Papers & Publications: Interdisciplinary Journal of Undergraduate Research Volume 6 Article 9 2017 Disparities in Emergency and Urgent Care Services in Rural and Urban Communities Sarah M. Smith Georgia Southern University Follow this and additional works at: https://digitalcommons.northgeorgia.edu/papersandpubs Part of the Nursing Commons Recommended Citation Smith, Sarah M. (2017) "Disparities in Emergency and Urgent Care Services in Rural and Urban Communities," Papers & Publications: Interdisciplinary Journal of Undergraduate Research: Vol. 6 , Article 9. Available at: https://digitalcommons.northgeorgia.edu/papersandpubs/vol6/iss1/9 This Article is brought to you for free and open access by the Center for Undergraduate Research and Creative Activities (CURCA) at Nighthawks Open Institutional Repository. It has been accepted for inclusion in Papers & Publications: Interdisciplinary Journal of Undergraduate Research by an authorized editor of Nighthawks Open Institutional Repository. Disparities in Emergency and Urgent Care Services in Rural and Urban Communities Acknowledgments Acknowledgment The uthora s would like to thank their faculty mentors Drs. Marian Tabi, PhD, MPH, RN and Susan Sanders, PhD, APRN, ACNS-BC, CEN for their guidance and support through the research process and writing of the paper. Marian Tabi is a Professor and the Director of Outcomes for the School of Nursing. Susan Sanders is an Assistant Professor in the School of Nursing. This article is available in Papers & Publications: Interdisciplinary Journal of Undergraduate Research: https://digitalcommons.northgeorgia.edu/papersandpubs/vol6/iss1/9 Papers & Publications, vol. 6 Disparities in Emergency and Urgent Care Services in Rural and Urban Communities t is well documented that people in rural areas have worse access to Sarah Smith, health care than those in urban areas (Agency for Healthcare Research Melissa Monticalvo, & Quality [AHRQ], 2012, 2015; Goodwin & Tobler, 2013; Adler & Sayde Smith, and IRehkopf, 2008). They face many challenges: less than 10% of the health Hannah Herman care workforce practice in rural communities (Burrow, Suh, & Hamann, Georgia Southern University 2012), access to health care is often difficult due to lower income and lower rates of health insurance (Kaufman et al., 2016), and many live farther away from available health care resources (Wilken, Ratnapradipa, Presley, & Wodika, 2014). The isolation of rural areas leaves residents the need to travel farther for health care, and many face difficulties in trans- portation. For example, 13 percent of rural residents travel more than 30 minutes to routine medical visit with their health care provider compared to 10 percent of urban residents (Wilken et al., 2014). Furthermore, rural residents often travel longer distances for specialty care or surgical proce- dures; the average distance to the referred specialty care is about 60 miles. Chronic health conditions such as diabetes, cardiovascular disease, stroke, and hypertension are more common among rural residents (Amponsah & Tabi, 2015; Alkadry & Tower, 2010; Parks, Hoegh, & Kuehl, 2015; Adler & Rehkopf, 2008). Access to quality health services remains a top priority in Rural Healthy People 2020 (Bohn & Bellamy, 2012). Rural residents experience more delayed care due to cost and are less likely to use preventive health services. The shortage of primary medical health professionals and specialists is more severe in rural areas than in urban areas (Burrows, Suh, & Hamann). Quality of rural medical primary care is often rated lower compared to urban residents. About 19.3% of the U.S population lives in rural areas (U.S. Census Bureau, 2010 2016). Health and heath care issues affect the lives of rural individuals and families. Rural residents are recognized as a health disparity vulnerable population due to the prevalence of chronic disease and rate of early death, which is higher compared to urban residents living in the United States. Of concern are the persistent resource dis- parities in rural areas. Though rural residents experience many of the same health issues and challenges as urban residents, rural populations All authors are recent graduates of Fall 2016 often fare worse on a number of measures due to their limited income, from the undergraduate Bachelor of Science poorer health outcomes, and limited health care access compared with in Nursing (BSN) Program at Georgia Southern urban populations (Hardie et al., 2015; Chanta, Mayorga, & McLay, University. All authors successfully passed their NCLEX and are practicing as registered 2014; Alkadry & Tower, 2010). The limited service offerings in many nurses in their respective communities. Sarah rural health care facilities lead some rural residents to use urban health Smith and Melissa Monticalvo are working facilities. in Medical-Surgical, Sayde Smith is in Neuro- ICU, and Hannah Herman is in Oncology. Smith, Monticalvo, Smith, and Herman | 37 Emergency and Urgent Care Services Rural residents face numerous challenges and emergency care services among college to their rural health delivery system including students who reside in rural and urban limited health care access, shortage of health communities? care providers, limited transportation, and 2. Is there a difference in confidence in greater travel distance. The rural health delivery hometown ER and UCC to provide quality system includes various health facilities such as care among rural and urban residents? hospitals with emergency departments, health clinics, urgent care clinics, community health Review of Literature: Access to Emergency centers including federally-qualified health Department vs. Urgent Care Clinics centers that provide primary health care services Some rural areas have access to some type of to rural residents (Ellison, 2016). Rural hospitals emergency care, but the quality may differ in provide primary, acute, chronic, and long-term rural areas versus urban areas. Kinsman et al. care. These hospitals are often smaller and (2012) reported that the outcomes of acute myo- non-profit, and their revenue heavily depends cardial infarctions are far worse in rural areas as on reimbursement from public programs compared to urban areas (Kinsman et al., 2012). (Medicaid and Medicare) for their financial For many people, getting to non-emergency ability to continue services (Kaufman et al., care and maintenance appointments poses so 2016). Low reimbursement for services has been much difficulty that they do not go; this leads a critical challenge for rural hospitals to provide to an emergency visit once the problem becomes quality services in addition to challenges such as more severe (Wilken, Ratnapradipa, Presley, & recruitment and retention of skilled health care Wodika, 2014). This creates an even larger need providers, financial stress, and low and declining for emergency care that may not be available in occupancy. More than 70 rural hospitals in the their rural community. While it may be possible U.S. have closed since the 2010 (Ellison, 2016). for people to seek healthcare elsewhere, studies In 2013, there were approximately 6,400 urgent have shown that there are barriers. Wilken care centers (UCCs) (Urgent Care Association of et al. (2014) conducted a study in southern American, 2014) and 5,025 emergency depart- Illinois which found that parents had problems ments (EDs) in the U.S. (National Emergency with non-emergency transportation. Findings Department Inventory-USA, 2015). Urgent indicated that children transferred to a metro- care centers are on the rise and they offer an al- politan hospital that was few hours away, whose ternative to waiting for hours for medical care in parents did not have transportation and/or the a hospital Emergency Department. finances, often had longer stays in the hospital. This experience can be traumatic and terrifying Purpose and Research Questions for both the child and parents. There is little research on the differences in the Goodwin and Tobler (2013) found that 85% quality of care and access to urgent care and of Americans have access to a level one or level emergency care on college students who reside two trauma center one hour away. In rural areas, in rural and urban areas. There is, however, only 24% of Americans had access to a level one research on issues such as costs for emergency or two trauma centers within an hour distance, transportation to the necessary facilities, lack meaning that 76% of Americans living in rural of rural healthcare workers, and the growing areas lacked access to immediate emergency number of rural hospitals and emergency depart- medical care. Hardie et al. (2013) stated that ments that are closing. The purpose of this study patients, who frequent the emergency room was to investigate the perception of emergency for non-emergency care, increased Medicare and urgent care services among college students costs. Patients that were considered frequent or in rural and urban communities. The research heavy users of the emergency department had a questions addressed were: minimum of four or more annual visits (Hardie et al., 2013). Their study findings indicated that 1. Is there a perceived difference in urgent patients that lived within a few miles of the 38 | Smith, Monticalvo, Smith, and Herman Papers & Publications, vol. 6 emergency department were more likely to go to Findings revealed that as a result of insufficient that emergency department, than those that lived non-urgent medical transportation, patients farther away