Clinical Service Delivery Disparities along the Urban/Rural Continuum

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background: Rural communities face numerous health disparities related to health behaviors, health outcomes, and access to medical care. LHDs serving rural communities have fewer resources to meet their community needs. The number and types of community organizations (hospitals, health clinics, not-for-profits), available to partner with may be limited geographically. These factors may affect availability of clinical services in rural communities. This study will assess LHD clinical service delivery levels based on rurality.

data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area (RUCA) Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy.

analysis: Bivariate analysis for 25 clinical services offered by rurality . For each service, we compared the proportions of LHDs that: 1) directly performed, 2) contracted with organizations, and 3) reported that the service was provided independently by organizations in the community.

principal findings: Analyses show significant differences in patterns of clinical services offered, contracted or provided by third parties based on rurality. LHDs in micropolitan areas provided more services directly than urban and rural LHDs (p≤0.001). Urban LHDs were more likely to contract with other organizations (p≤0.001).

conclusions: Rural LHDs are less likely to offer, contract, or have services provided by another organization in the community, whereas larger rural (i.e., micropolitan) jurisdictions are more likely to directly provide these services.

implications for public health practice and policy: Lower levels of clinical service delivery by rural LHDs may contribute to the access issues facing rural communities. Health care reform brings threats and opportunities for LHD clinical service delivery. Further analyses to assess impacts on rural LHDs and identify strategies to ensure access to clinical services is encouraged.


Chicago, IL

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