Quality of care, not access, primary concern of rural physicians


Editor’s note: This article describes a report produced as part of a partnership between Medscape and Walmart. Walmart was not involved in the writing of this article.

Primary care clinicians in rural America are most concerned about the quality of patient care, according to a new report. The issue was a bigger concern than access to care, especially for providers treating patients with chronic conditions and those with mental health issues.

A new survey of more than 10,000 primary care clinicians examined barriers to care delivery from the perspective of clinicians in rural and non-rural communities. The report, Health professionals’ perspective on health care in rural America, is the result of a partnership between Medscape and Walmart.

John Whyte, MD, MPH, WebMD’s chief medical officer, said it was “striking” that rural healthcare professionals are most concerned about quality. “It gives us a new perspective on what we need to focus on – and that’s quality.”

Historically, access to care has been the greatest barrier to providing health care to the approximately 60 million Americans living in rural areas. And, Whyte pointed out, it was the doctors who said the quality of care needs to improve.

Learn more about survey methodology, results

Respondents were randomly invited by email to complete a brief online survey. Almost half of the respondents were primary care physicians, while the rest included physician assistants, nurse practitioners, registered nurses, pharmacists and optometrists. Each provider saw a minimum of 10 patients per week. Those who completed the survey received a gift card.

About 30% of respondents reported practicing in rural areas and 70% in non-rural communities. Respondents came from all geographic regions of the United States. Workplaces included hospitals, retail or grocery stores, pharmacies, and outpatient clinics, as well as academic medical centers, military installations, and other government institutions.

Other key findings:

  • Less than 40% of rural providers rated the quality of specialist, urgent, and chronic care as high, compared to 62%, 57%, and 53% of non-rural providers, respectively, for the three regions.

  • Only 25% of rural providers said they believed their patients had reasonable access to mental or behavioral health services, compared to 43% of non-rural clinicians.

  • While 45% of rural primary care providers versus 60% of non-rural primary care providers said that personal health technology for patient monitoring would be beneficial or very beneficial, 65% of rural versus 69% of non-rurals thought remote monitoring would be beneficial or very beneficial. The finding also surprised Whyte, who said he would have expected vendors to adopt the technologies. After all, he said, telehealth was originally designed for rural communities.

What’s needed?

Additional staff for team-based care, financial assistance to patients, and community support systems were all mentioned by rural health care providers as ways to improve the quality of care.

The best opportunities for improvement, rural respondents said, are to build on existing approaches and devices, such as better medical equipment and more reliable internet services.

Community support systems such as patient assistance programs outside the doctor’s office would help, as would financial assistance for patients, rural health clinicians said.

Rural health professionals said that upgrading medical equipment and getting faster or more reliable internet service would help improve the quality of care they could provide. Providers also reported needing more staff, community support and financial assistance for patients.

The partnership has resulted in valuable insights from suppliers, Whyte said, “and nobody really talks to suppliers.” Information is crucial and the results will contribute to improvement, he added.

As for what’s next, Whyte said they were discussing how best to provide leadership: “We have this new idea; what do we do with it?”

Origins of the partnership

Cheryl Pegus, MD, MPH, executive vice president of Walmart Health & Wellness, and Whyte have previously worked together on projects like the one that targeted awareness of HIV and access to care for young black men.

“We’ve always had this common interest” in addressing disparities, Whyte said. When the two leaders began talking about rural health care, Whyte noted that Medscape had the potential to survey large numbers of physicians and others who practice in both rural and non-rural settings.

About 90% of the US population lives within 10 miles of a Walmart, and 4,000 of the company’s stores are located in medically underserved areas, as designated by the Health Resources and Service Administration.

The company has also become increasingly involved in providing direct client care. The retail giant launched the first Walmart Health in 2019, a one-stop-shop for many care needs that provides services such as physical exams, wellness checks, sick and injured visits, dental examinations, optometry, laboratories and x-rays. The company now has 24 such facilities in four states: Arkansas, Florida, Georgia and Illinois.

Walmart has drawn criticism from healthcare industry consultants who call the new venture a “threat” to traditional healthcare providers and predict the company will employ lower-cost clinicians such as nurses and assistants. others to reduce the cost of care. However, Whyte said society is addressing a significant unmet need and lagging attention to rural health care.

“The cure is not to provide none,” he said. “The cure is to provide the best possible care in the community with the providers you have.”

“Patients want to be cared for by people they know and trust, who are part of their community, and who understand their local challenges and needs,” Pegus said. “What we learned in our rural HCP study with Medscape is that the unique needs of rural America are known to health care professionals in these communities, and their input before policy changes are implemented is We partner with all the communities we serve to close gaps in care, community by community, to provide quality health care, including programs to support the social determinants of health such as food insecurity, maternal and child health, diabetes and hypertension solutions to improve health outcomes.

Doc Country, Doc City

Although the survey is not necessarily a representative sample of rural clinicians, the findings presented align with other research, said Yalda Jabbarpour, MD, medical director of the Robert Graham Center, a primary care research group in Washington, DC. “The gap in access and quality of health care reported by clinicians in rural areas is not surprising, but it underscores the fact that we need to redouble our efforts” to close the gap between rural and urban,” she said.

Jappapour also pointed out that the opinion gap between rural and non-rural providers was narrower for primary care physicians than for specialist and hospital physicians.

Although 76% of rural primary care clinicians rated care as accessible or very accessible, 84% of non-rural clinicians did. And while 63% of rural primary care clinicians said the quality of care was excellent, 69% of non-rural clinicians felt the same way.

Numerous studies have shown that primary care specialists, especially family physicians, constitute the predominant clinical workforce in rural America.

“They are helping fill that specialist and mental health gap that the report highlights given their broad and deep training,” Jabbarpour told Medscape. “But the report also underscores the importance of having a base of primary care clinicians who have received rigorous training and can function independently to address gaps in mental health care, maternity care and patient care. patients with multiple chronic diseases.”

The challenges facing clinicians practicing in rural areas have not changed much in recent years, she added. “The same issues that existed for rural clinicians 5 or 10 years ago exist today.”

Walmart and Medscape: “Health Professional Perspectives on Health Care in Rural America.” June 2022.

Kathleen Doheny is a freelance journalist in Los Angeles. Follow her on Twitter: @DohenyKathleen

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