Contemporary Issues in Rural Health Policy and Research Ty Borders, - PowerPoint PPT Presentation

Contemporary Issues in Rural Health Policy and Research Ty Borders, PhD Professor Founda3on for a Healthy Kentucky Endowed Chair in Rural Health Policy Director, Rural and Underserved Health Research Center Editor, The Journal of Rural Health

• Conducts research to inform decisions about how to • organize health services • facilitate access • improve population health • In rural and undeserved rural areas Coopera3ve agreement # U1CRH30041

4 Key Points 1. Not all rural areas are alike 2. Low capacity, consumer preferences require regionalization 3. Mental health and substance abuse are inextricably linked 4. Need to move beyond rural / urban comparisons

1. Not All Rural Areas Are Alike

2. Low Capacity and Consumer Preferences Require Regionalization • Small capacity constraints in rural areas • Insufficient demand for low volume, specialized services • Lower availability of providers • Even telehealth relies on providers at another location • Many rural residents prefer non-local care • Migration/travel for physician and hospital services • Example of preferred drug use treatment site 1 Borders et al. JRH 2000; 2 Borders et al. HCMR 2001; 3 Radcliff et al. JRH 2003; 4 Xu & Borders JRH 2003

Preferred Drug Use Treatment Site 20.2 Rural 22.2 In town where live 57.6 In other town nearby 57.1 In other town Urban 9.1 farther away 33.8 0 10 20 30 40 50 60 70 80 90 100 % % Borders et al. Journal of Substance Use Treatment , 2015 NIDA grant to Borders

3. Mental Health and Drug Abuse Are Inextricably Linked, but Undertreated

Suicidal Plans and Ideation by Opioid Misuse (%) 3.55 No opioid misuse 25.82 Suicidal 14.88 Plans Opioid misuse 36.51 0 10 20 30 40 Suicidal Ideation P <.0001 % Suicidal Plans P =.0057

Prevalence of Treatment Utilization among Persons with a Drug Use Disorder 30 26.67 24.25 24.13 25 21.4 20 17.85 13.94 13.7 % 15 13.05 12.5 12.4 11 10.8 10 5 0 Metro Non-Metro Metro Non-Metro Any Drug Use Disorder Opioid Use Disorder Treatment Use 2008-2010 2011-2013 2014-2015

4. Need to Move Beyond Rural / Urban Comparisons • Pros of R/U comparisons: Easy to understand and use • Cons of simple R/U comparisons: • R/U based on # of persons in arbitrary geopolitical boundaries • R/U is a “proxy” for other factors • Health system (could be modified by policy) • Economics (could be modified by policy) • Social and demographics Borders TF. Advancing the field of rural health research: moving beyond simply documenting rural vs urban differences. Journal of Rural Health . 2017;33(1):3-4.

Concluding Comments • Not all rural areas are alike • Need rural-oriented policies • Most innovation will come at the state level Acknowledgments Some of the information in this presentation was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement # U1CRH30041. The information, conclusions and opinions expressed in this document are those of the authors and no endorsement by FORHP, HRSA, HHS, or the University of Kentucky is intended or should be inferred.