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PurposeGeographic disparities exist in uptake of the human papillomavirus vaccine (HPV). In 2020, the National Immunization Survey-Teen reported that adolescents living in nonmetropolitan statistical areas (MSAs) had lower HPV vaccination coverage (≥ 1 dose) compared to adolescents living in MSA principal cities. This paper describes the implementation and evaluation of a multilevel pilot intervention study to increase uptake of the HPV vaccine among adolescent patients ages 11-17 of a rural health clinic.MethodsThis parent, primary care team, and clinic multilevel pilot intervention was guided by evidence-based approaches to increase HPV vaccinations, formative research, and input from the community. HPV vaccination initiation and completion rates were analyzed at baseline and 23 months follow-up.FindingsThe proportion of adolescent patients ages 11-17 who had initiated the HPV vaccine series was significantly greater at follow-up compared to baseline, (82.7% compared to 52.4%), χ2 (1, n = 498) = 49.2, P < .0001. The proportion of adolescent patients ages 11-17 who had completed the HPV vaccine series was also significantly greater at follow-up compared to baseline, (58.0% compared to 27.0%), χ2 (1, n = 498) = 50.8, P < .0001.ConclusionsThe multilevel intervention significantly increased HPV initiation and completion rates among adolescent patients ages 11-17 at this rural health clinic. This study demonstrates the feasibility of utilizing a multilevel intervention to address low HPV vaccination rates among rural adolescents and the potential of employing this strategy for a large-scale randomizing-controlled trial.

This paper investigated the techno-economic viability assessment of solar PV/wind/diesel generator (DG)/battery hybrid energy systems (HES) for powering an isolated rural health clinic in northern Nigeria. HOMER–software tool developed by the US National Renewable Energy Laboratory (NREL) has been utilized for the techno-economic assessment of the proposed HES. The results of the simulation reveal that PV/DG/battery HES with 5.43 kW PV, 2 kW DG, 3.06 kW power converter, and 10 units of batteries emerged as the optimum system and most preferable with the minimum Net Present Cost (NPC) of $16,457 and Cost of Energy (COE) of $0.259/kWh compared to other system cases. The outcome also shows that the optimized solution is environmentally friendly as it presented an acceptable carbon dioxide emission of 1304 kg/year, which was about 80% and 82.5% less than that of system case 3 (DG/battery) and system case 5 (DG-Only). To have a good understanding of the operation of various system configurations considered, details of the system’s battery storage status and power flow are discussed via the energy balance of the various system configurations. This analysis shows operating cost, fuel cost, COE, fuel consumption, and renewable fraction are sensitive to the variation in all the considered sensitivity parameters.

This paper investigated the techno-economic viability assessment of solar PV/wind/diesel generator (DG)/battery hybrid energy systems (HES) for powering an isolated rural health clinic in northern Nigeria. HOMER–software tool developed by the US National Renewable Energy Laboratory (NREL) has been utilized for the techno-economic assessment of the proposed HES. The results of the simulation reveal that PV/DG/battery HES with 5.43 kW PV, 2 kW DG, 3.06 kW power converter, and 10 units of batteries emerged as the optimum system and most preferable with the minimum Net Present Cost (NPC) of $16,457 and Cost of Energy (COE) of $0.259/kWh compared to other system cases. The outcome also shows that the optimized solution is environmentally friendly as it presented an acceptable carbon dioxide emission of 1304 kg/year, which was about 80% and 82.5% less than that of system case 3 (DG/battery) and system case 5 (DG-Only). To have a good understanding of the operation of various system configurations considered, details of the system's battery storage status and power flow are discussed via the energy balance of the various system configurations. This analysis shows operating cost, fuel cost, COE, fuel consumption, and renewable fraction are sensitive to the variation in all the considered sensitivity parameters. [ABSTRACT FROM AUTHOR]

Purpose: Hepatitis C incidence is higher among American Indian/Alaskan Native populations than any other racial or ethnic group in the United States. Chronic Hepatitis C complications include cirrhosis of the liver, end stage liver disease, and hepatocellular cancer. Direct acting antiviral treatment taken orally results in > 90% cure, yet rural primary care providers lack the training and confidence to treat and monitor patients with chronic Hepatitis C. Rural patients are reluctant to travel to urban areas for Hepatitis C treatment. Project ECHO is an innovative tele-mentoring program where specialists mentor primary care providers via videoconferencing to treat diseases they would otherwise be unable to manage. The purpose of this quality improvement project was to increase Hepatitis C treatment at a rural Navajo health clinic through partnership with Project ECHO specialists. Methods: This quality improvement project was guided by Lippitt's Phases of Change Theory. The systematic process plan included a protocol for roles and expectations of all members of the healthcare team, a documentation and communication plan, and a tracking system for monitoring patient progress through the plan of care. Outcomes were analyzed by descriptive statistics. Findings: Following partnership with Project ECHO, six patients (31.6%) consented to receiving Hepatitis C treatment at the rural Navajo health clinic. All six were contacted by outreach staff at multiple points during the project. Five (26.3%) completed the full course of drug therapy. Four (21.1%) completed follow-up lab work, of which three (15.8%) had a documented cure by sustained virologic response. Conclusions: Hepatitis C care via Project ECHO-rural clinic partnership was affordable, feasible and not excessively time consuming for a facility with substantial patient outreach resources. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to determine the factors and predictors of good glycaemic control among patients with Type 2 Diabetes Mellitus (T2DM) in two rural government health clinics in Kuala Selangor. Methods: This cross-sectional study involved 200 patients selected through systematic random sampling from a list of T2DM patients in two government health clinics in Kuala Selangor. Data was collected using a self-administered questionnaire while glycosylated haemoglobin (HbA1c) results were obtained from the patients' blood results record at the clinic. HbA1c of 6.5% and below was categorized as good glycaemic control. The factors studied were socio-demographic characteristics (age, gender, ethnicity, level of education, occupation and household income), T2DM medical history (T2DM duration and type of treatment), diabetes knowledge, health literacy, adherence to treatment, body mass index (BMI) and physical activity. Pearson's chi square test was used to test for associations and multiple logistic regressions were used to determine the predictors. Results: The response rate was 86.9%. The proportion of good glycaemic control was 34.0%. Level of glycaemic control was significantly associated with duration of being diagnosed with T2DM (p=0.006) and type of treatment (p=0.009). The probability of having good glycaemic control was 2.5 times more likely among respondents diagnosed with T2DM for less than 10 years (AOR=2.458, 95% of CI=1.504-14.282, p=0.037). Conclusion: Shorter duration of being diagnosed with T2DM has been found to be a predictor of good glycaemic control in this study population, thus warranting stricter monitoring among patients who have been diagnosed for a longer period. [ABSTRACT FROM AUTHOR]

This paper assessed optimal configurations of hybrid renewable system for rural health clinic (RHC) application in three grid-unconnected rural villages in Nigeria. The RHC consist of an emergency room, consulting room, nurse/injection room, male ward, female ward, a delivery room and a laboratory with average total daily energy consumption of 15.5 kWh and 2.75 kW peak demand. The assessment of configurations that optimally meet the daily load demand with zero loss of power supply probability (LPSP) was carried out using HOMER software, by considering three energy resources; photovoltaic (PV), wind and diesel with battery energy storage. The result obtained revealed hybrid PV/wind/diesel/battery system as the most cost-effective configuration for powering rural health clinic in both Maiduguri and Enugu sites, while that of Iseyin site was found to be hybrid PV/diesel/battery system. In all the sites, the selected optimal configuration is far better than the conventional diesel stand-alone system in terms of cost and emission reduction.

Objectives: A pilot study exploring how elderly patients of a rural outpatient health clinic in Appalachia perceive design elements of the facility as imposing barriers to healthcare participation. Background: Outpatient clinics play a critical role in the delivery of healthcare in rural settings in Appalachia. While the concept of patient participation in healthcare does not enjoy a widely adopted, standardized definition, it is believed that patients who are more actively engaged in their healthcare will potentially realize improved health outcomes. This study examines the role facility design could play in participation. Methods: A pilot qualitative study was conducted involving focus groups with a targeted elderly population of a rural outpatient clinic in southern West Virginia. The goal was to assess the perceptions of impacts of clinical design elements on participation. Results: Patients identified and characterized 10 design-related elements they felt impacted participation. Conclusions: The design of the outpatient clinic has the potential to impact the level of engagement of patients in the healthcare process, thus providing another leverage point for improving population health in rural settings. [ABSTRACT FROM AUTHOR]

Context Emergency Department (ED) overcrowding due to nonemergent use is an ongoing concern. In 2011, a regional health system that primarily serves rural communities in Texas instituted a new program to medically screen and refer nonemergent patients to nearby affiliated rural health clinics (RHCs). Purpose This formative evaluation describes the program goals, process, and early implementation experiences at 2 sites that adopted the program before wider implementation within the rural health system. Methods Primary data collection including document review, internal stakeholder interviews, and direct observation of program processes were used for this formative evaluation of program implementation in light of program goals and objectives. Fourteen key informants were asked questions related to the program concept, structure, and implementation. Results The program, as implemented, aligned with initial program goals, but it was dependent on ED screening staff and RHC availability. Some adjustments to the program were needed, including RHC hours, consistency among staff in making referrals, patient education, and improving patient uptake on the referral. Stakeholders reported lessons learned related to training, staff buy-in, Emergency Medical Treatment and Labor Act (EMTALA), and intraorganizational cooperation. Discussion The system was able to leverage excess capacity of affiliated RHCs to accommodate low-acuity patients referred from the ED and may lead to improvements in Triple Aim goals of increased patient satisfaction, better population health and outcomes, and lower per capita costs. Lessons learned from this program may inform similar processes aimed to reduce nonemergency ED utilization by other rural health systems. [ABSTRACT FROM AUTHOR]

Context As today's rural hospitals have struggled with financial sustainability for the past 2 decades, it is critical to understand their value relative to alternatives, such as rural health clinics and private practices. Purpose To estimate the willingness-to-pay for specific attributes of rural health care facilities in rural Kentucky to determine which services and operational characteristics are most valued by rural residents. Methodology We fitted choice experiment data from 769 respondents in 10 rural Kentucky counties to a conditional logit model and used the results to estimate willingness-to-pay for attributes in several categories, including hours open, types of insurance accepted, and availability of health care professionals and specialized care. Findings Acceptance of Medicaid/Medicare with use of a sliding fee scale versus acceptance of only private insurance was the most valued attribute. Presence of full diagnostic services, an emergency room, and 24-hour/7-day-per-week access were also highly valued. Conversely, the presence of specialized care, such as physical therapy, cancer care, or dialysis, was not valued. In total, respondents were willing to pay $225 more annually to support a hospital relative to a rural health clinic. Conclusion Rural Kentuckians value the services, convenience, and security that rural hospitals offer, though they are not willing to pay more for specialized care that may be available in larger medical treatment centers. The results also inform which attributes might be added to existing rural health facilities to make them more valuable to local residents. [ABSTRACT FROM AUTHOR]

Children living in poverty are vulnerable to the adverse effects associated with unmet basic needs, such as food and housing. Poverty threatens the overall growth and development of children placing them at risk for poor cognitive, behavioral, and psychological outcomes. Addressing social determinants of health in the pediatric primary care setting is within the role of the pediatric primary care provider. The Model for Improvement guided this quality improvement project in the implementation of food and housing insecurity screening during well-child appointments in a rural health clinic., (Copyright © 2018 Elsevier Inc. All rights reserved.)