Describe the problem to be addressed (The proposed project is Telemedicine implementation in EMS
), what approaches have been used to address it, and where gaps in understanding remain. The targeted literature review, as well as the stakeholder interviews, should inform the development of this section. This section provides support/rationale for your Capstone Project. The final paragraph of this section should briefly describe the proposed project.
*** The proposed project is Telemedicine implementation in EMS***
***I just submitted the proposal, this is the 2nd
part***
***Attached is the target literature Review as well as stakeholder interviews***
***The PDF Document, Telemedicine Framework for EMS and 911 Organizations is being enclosed, This is the PDF I utilized***
Running head: CRM 715a LTR CRM 715a LTR 2 Literature Review: Rural Access to Healthcare / Barriers to Access in Healthcare Kristopher Durham Wake Forest School of Medicine CRM – 715a Professor, Michael E. Booth, MBA 8/16/2021 Abstract The purpose of this literature review is to explore different barriers that impact the access of healthcare within rural settings. Key barriers addressed include: access to primary care, travel burdens caused by distance and transportation, and health literacy of those accessing healthcare services. The barriers addressed within the literature review help to identify additional areas of need or gaps within literature. The identification of these needs or gaps helps to pose future ideas in research to better serve the individuals within rural communities. Keywords: healthcare, access, barriers, literacy, travel, primary Literature Review: Rural Access to Healthcare The access of healthcare services for rural Americans continues presents a dire issue. Through classification, rural areas tend to have a decreased population or census, resulting in rural communities needing to travel greater distances to access necessary healthcare needs or services (Chi & Ventura, 2011). Therefore, access to healthcare services necessitates the need for primary care access, availability of healthcare within a reasonable timeframe, and the understanding of needed healthcare services. Barriers to the access of healthcare affect an individual’s overall quality of life and pose an impact to the surrounding family and community members. That being said, this literature review aims at identifying barriers within rural areas such as access to primary care, travel burdens of rural communities, and the understanding of health information to optimize health outcomes. Literature Review: Barriers to Access in Healthcare Access to Primary Care As healthcare needs continue to rise across the United States and more specifically within rural areas has resulted in an increased need for healthcare providers. Therefore, the shortage of healthcare workers has posed a significant burden on the access to healthcare needs or services through resource limitations of accessible services. For rural areas within the United States, this holds to be true. In the research article by Laditka, Laditka, & Probst, suggested “rural residents may face more barriers in receiving primary healthcare of reasonable quality than urban residents” (2009, p.761). Therefore, obtainability of accessible and effective primary care services within rural America is a considerable developing issue or trend that is significantly impacted by rurality. That being said, physician supply in rural areas continues to rank high on the needs within rural areas and significantly impacts or impedes healthcare. In review of the Laditka, Laditka, & Probst article, the study utilized data from eight states within the United States which are “broadly geographically distributed”, and the underlying objective was to examine to what degree rural areas are connected with provider availability and access to primary care services (2009). The article hypothesized rural areas are susceptible to decreased access and quality of primary healthcare services (Laditka, Laditka, & Probst, 2009). In addition, the established relationship between rural location and access to primary care, suggests the more rural the area, that harder it may be to access primary care services (Laditka, Laditka, & Probst, 2009). The study analyzed unadjusted and adjusted results which included factors such as physician supply and demographics of the county (Laditka, Laditka, & Probst, 2009). From comparison and review of this data, it was determined access to primary care services for children did not vary systematically within the rural counties. However, rural counties in comparison to urban counties within these eight states, ranged between 45-90% for adults older than eighteen and percentages of accessibility increased as the area became more rural (Laditka, Laditka, & Probst, 2009). Overall, the study conducted by Laditka, Laditka, & Probst, supports the initial hypothesis, as access to primary care was largely dependent on the degree of rurality of the individual seeking healthcare needs (2009). Applications from this study help to display the need for primary care providers to help prevent current and future health gaps of those within rural areas. In order to address issues with regards to access to primary care, one could look beyond traditional physician supplied healthcare. For instance, seek alternative of care such as nurse practitioners, midwifes, or physician assistants and depending on the necessary services providers such as care coordinators, community healthcare personnel, social workers, or community paramedics may suffice and serve has vital roles within the healthcare dynamic. Nonetheless, there are avenues to provide and increase healthcare workers within the rural population to address access to primary care and help combat health disparities individuals face as a result of rurality. Travel Burden Another barrier to the access of healthcare within rural areas includes the distance and transportation needs of the individuals within a rural setting. For instance, individuals located within rural regions tend to travel extended distances to obtain healthcare amenities or services (Buzza, Ono, Turvey, Wittrock, Noble, Reddy, Kaboll, & Reisinger, 2011). For this reason, distances from accessible healthcare and lack of transportation for healthcare needs, can pose a substantial problem in relation to time and means of affordability. The following literature represents the impacts of distance and transportation on the access to healthcare within rural areas. Distance. The purpose of the article was to detect significant aspects related to distance which hinders the access to care for rural populations, in this case study specifically veteran access. The study utilizes both a quantitative and qualitative approach through surveys, interviews, focus groups, data compilation, and the transcription of interviews to identify correlated content (Buzza et al., 2011) The mixed-methods approach was utilized within the rural veteran population, amongst providers, and healthcare staff to explore the influence of travel distance for services and healthcare delivery with the identified rural setting. Through the data collection process, one major gap was identified pertaining to the access of healthcare in a rural setting and this gap was representative of the insights and experiences pertaining to distance for both the provider and patient (Buzza et al., 2011). Therefore, the participants within the mix- methods study consisted of patient, providers, and healthcare staff. Following this study, distance was detected by all parties involved to be the most significant barrier in accessing healthcare for rural veterans (Buzza et al., 2011). Overall, gaining a better understanding of the effect distance has on accessing healthcare in rural areas will help to further develop efficient and effective ways to overcome this barrier. Following a review of the article, additional areas of study to address gaps in access to healthcare include: the impacts of specific rural locations in the access of diagnostic services versus routine care versus emergent services, implications of travel cost and access to healthcare, and overall impacts of an individual’s health status of those in a rural setting with a larger distance as a barrier. Identifying and addressing these gaps will help to improve rural access to healthcare in hopes to diminish set barriers and improve upon an individual’s health status. Although, the study can be applicable across rural settings where distance plays a role in access to healthcare, this study was limited to a specific population within a specific region. For instance, the article represented the white, male, veteran population within the Midwest (Buzza et al., 2011). This situation can be limiting, as there are numerous rural regions within the United States in which distance becomes a factor in accessing healthcare. Also, a distance barrier in the access of healthcare does not only pertain to white males, rather all ethnicities and genders within the United States. Thus, gaps within the literature could address additional aspects including: specific rural regions, ethnicities, or gender differences in access to healthcare. Transportation. Essentially transportation correlates with distance, as an individual needs a mode of transportation to travel a set distance to access healthcare needs. For this reason, transportation and distance are key barriers within access to healthcare within a rural setting. According to Syed, Gerber, & Sharp, transportation issues precede missed appoints, interrupt care, and contribute to missed or delayed medication use or refills (2013). This specific case study synthesized available peer-reviewed literature on the occurrence of transportation barriers impacting access to healthcare within the rural setting. Often transportation barriers pose significant consequences that could have long lasting effects such as poor healthcare management of chronic or acute illnesses and overall poor healthcare outcomes (Syed, Gerber, & Sharp, 2013). Overall, the case study supports the stance on transportation and its barriers within access to rural healthcare to improve upon not only access but an individual’s overall health. Following review of this article, helped to identify gaps and the need for additional research. Areas for additional research include: identifying specific aspects of transportation that limit healthcare access, measure the effect of transportation barriers on clinically significant results, and measure the influence of transportation barrier interpositions and transportation policy changes (Syed, Gerber, & Sharp, 2013). In addition, as researchers move forward in addressing barriers in accessing healthcare, necessary interventions could include: addressing transportation policies, public costs of transportation, location of public transportation, discounts, or travel reimbursements available to those within a rural setting, or development of medical transport services for rural areas or correlated with specific healthcare groups. No matter the gap or future intervention addressed, the transportation and distance barriers imposed with regards to access of healthcare need to continually be attended to for access within rural healthcare to improve and an individual’s overall health to improve. Health Literacy In addition to the access to primary care providers and travel burdens such as transportation and distance, health literacy of an individual also impacts access healthcare services. Health literacy affects an individual’s capability to comprehend health information or directives from a healthcare provider. The inability to comprehend or grasp health information is a significant barrier to accessing healthcare. This is a definite concern within rural areas subjected to decreased educational levels and higher instances of poverty often impact residents of rural regions (Guo, Logan, Dodd, Muller, Marks, & Riley, 2014). The article reviewed by Guo et al., studied whether health literacy was linked with self-rated oral health status and whether the relationship was facilitated by patient-provider communication and healthcare patterns (2014). This study collected data over two separate telephone surveys over the span of three years and included 36 rural regions identified in northern Florida (Guo et al., 2014). To aid in survey data analysis, researchers attempted to adjust for oversampling and limited samples to homes with landlines (Guo et al., 2014). Over the course of data collection and research, the study helped to correlate higher levels of health literacy and the association with better oral health status, better patient-provider communication, and better healthcare patterns (Guo et al., 2014). Overall, various