Rural Health

Why Rural Health Matters

_{Source: See Rural Health Resources (References 3)}‍

Barriers to Cardiometabolic Care in Rural Communities

• Limited access to primary care and specialty services
• Workforce shortages
• Transportation barriers
• Limited availability of nutrition, pharmacy, behavioral health, and diabetes education services
• Technology limitations affecting telehealth access
• Financial barriers
• Insurance coverage
• Medication access and adherence due to limited rural pharmacies, and cost of medications
• Food access and nutrition
• Social determinants of health (housing, poverty, etc.)
• Fragmented healthcare

Clinical implications:

• Use every visit as an opportunity for prevention and early identification
• Prioritize evidence-based interventions that can be delivered within primary care
• Identify community resources and care team members to support long-term management

_{Source: See Rural Health Resources (References 2)}‍

‍Rural Team-Based Care

Team-based care can improve chronic disease outcomes by expanding care beyond the clinician and leveraging pharmacists, nurses, community health workers, dietitians, and care coordinators.

Examples:

• Pharmacist-led medication management
• Nurse-led chronic disease monitoring
• Community health worker navigation
• Dietitian referral pathways
• Shared care plans between rural clinics and regional health systems

Buchanan CARES: Rural Team-Based Care Model

‍CMS Rural Health Transformation Program: Wisconsin Rural Health Transformation

Rural Health Transformation (RHT) Program

Rural Health Information Hub (RHIhub)

Aging and Disability Resource Centers (ADRCs)

Community Resources

Public Health

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When specialty access is limited:

• Use guideline-based treatment pathways
• Use evidence-based guidelines
• Utilize e-consults when available
• Establish referral criteria for:
  
  • Nephrology (CKD progression, significant albuminuria)
  • Endocrinology (complex diabetes)
  • Cardiology (high cardiovascular risk)

^{Source: See Rural Health Resources (References 1, 4-7)}

‍Expanding Access Through Telehealth & Technology

• Telehealth for chronic disease management
• Remote patient monitoring
• Virtual specialty care (endocrinology, nephrology, cardiology)
• Digital tools for patient self-management

Clinician considerations:

• Assess patient access to internet, devices, and digital literacy
• Consider hybrid models (in-person + virtual)
• Use technology to reduce travel burden when appropriate
• Telemedicine for exercise training, behavioral modification, medication adherence, and psychosocial support
• Health literacy
• Patients culture—cultural differences and beliefs

_{Source: See Rural Health Resources (References 2, 3)}