Advertisement

Local Health Departments as Clinical Safety Net in Rural Communities

      Introduction

      The appropriate role of local health departments (LHDs) as a clinical service provider remains a salient issue. This study examines differences in clinical service provision among rural/urban LHDs for early periodic screening, diagnosis, and treatment (EPSDT) and prenatal care services.

      Methods

      Data collected from the 2013 National Association of County and City Health Officials Profile of Local Health Departments Survey was used to conduct a cross-sectional analysis of rural/urban differences in clinical service provision by LHDs. Profile data were linked with the 2013 Area Health Resource File to derive other county-level measures. Data analysis was conducted in 2015.

      Results

      Approximately 35% of LHDs in the analysis provided EPSDT services directly and 26% provided prenatal care. LHDs reporting no others providing these services in the community were four times more likely to report providing EPSDT services directly and six times more likely to provide prenatal care services directly. Rural LHDs were more likely to provide EPSDT (OR=1.46, 95% CI=1.07, 2.00) and prenatal care (OR=2.43, 95% CI=1.70, 3.47) services than urban LHDs. The presence of a Federally Qualified Health Center in the county was associated with reduced clinical service provision by LHDs for EPSDT and prenatal care.

      Conclusions

      Findings suggest that many LHDs in rural communities remain a clinical service provider and a critical component of the healthcare safety net. The unique position of rural LHDs should be considered in national policy discussions around the organization and delivery of public health services, particularly as they relate to clinical services.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wall S.
        Transformations in public health systems.
        Health Aff. 1998; 17: 64-80https://doi.org/10.1377/hlthaff.17.3.64
        • Berkowitz B.
        • Ivory J.
        • Morris T.
        Rural public health: policy and research opportunities.
        J Rural Health. 2002; 18: 186-196https://doi.org/10.1111/j.1748-0361.2002.tb00930.x
        • Berkowitz B.
        Rural public health service delivery: promising new directions.
        Am J Public Health. 2004; 94: 1678-1681https://doi.org/10.2105/AJPH.94.10.1678
        • IOM
        Committee on the Study to Improve Public Health.
        The Future of Public Health. National Academies Press, Washington, DC1998
        • IOM
        Committee on Assuring the Health of the Public in the 21st Century.
        The Future of the Public’s Health in the 21st Century. National Academies Press, Washington, DC2003
        • IOM
        Committee on Public Health Strategies to Improve.
        For the Public’s Health: Investing in a Healthier Future. National Academies Press, Washington, DC2012
        • Hale N.L.
        • Smith M.
        • Hardin J.
        • Brock-Martin A.
        Rural populations and early periodic screening, diagnosis, and treatment services: challenges and opportunities for local public health departments.
        Am J Public Health. 2015; 105: S330-S336https://doi.org/10.2105/AJPH.2014.302449
        • Beatty K.E.
        • Meit M.
        • Hale N.
        • Khoury A.
        • Masters P.
        Clinical service delivery disparities along the urban/rural continuum.
        Frontiers in Public Health Services and Systems Research. February 21, 2015;
        • Basco W.T.
        • Rimsza M.E.
        Pediatrician workforce policy statement.
        Pediatrics. 2013; 132: 390-397https://doi.org/10.1542/peds.2013-1517
        • American College of Obstetricians and Gynecologists
        ACOG Committee Opinion No. 586: Health disparities in rural women.
        Obstet Gynecol. 2014; 123: 384-388
        • Cohen D.
        • Coco A.
        Declining trends in the provision of prenatal care visits by family physicians.
        Ann Fam Med. 2009; 7: 128-133https://doi.org/10.1370/afm.916
        • Johnson R.
        • Morris T.
        Rural Public Health: Issues and Considerations. A Report to the Secretary, U.S. Dept. of Health and Human Services.
        The National Advisory Committee on Rural Health. February 2000;
        • National Association of County and City Health Officials
        2013 National Profile of Local Health Departments.
        NACCHO, Washington, DC2014
      1. U.S. DHHS, Health Resources and Services Administration Health Workforce. Area Health Resources Files (AHRF): National, State and County Health Resources Information Database. Rockville, MD: U.S. DHHS.
        • Baer L.D.
        • Johnson-Webb K.D.
        • Gesler W.M.
        What is rural? A focus on urban influence codes.
        J Rural Health. 1997; 13: 329-333https://doi.org/10.1111/j.1748-0361.1997.tb00975.x
        • Hart L.G.
        • Larson E.H.
        • Lishner D.M.
        Rural definitions for health policy and research.
        Am J Public Health. 2005; 95: 1149-1155https://doi.org/10.2105/AJPH.2004.042432
        • Hale N.
        • Probst J.
        • Robertson A.
        Rural area deprivation and hospitalizations among children for ambulatory care sensitive conditions.
        J Community Health. 2016; 41: 451-460
        • Coburn A.F.
        • McBride T.D.
        • Ziller E.C.
        Patterns of health insurance coverage among rural and urban children.
        Med Care Res Rev. 2002; 59: 272-292https://doi.org/10.1177/1077558702059003003
        • Crosby R.
        • Monica M.L.
        • Vanderpool R.C.
        • Casey B.
        Rural Populations and Health: Determinants, Disparities, and Solutions. Jossey-Bass, San Francisco, CA2012
        • Beatty K.E.
        • Wilson K.D.
        • Ciecior A.
        • Stringer L.
        Collaboration among Missouri nonprofit hospitals and local health departments: content analysis of community health needs assessments.
        Am J Public Health. 2015; 105: S337-S344https://doi.org/10.2105/AJPH.2014.302488
      2. Patient Protection and Affordable Care Act. 42, U.S.C. § 18001 (2010).
        • Wilson K.D.
        • Mohr L.B.
        • Beatty K.E.
        • Ciecior A.
        Describing the continuum of collaboration among local health departments with hospitals around the community health assessments.
        J Public Health Manag Pract. 2014; 20: 617-625https://doi.org/10.1097/PHH.0000000000000030
        • Sampson G.
        • Miner Gearin K.J.
        • Boe M.
        A rural local health department–hospital collaborative for a countywide community health assessment.
        J Public Health Manag Pract. 2015; 21: 23-30https://doi.org/10.1097/PHH.0000000000000088
        • Harris J.K.
        • Mueller N.L.
        Policy activity and policy adoption in rural, suburban, and urban local health departments.
        J Public Health Manag Pract. 2013; 19: E1-E8https://doi.org/10.1097/PHH.0b013e318252ee8c
        • Wetta R.E.
        • Pezzino G.
        • LaClair B.
        • Orr S.
        • Brown M.B.
        Voices across Kansas.
        J Public Health Manag Pract. 2014; 20: 39-42https://doi.org/10.1097/PHH.0b013e3182a9572a
        • Beatty K.E.
        • Mayer J.
        • Elliott M.
        • Brownson R.C.
        • Abdulloeva S.
        • Wojciehowski K.
        Barriers and incentives to rural health department accreditation.
        J Public Health Manag Pract. 2016; 22: 138-148https://doi.org/10.1097/PHH.0000000000000264
        • Beatty K.
        • Harris J.K.
        • Barnes P.A.
        The role of interorganizational partnerships in health services provision among rural, suburban, and urban local health departments.
        J Rural Health. 2010; 26: 248-258https://doi.org/10.1111/j.1748-0361.2010.00285.x
        • Mays G.P.
        • McHugh M.C.
        • Shim K.
        • et al.
        Getting what you pay for: public health spending and the performance of essential public health services.
        J Public Health Manag Pract. 2004; 10: 435-443https://doi.org/10.1097/00124784-200409000-00011
        • Mays G.P.
        • Smith S.A.
        Evidence links increases in public health spending to declines in preventable deaths.
        Health Aff. 2011; 30: 1585-1593https://doi.org/10.1377/hlthaff.2011.0196