People who live in rural areas — as well as those who live in areas that are considered socioeconomically deprived — are less likely to access high-quality diabetes care, according to a new study published in the journal JAMA Network Open.
Many doctors and health care researchers have long known that there are barriers to accessing the range of health care needed for diabetes in certain areas of the United States, including many rural areas. Especially for rural residents, telemedicine (telehealth) — having virtual appointments over the phone or through a secure internet connection — has emerged as a potential tool for bridging the care gap in rural areas in recent years. Some services, though — like lab tests and filling certain prescriptions — may not easily be provided virtually. And not only do many rural residents not live near a doctor — let alone a diabetes specialist — many don’t even live near a pharmacy. Despite these challenges, many health care providers and researchers have come up with creative solutions for making telemedicine work for rural residents, such as using at-home test kits for A1C (a measure of long-term blood glucose control) and scheduling back-to-back appointments with different members of a person’s diabetes team to maximize convenience and engagement with the person.
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For the latest study, researchers used health records from adults with diabetes — ages 18 to 75, with an average age of 59 — who received care at any of the 75 primary-care locations of the Mayo Clinic Health System in Minnesota, Iowa, and Wisconsin. They looked at how many participants met five different outcomes that correlate with a high quality of diabetes care — an A1C level below 8.0%, blood pressure under 140/90 mmHg, taking statins to control blood cholesterol and triglycerides as needed, taking aspirin for cardiovascular disease as needed, and not using tobacco. Then, they compared the number of participants who met all five of these outcomes based on how rural or remote their location was, and based on how socioeconomically deprived their area was according to 17 different U.S. Census indicators. In making these comparisons, the researchers adjusted for other demographic factors like age and race or ethnicity, as well as certain aspects of participants’ health history.
Achieving high-quality diabetes care less likely in rural, deprived areas
The researchers found that out of 31,934 participants, 13,238 (41%) met the markers for high-quality diabetes care. For the 9,193 people (29%) who lived in rural areas, the likelihood of meeting these markers was 16% lower than for participants who lived in urban areas. For the subset of 2,299 people (7% of all study participants) who lived in highly rural areas, the likelihood of meeting these targets was 19% lower than for urban residents. The 1,614 participants (5%) who lived in the most deprived areas — rural or urban — were 28% less likely to meet the health targets, compared with the 4,090 participants (13%) who lived in the least deprived areas.
These results “call for geographically targeted population health management efforts by health systems, public health agencies, and payers,” the researchers wrote. “Telemedicine would not be a viable option for patients without broadband internet, which is frequently a barrier in highly rural areas. Community health workers, community paramedics, and endocrinology experts in rural primary care practices […] can help address some of the gaps in rural and remote areas.”
Want to learn more about health care in rural areas? Read “Many Rural Americans Live in Pharmacy ‘Desert’ With Limited Vaccine Access” and “Telemedicine for Rural Residents.”