Mobile Healthcare Applications Could Improve the Quality of Rural Life

   Today, physicians, investors, hospitals, and healthcare business partners, alike, will be gathering together at the Rutgers University Center in New Brunswick, New Jersey to discuss the future of accessible medicine. This year’s mHealthcon Conference is scheduled to focus on mobile healthcare applications for smartphones, tablets, and other wireless devices. The field of medicine is constantly growing and changing. As discussed earlier in the semester, IBM is currently working with WellPoint Inc. to develop a healthcare application based off of Watson, a supercomputer. While the success of such a project has the ability to change the culture of rural medicine as a whole, the use and success of mobile applications, paired with or without Watson, have the ability to diminish the huge healthcare discrepancies that currently exist between rural and urban America.

   This biannual conference is a reminder to how fast the mobile health industry is surging. In fact, as mHealthcon’s website explains, this “multi-billion dollar global sector” is growing by approximately 24 percent each year. With the surging popularity of this new industry, it is only a matter of time before healthcare can be managed remotely. In fact, researchers are working on a pill which can wirelessly transmit health information to one’s doctor. Others are working on interfaces which have the ability to monitor heart rate, blood pressure, and glucose levels. When such devices become a staple in our ever-evolving healthcare industry, one can expect the quality of rural healthcare to significantly increase. As it stands, rural areas suffer from a shortage of healthcare professionals as well as from access to quality healthcare. Such devices could help alleviate these problems by allowing doctors to access health information on a more regular basis.

How Multiple Pregnancies Could Increase Health

   The last blog entry that I posted described a common misconception about health in rural America. It was discussed that rural Americans are actually more likely than their urban counterparts to suffer from chronic health conditions. In the last entry, I discussed a new study which tied fish consumption to an improvement in overall cognitive function. While this has the possibility to improve mental health, it is also important to look at new, interesting ways to help rural Americans deal with some of the other chronic conditions, such as heart disease and stroke.

   According to another research study released this week, women who give birth to four or more children are one third less likely to die from cardiovascular disease and are also fifty percent less likely to die from a stroke. The study suggests that this is due to a longer period of elevated pregnancy hormones, although they could not say for certain. In the past, rural Americans have typically created a large family network. Only recently have the newer generations started to become more urbanized and, as a result, have fewer and fewer children. This decline in birthing rates has also coincided with an increase in chronic health conditions. Even though there are many other factors which have the potential to increase the prevalence of chronic conditions, this new study allows us to consider a possible solution to help such cases. For instance, even if having multiple pregnancies is not a financial option, there is the potential that an increase in certain hormone levels could also help to accomplish the same goal. 

Fish and Its Connection to Improved Health

   A common misconception is that rural Americans are healthier and live longer lives than the rest of the general population. Some argue that because rural life is more laid back, there is a lower degree of stress in people’s everyday lives. Others discuss how the lower amounts of air pollution or the use of locally grown, unprocessed foods lead to an overall healthier lifestyle. This, however, is not the case. In fact, as discussed in the article Rural Americans Have Less Healthcare Access: Report, it is explained that rural Americans are actually more likely than their urban counterparts to suffer from chronic health conditions. This, paired with the lack of access to quality healthcare, diminishes the health status of many rural Americans. And, without proper health care, longevity is even harder to strive for.

   Today, a groundbreaking study was presented at the annual meeting of the Radiological Society of North America (RSNA).

“People who eat baked or broiled fish on a weekly basis may be improving their brain health and reducing their risk of developing mild cognitive impairment (MCI) and Alzheimer’s disease.”

~ ScienceDaily (November 30, 2011)

Even though eating fish is not necessarily helpful to other chronic conditions such as diabetes, heart disease and cancer, this does have the potential to help with any type of chronic, cognitive impairment. Improving one’s mental health is an essential step in leading a healthy life. This, however, is made difficult by the fact that many rural Americans currently live in landlocked areas with very few bodies of water. They do not necessarily have access to fish on a weekly basis which, if changed, could greatly reduce the degree and the quantity of cognitive impairment. Even those rural areas that do have lakes, such as Minnesota, still have a high rate of Alzheimer’s disease (www.health.state.mn.us). Although not definitive, this could be due to the way in which the fish is typically prepared. According to the study, the fish must be broiled or baked, fried fish did not give the same results.

   No matter the reason, rural Americans should be made more aware of this study’s results. It is important for physicians and other health professionals to encourage a weekly intake of fish in order to not only better one’s cognitive function but to also better one’s overall health. Rural America already suffers from a shortage of qualified health professionals, which makes it even more important to find preventative treatment plans which the patient could administer themselves.

Rural Americans Not Helped by New Health Care Bill

   In just under a year, the United States will be holding their 57^th quadrennial presidential election. Campaigning has already begun and promises are already being made. Just four years ago, our now incumbent president BarackObama made a campaign promise to instill a universal health care bill by the end of his first term:

"I have made a solemn pledge that I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family's premium by up to $2,500 a year."

 -- Hartford, Conn.

JUNE 23, 2007

Although both the Senate and the House passed Obama’s health care bill in 2009 and 2010, respectively, there has still been much debate surrounding the issue. As it stands, all citizens and legal residents of the United States will be required to purchase health-insurance coverage by 2014 or else face a tax penalty. Despite promising many potential benefits for our current health care system, the implementation of this particular bill does not bode well for rural America.

   One major change that U.S. citizens can expect to see is the expansion of Medicaid. According to Medicaid and Its Importance to RuralHealth, Medicaid is more highly relied upon in rural settings. After all, rural populations face higher rates of poverty and are also less likely to carry health insurance (raconline.org). Under Obama’s new, universal health care bill, Medicaid is expected to increase its total enrollees by 35-40 million in the next decade (news.heartland.org). Even though this opens up healthcare to more people, it is ultimately a detriment to the health care system. It is impossible to offer the same quality care when the supplies are not there. Furthermore, the bill also proposes budget cuts be made to the overall Medicaid system. So, not only has this new bill proposed adding 40 million enrollees, but it also proposes a decrease in total amount of accessible funds.

   As mentioned earlier, the implementation of this particular health care bill does not figure well for rural hospitals whose bulk income is primarily based off of the funds received from Medicaid. As Freudenheim discussed in his article, Hospital Groups Assess Health Care Law, Medicaid payments currently do not cover all costs, especially in a rural setting. This, paired with an increase in patients and budget cuts, is projected to nearly triple the annual shortfall payments in most hospitals. Most rural hospitals will not be able to survive this – it would simply be “unsustainable.”

   In one year, we will elect our 57^th President of the United States. No matter the outcome of the election, it is important that the chosen candidate look more closely at this health care bill and see that its actions will negatively impact a great majority of our country’s population. Rural areas already have a shortage of doctors and other health care professionals. The last thing that they need is an even greater shortage of hospitals.

Improving Emergency Medical Response

  In 2004, the National Cooperative Highway ResearchProgram (NCRHP) completed their StrategicHighway Safety Plan. The third section of this plan focused on Rural Emergency Medical Services in conjunction with the high number of rural traffic fatalities each year. Their report showed that rural areas not only suffer from a large number of traffic fatalities but also a larger degree of fatal car crashes per vehicle miles traveled (see the two graphs above).  Furthermore, these areas also have a significantly slower EMS response time. This, in particular, is cause for 

worry since there is a direct correlation between length of response time and increase in the severity of an injury. As shown in the figure on the right, the average EMS response times in rural areas are approximately 17 min longer than those in urban areas. This, as the safety plan suggested, can be attributed to many different factors including the increased distance between the accident and the closest first responders. Another cause for delay, as Stacy Vogel discussed in her article, is the fact that many rural responders are volunteers and they must first travel to the station before heading out to the scene.  While these delays are unavoidable, there are other ways to help reduce response-to-treatment time which, in turn, will also help to reduce the progression of more serious injuries.

“CodeHeartSends Real-time Emergency Vitals from Ambulances to Physicians”

   Last week, Washington Hospital Center announced a mobile application which has the potential to significantly improve patient care. This secure device has the ability to stream real-time audio and video from moving ambulances to their emergency center destination. This, as Potts explains, will allow trauma personnel to gather basic information while the patient is in transit as opposed to waiting until the patient is already in the hospital emergency room. This would then allow doctors to start treatment immediately, thereby reducing the time between injury and treatment. Although the device is not widely available and is only being used to help cardiac patients in route to the hospital, Washington Hospital Center hopes that, in the future, the device will become widely utilized and can then be used to start evaluating trauma cases. Although CodeHeart is not yet a viable option for many rural areas, the promise of such a device offers hope at improving the current standards of rural medicine, particularly response time.

Breast Cancer in Rural America

   This month, thousands of Americans have joined together in the annual fight against breast cancer, one of the most common cancers among women in the United States. National Breast Cancer Awareness Month (NBCAM) has been widely supported by family and friends of both the survivors and those newly diagnosed. When October began, the color pink became a staple of our consumer culture. People across the country have donned pink t-shirts, wristbands, and ribbons. The National Football League has incorporated the color pink into all aspects of media including their website graphics as well as other advertisements. Professional sports players have added pink accents to their uniforms. As the days have passed, people have joined in walks while others are encouraged to donate toward breast cancer research. October has become a time when people are made aware or reminded of this disease; they are encouraged to be proactive and to take every possible step toward disease prevention.

"MU Research Shows Breast Cancer Patients Still Need Post-Treatment Support"

   Last October, journalist Daniel Longar interviewed a woman from rural Missouri who was battling breast cancer at the time. For her, it was important to find the necessary support that she needed to make it through the treatments. While interviewing an assistant professor of health psychology at Missouri University, Longar found that cancer patients and survivors in rural areas are at a disadvantage to those living in a more urban setting. According to Stephanie Reid-Arndt,

“Rural areas have a lot of social interaction and community support, but they have less access to services, such as a mental health facilities [sic].”

   In addition to not having a variety of specialist options, those with cancer in rural America do not have access to other professional help. Although having support from family and friends is necessary, it is also important to have access to therapists who can help you make sense of what is happening and come to terms with your situation. Furthermore, as Reid-Arndt mentioned, support from family and friends typically diminishes once a patient has entered remission or has completed treatment. This is the point where therapy or other support groups can help a patient continue and help others even after the cancer is gone.
   For the past 26 years, Americans have been joining together to raise awareness and research funds for breast cancer. Each October, survivors join together with current patients and share their experiences and stories. One cancer survivor that Longar interviewed commented on the fact that breast cancer never really leaves a person – even if the cancer is gone, the memory and the experiences will never be. Men and women in rural America are already at a disadvantage when it comes to prevention of this cancer. Yearly mammograms as well as self-testing are important but many rural Americans do not have access to such tests and specialists as do those living in an urban area. What is possibly even worse is that many rural cancer patients and survivors do not have access to treatment “after” cancer. So, even though it is very important to work to better the medical care in rural areas, it is equally (if not more) important to better the psychological care one can receive either during or after a particular treatment.

Cultural Barriers in the Rural U.S.

   Health care, as well as the aging process in general, is grossly dependent upon cultural diversity. Various cultures all experience aging in their own way - most of which is dependent upon a particular group’s cumulative advantage or disadvantage. This, in turn, leads to a variety of health disparities between groups. Most of the literature on the subject of aging compares groups of people based on race or on religious affiliation. Even though this is an important point of analysis, it is also important to analyze cultural differences within races. A large majority of the United States, for instance, is Caucasian and, within this single race, there is still a great deal of cultural diversity. Unfortunately, many people, including physicians, do not realize the importance of rural culture. Life is different in rural America and, because of this, people behave and process things differently than other areas of the country would. While this is not unique to rural areas of the United States, it does create a noticeable difference when paired with the severe shortage of physicians who practice rural medicine.

“Learning to Speak Iowan”

   This particular article, which was published in the Wall Street Journal earlier this month, provided an interesting analysis of how understanding Iowan culture is essential to the practice of medicine in the area. The primary focus was on Mercy Medical Center in Mason City, which requires “foreign” medical residents to attend two cultural workshops in order to better learn about Iowan culture as well as dialect. After all, if you are not from the area, it is hard to understand how important football and college rivalries are or even how much rural life revolves around the farm and the harvest cycle. The majority of people in rural areas either farm or have a family member who does. And, as the article explained, many patients will refuse to accept bed rest or to even have surgery until after the harvest season is over. Others will ignore an injury or recuperation time in order to push themselves further in sports.

   Another problem arises from the language barrier. Even though the physician and the patient may both be fluent in English, a different dialect exists in various parts of the country. Not knowing and, even worse, not understanding an area’s particular dialect can lead to confusion and miscommunication. The article noted that 63 percent of the counties in Iowa have a shortage of physicians which, when combined with cultural ignorance, adds to a poor degree of health care in many rural areas. But, most importantly, one cannot make ill-construed presumptions of
a person just based on their culture. As the article stated: 

“An Iowa farmer can be university educated, worth millions of dollars and know all about grain futures. But a rural, small-town feel permeates the culture. It's a place where patients are used to knowing their doctors well, down to the pew their families occupy in church on Sundays…” 

   This is an important note because many people do tend to associate rural, small-towns with under-educated “hicks.” This presumption and potential lack of small-town understanding can lead to a poor doctor-patient relationship. As the above quote explained, this relationship is dependent upon both parties. Not only must the doctor work hard to understand the patient’s culture, but the patient must also be willing to accept “outside” doctors and their respective cultures. Just as in every relationship, it takes both parties to make it work. And, as always, it is important to learn about others’ backgrounds and cultures and to not prejudge those who we do not yet know.