Providing Health Care in Rural Communities

By Kathryn Ruscitto
Wednesday, June 26, 2019

We live in a beautiful region that includes areas that are urban, suburban and rural — from the Finger Lakes to the Adirondacks.

That beauty and remoteness provides unique challenges in delivering health care to rural communities. In some areas, the drive is one hour or more to any area hospital to receive care, and families struggle to receive basic services, from home care to hospice care. This often results in individuals seeking care outside their home communities.

Kathryn Ruscitto

I remember visiting a patient from a rural community who had driven to Syracuse because he could not find care close to home. He was working to overcome alcoholism and also had diabetes and a heart condition. He finally drove to an emergency room and was admitted when he felt he had no other options. Would earlier access have helped to prevent his decline and a long hospital stay?

New models for access to health care are developing across the country. From telemedicine to community paramedicine and in-home hospital care, we are watching communities experiment with ways to deliver care that closes the distance gap. Hands-on primary care is still important, but when it is not available, what types of care can fill the gap? How do providers link access using these new models to deliver care?

In speaking with experts who are providing care in rural communities, provider recruitment and retention looms as a large challenge, but there are many opportunities for physicians and providers to develop ways to respond using technology or new models of assessment and intervention.

What Healthcare Leaders are Saying

“First of all, being a provider in a rural community often allows for a closer relationship to the patient and more personalized care, because the rural provider is the one source of available health care,” says Walter Priest, CEO of Family Health Network in Cortland. “The primary care provider is able to use all of their skills in a rural community rather than just a limited set of skills. Rural providers often see multiple generations of the same family, which provides a unique context for evaluation of potential inherited predispositions. These providers also have the opportunity to become part of the community at large, and the overall quality of life of the provider is enhanced.”

Gary Fitzgerald from the Iroquois Healthcare Association actively supports outreach to primary care physicians to move to rural areas.

“We continue to bring physician residents and medical students to Upstate New York to showcase the unique opportunities in health care,” Fitzgerald says. “Our next ‘Take a Look’ tour will be this fall.”

In speaking with providers across our health system I hear many observations about what rural communities need.

“As a retired physician, I see opportunities for care in the management of acute conditions from myocardial infarction, stroke, suicidal depression and serious trauma for providers in rural areas,” says John Butchart, MD, Old Forge, New York. “Distance is our greatest challenge, and services that close that gap will help rural communities.”

“Teleradiology has given rise to a new standard of medical care in diagnostic radiology. The same will be true of the impact of telemedicine on other medical fields,” says Christine Rowe-Button, MD, diagnostic radiologist at Community Care Physicians. “Doctors, healthcare administrators and insurers will be able to provide the highest level of care for each individual, no matter where they live.”

“Rural communities need easy access to health care through a network of providers that includes physicians, nurse practitioners, physician assistants and local, health-related agencies. The real challenge is to provide all or a mix of these resources in an affordable, available manner,” says David Lundquist, CEO at Rome Memorial Hospital. “In today’s shortage of healthcare providers, the challenge for rural communities is to collaborate with healthcare organizations that can provide a variety of provider resources on a regular basis. The key is collaboration.”

“Outreach is essential to alleviate some of the obstacles that result in unmet healthcare needs found in rural communities. Barriers, such as transportation, limited access to providers and services, and restricted health literacy can be minimized,” says Mary Kate Rolf, FACHE, MBA, MHSA, President and CEO at Nascentia Health. “This results in the improvement in patient care and quality outcomes through improved communication, care coordination and integration of technology solutions, allowing providers and community organizations to work collaboratively with the best interest of the residents in mind.”

In summary, we need to think beyond county boundaries and ask how we are responding to the needs of rural communities as a region. Whom can we collaborate with to better understand the challenges and to provide access?