural residents face increased risk of developing diabetes. Diabetes screening is a useful tool that can be used to identify people with newly developed type 2 diabetes and offer them early treatment. In this study, we examined whether there are differences in diabetes screening levels between rural and urban areas across the US using nationally representative survey data from 2011, 2013, 2015, and 2017.   (more…)
Author Interviews, Cost of Health Care, Medicare / 14.08.2019

MedicalResearch.com Interview with: ABT-AssociatesMatthew Trombley, Ph.D. Associate/Scientist Abt Associates  MedicalResearch.com: What is the background for this study?   Response: CMS developed the Accountable Care Organization (ACO) Investment Model (AIM) as part of the Medicare Shared Savings Program (MSSP) to encourage the growth of ACOs in rural and underserved areas.  The goal of our study was to see if AIM ACOs could successfully decrease Medicare spending in these areas. (more…)
Annals Internal Medicine, Author Interviews, Technology / 22.05.2019

MedicalResearch.com Interview with: Coleman Drake, PhD Assistant Professor, Health Policy and Management Pitt Public Health University of Pittsburgh Graduate School of Public Health  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Telemedicine is frequently proposed as a solution to improve access to care in rural areas where driving to the nearest physician can take up to several hours. However, there needs to be sufficient broadband infrastructure for patients to actually use telemedicine. We found that broadband infrastructure is often insufficient to support telemedicine in the most rural areas, particularly in areas where there is inadequate access to primary care physicians and psychiatrists.  (more…)
Author Interviews, Emergency Care, Global Health, JAMA / 12.04.2019

MedicalResearch.com Interview with: Margaret B. Greenwood-Ericksen MD, MSc Department of Emergency Medicine University of New Mexico Albuquerque, NM 87109 MedicalResearch.com: What is the background for this study?   Response: I’m an emergency physician, so I see first-hand how emergency department use patterns provide a lens into the status of health care delivery in the communities they serve. Troubling declines in the health of rural Americans coupled with rising rural hospital closures – with little access to alternative sites of care like urgent care – all led me to hypothesize that rural populations may be engaging with the health care system differently than their urban counterparts. Understanding the health care use of individuals in rural areas may yield insights into addressing rural health disparities. Further, this information may help healthcare systems and policymakers to make data-driven decisions informing new models of healthcare delivery for rural communities. (more…)
Author Interviews, Mental Health Research, Pediatrics / 02.05.2018

MedicalResearch.com Interview with: “dog” by Neil Mullins is licensed under CC BY 2.0Prof. Dr. rer. nat. Stefan O. Reber Laboratory for Molecular Psychosomatics Clinic for Psychosomatic Medicine and Psychotherapy University Clinic Ulm Ulm, Germany  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our hypothesis was that people who grew up in cities with more than 100.000 inhabitants  and without pets will show a more pronounced immune activation towards psychosocial stressors compared with people raised in rural areas in the presence of farm animals. This hypothesis is based on the fact that stress-associated psychiatric disorders, which are linked to or even promoted by an over(re)active immune system and chronic low grade inflammation,  are more prevalent in urban compared with rural areas. One possible explanation for a hyper(re)active immune system in people raised in urban relative to rural environments might be a reduced contact to immunoregulatory microorganisms (the so called “old friends”), which is significantly increased in rural people with regular contact with farm animals compared with urban people in the absence of pets. Our results show that a standardized laboratory psychosocial stressor causes a greater inflammatory response in young healthy participants with an urban upbringing in the absence of pets, relative to young healthy participants with a rural upbringing in the presence of farm animals. (more…)
Author Interviews, Dental Research / 15.10.2016

MedicalResearch.com Interview with: Jonathon P. Leider, PhD Department of Health Policy and Management Johns Hopkins University Baltimore, MD MedicalResearch.com: What is the background for this study? Response: The increasing utilization of Emergency Departments (ED) for the treatment of non-urgent and non-traumatic dental conditions among adults in the United States is an increasing policy issue. Research shows that seeking dental care in an ED is often more expensive and less effective when compared to a traditional dental office. Seeking care in the ED for non-traumatic dental conditions is more frequent among low income individuals and people in rural areas, who must often overcome insufficient dental coverage and access to receive office-based care. Under the Affordable Care Act, there has been considerable expansion in state Medicaid dental coverage for adults. However, not all states are participating in the expansion or extension of dental benefits and dental professional shortage areas are fairly common– over 4,900 exist in the United States. Innovative programs are needed to effectively address the challenges low income individuals in rural areas encounter accessing care. Our study examined the expansion of a Community Dental Program (CDP) in rural Western Maryland and its impact on dental-related visits at a regional ED. (more…)