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Background Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. Methods A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. Results Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation , appropriateness , and ability to perceive. Four new identified dimensions were: government and insurance policy , health organization and operations influence , stigma , and primary care and specialist influence . Conclusions While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.

Purpose While it is established that rural cancer patients face multi-level barriers to high-quality treatment, the interconnections between these barriers and how they drive rural cancer disparities is not well-understood. Therefore, our objective was to better understand the interconnections between barriers to high-quality treatment faced by rural endometrial cancer (EC) patients. Methods We conducted semi-structured interviews with 32 clinicians and healthcare personnel from three large, geographically diverse, rural-serving, integrated healthcare systems in North Carolina. A semi-structured interview guide was developed to examine barriers to high-quality treatment for rural EC patients. Initial codes were derived from a multi-level conceptual framework of rural cancer control, and transcribed interviews were analyzed using thematic analysis. Results We identified three domains of interconnected barriers. First, travel distance, the most frequently noted barrier, amplified financial barriers and caregiver burden. While gynecologic oncologists could reduce travel burden by referring patients to nearby treatment facilities, provider participants expressed mixed opinions regarding the quality of care received at local facilities. Second, limited health literacy among rural patients often led to challenges in patient-provider communication, including challenges with care-related decision making and comprehension of diagnosis and treatment goals. Finally, supportive care and financial resources were often concentrated at large, urban facilities and not accessible to rural patients. However, even these large facilities lack established systems or standardized processes for supporting the most vulnerable patients. Conclusion To achieve equitable access to care and outcomes among EC patients, those living in rural areas may require more targeted, intensive outreach, support, and resources.

Background Rural caregivers experience significant financial stressors while caring for their older family members with chronic illnesses. Limited access to care, support, and resources in rural areas poses significant financial threats and insecurity for some caregivers. As the majority of rural family caregivers are women, these challenges also represent gender disparities, role imbalances, and division of labor in the society that has rarely been explored in the literature from a rural context. To address these gaps, our study aims to explore the lived experiences of financial burdens and struggles of rural female family caregivers of older adults with chronic illness. Method Using a purposive sampling approach, qualitative interviews among N  = 20 rural woman caregivers of older adults with any serious chronic illness was carried out. Interviews were done in-person, telephone or online as preferred by the participants. Each interview was about 45–60 min. All the data were recorded, transcribed, and analyzed using the thematic content analysis approach. Results Our findings showed significant gender role imbalances and financial disparities among the rural women caregivers. Major themes identified were indirect caregiving costs, direct caregiving costs, and barriers in navigating financial support systems. Participants reported losing jobs, experiencing caregiving stress and poor wellbeing, time constraints, financial losses, using pension plan and health coverage benefits to support themselves and their family. Barriers reported include financial decision making and documentation struggles, and difficulties in accessing savings and health coverage benefits and other legal complications. Conclusion Rural female caregivers face significant financial threats and insecurities exacerbated by the interplay of gender roles and rural inequities. These inequities need to be addressed to support better caregiving policies and interventions. Provision of financial services and guidance to support rural and disadvantaged women family caregivers in navigating financial resources, financial health planning and decision-making processes is needed. Future comparative and longitudinal studies are recommended to see the long-term effects of financial burdens and inequities on the wellbeing of female caregivers of older adults in the rural communities.

Background The Health Information Technology for Economic and Clinical Health Act of 2009 introduced the Meaningful Use program to incentivize the adoption of electronic health records (EHRs) in the U.S. This study investigates the disparities in EHR adoption and interoperability between rural and urban physicians in the context of federal programs like the Medicare Access and CHIP Reauthorization Act of 2015 and the 21st Century Cures Act. Methods A cross-sectional analysis was conducted using the 2021 Quality Payment Program Experience Report Public Use File to compare EHR adoption and Promoting Interoperability scores (PISs) between urban and rural physician participants. Data were linked with the Certified Health IT Product List to assess certified EHR adoption and interoperability. Results The study included 209,152 physician participants, 12% of whom practiced in rural communities. EHR adoption was significantly higher in urban (74%) than in rural areas (64%). Epic Systems dominated the market in both settings. Multivariable logistic regression indicated lower odds of EHR adoption among rural physicians (OR: 0.79, CI: 0.76–0.82). Rural physicians also had lower PISs (β: –3.5, CI: –4.1 to –3.0). Factors like extreme hardship, small practitioner status, and location in a health professional shortage area significantly impacted EHR adoption and PISs. Conclusions Significant disparities exist in EHR adoption and interoperability between rural and urban physicians. These disparities highlight the need for targeted interventions to enhance EHR adoption and interoperability in rural settings to ensure equitable access to healthcare technologies and improved patient outcomes across all communities.

Background Hypertension is a leading cause of cardiovascular morbidity and premature mortality worldwide. Limited access to specialist care in rural areas contributes to suboptimal blood pressure control and persistent healthcare disparities. Telemedicine offers a potential solution to bridge this gap. Methods This retrospective observational study assessed the feasibility of WhatsApp-based teleconsultations for managing arterial hypertension in rural Kazakhstan. The intervention was conducted in three remote villages served by a district medical center. Patients with uncontrolled hypertension or cardiovascular symptoms were referred for remote cardiology consultations via WhatsApp, integrated with the national electronic health record system. Data on clinical decisions, treatment modifications, and patient self-monitoring behaviors were analyzed. A patient satisfaction survey was conducted between September and December 2024. Results A total of 78 patients with arterial hypertension were included. Most consultations were conducted at patients’ homes using smartphones. Stage 3 hypertension was observed in 63% of participants. Treatment adjustments were made in 73.1% of cases following teleconsultation. Gender differences were identified in self-monitoring practices, with women more likely to perform regular home blood pressure monitoring. Among 54 respondents, 82% reported convenience of teleconsultations, and 63% expressed high satisfaction with the quality of care. Conclusions Mobile-based teleconsultation using widely available messaging platforms is a feasible and acceptable approach that may improve access to specialist care. This model demonstrates potential for integration into primary healthcare systems to support hypertension management in resource-limited environments. Further studies are needed to evaluate clinical outcomes and long-term effectiveness. Trial registration Not applicable.

Abstract This systematic review aimed to synthesize evidence on consumer engagement in rural health practice, research, and education. It was conducted using the JBI mixed methods methodology, specifically the convergent integrated approach. PubMed, PsychINFO, Cochrane Library, SCOPUS, Web of Science, EMBASE, and CINAHL were searched, along with gray literature sources—Google, ProQuest Dissertation, and Theses Global. Primary research studies published globally in English, from 2011 to 2024 were included. Dual reviewer screening occurred in two stages, title and abstract, then followed by full text. Critical appraisals of included studies were undertaken using McMaster Critical Appraisal Tool for quantitative and qualitative studies, respectively, and the Mixed Methods Appraisal Tool. Extracted data was synthesized to develop themes for reporting per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This review identified 25 studies that explored the top three levels of consumer involvement in rural healthcare settings, namely Partnership, Involving, and Consumer-led, adapted from the 2011 National Framework for Consumer Involvement in Cancer Control. Five key themes were developed from the data: positive impacts of co-design, importance of relationship building, sustainability of interventions, power issues in co-design, and the importance of context. Findings showed that interventions utilizing the top three partnership levels (consumer-led, partnership, and involving) consistently lead to positive impacts on health outcomes of rural communities with higher levels of sustained engagement. Enablers and barriers were identified and categorized into a macro, micro, and meso framework for direct comparison between studies. Rural healthcare initiatives involving consumer engagement appear to have several benefits including strengthening community-researcher relationships, enhanced sustainability, and enriching local contexts while addressing power imbalances to enhance healthcare outcomes.

Internet hospital consultations are emerging in China as a new channel for patients to access health care services. Unlike third-party health care platforms such as Haodf, Teladoc Health, and MDLive, internet hospitals seamlessly integrate patients' offline medical records with online consultations, offering a cohesive online and offline health care experience. However, its impact on outpatient visits remains ambiguous. While it may encourage outpatient visits due to better continuity of care, it could also reduce face-to-face visits because of the convenience of online consultations. Given that patients in China have the autonomy to freely choose their health care providers, it is critical for hospitals to understand the effect of this telehealth technology on outpatient visits. This study aimed to analyze the impact of patients' adoption of internet hospital consultations on their outpatient frequency and expenses, and whether these impacts vary between urban and rural patients. The data used in this study were collected from a public tertiary hospital situated in a southeastern county of China, covering internet hospital consultations from January 2021 to October 2022, and offline outpatient records from January 2020 to October 2022. The dataset also includes patient demographic information. To estimate the causal effect, we used a quasi-experimental design, combining the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, 2065 pairs of patients (4130 patients) were obtained for data analysis. Our findings highlight 3 key results. First, patients' adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4% per month (P<.001), and the associated expenses by 15.5% per month (P<.001). Second, such positive effects are more pronounced for patients residing in rural areas. Specifically, for every 1% increase in the distance between patients' residences and the county government (an urban center), the positive effect on monthly outpatient visits increases by 0.3% (P=.06), and the positive effect on monthly outpatient expenses increases by 2.4% (P=.03). Third, our post hoc analysis shows that rural patients living in areas with higher local health care quality experience a mitigated positive effect of internet hospital consultations, compared with those in areas with lower health care quality. This study extends the research scope of telehealth technologies by investigating internet hospitals, which are characterized by the integration of online and offline services. Our findings suggest that patients' adoption of internet hospital consultations is associated with an increase in both the frequency and expenses of outpatient visits. In addition, these effects vary based on patients' urban-rural status and local health care quality. These insights offer valuable guidance for policy makers and health care providers in promoting and optimizing the development and operation of internet hospitals.

Policy Points The White House Blueprint for Addressing the Maternal Health Crisis report released in June 2022 highlighted the need to enhance equitable access to maternity care. Nationwide hospital maternity unit closures have worsened the maternal health crisis in underserved communities, leaving many birthing people with few options and with long travel times to reach essential care. Ensuring equitable access to maternity care requires addressing travel burdens to care and inadequate digital access. Our findings reveal socioeconomically disadvantaged communities in the United States face dual barriers to maternity care access, as communities located farthest away from care facilities had the least digital access. Context With the increases in nationwide hospital maternity unit closures, there is a greater need for telehealth services for the supervision, evaluation, and management of prenatal and postpartum care. However, challenges in digital access persist. We examined associations between driving time to hospital maternity units and digital access to understand whether augmenting digital access and telehealth services might help mitigate travel burdens to maternity care. Methods This cross‐sectional study used 2020 American Hospital Association Annual Survey data for hospital maternity unit locations and 2020 American Community Survey five‐year ZIP Code Tabulation Area (ZCTA)–level estimates of household digital access to telecommunication technology and broadband. We calculated driving times of the fastest route from population‐weighted ZCTA centroids to the nearest hospital maternity unit. Rural‐urban stratified generalized median regression models were conducted to examine differences in ZCTA‐level proportions of household lacking digital access equipment (any digital device, smartphones, tablet), and lacking broadband subscriptions by spatial accessibility to maternity units. Findings In 2020, 2,905 (16.6%) urban and 3,394 (39.5%) rural ZCTAs in the United States were located >30 minutes from the nearest hospital maternity units. Regardless of rurality, these communities farther away from a maternity unit had disproportionally lower broadband and device accessibility. Although urban communities have greater digital access to technology and broadband subscriptions compared to rural communities, disparities in the percentage of households with access to digital devices were more pronounced within urban areas, particularly between those with and without close proximity to a hospital maternity unit. Communities where nearest hospital maternity units were >30 minutes away had higher poverty and uninsurance rates than those with <15‐minute access. Conclusions Socioeconomically disadvantaged communities face significant barriers to maternity care access, both with substantial travel burdens and inadequate digital access. To optimize maternity care access, ongoing efforts (e.g., Affordable Connectivity Program introduced in the 2021 Infrastructure Act), should bridge the gaps in digital access and target communities with substantial travel burdens to care and limited digital access.

Background Medical emergencies are the leading cause of high mortality and morbidity rates in rural areas of higher and lower-income countries than in urban areas. Medical emergency readiness is healthcare providers’ knowledge, skills, and confidence to meet patients’ emergency needs. Rural healthcare professionals’ medical emergency readiness is imperative to prevent or reduce casualties due to medical emergencies. Evidence shows that rural healthcare providers’ emergency readiness needs enhancement. Education and training are the effective ways to improve them. However, there has yet to be a scoping review to understand the efficacy of educational intervention regarding rural healthcare providers’ medical emergency readiness. Objectives This scoping review aimed to identify and understand the effectiveness of educational interventions in improving rural healthcare providers’ medical emergency readiness globally. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews were used to select the papers for this scoping review. This scoping review was conducted using MEDLINE, CINHAL, SCOPUS, PUBMED and OVID databases. The Population, Intervention, Comparison and Outcome [PICO] strategies were used to select the papers from the database. The selected papers were limited to English, peer-reviewed journals and published from 2013 to 2023. A total of 536 studies were retrieved, and ten studies that met the selection criteria were included in the review. Three reviewers appraised the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. A descriptive method was used to analyse the data. Results From the identified 536 papers, the ten papers which met the PICO strategies were selected for the scoping review. Results show that rural healthcare providers’ emergency readiness remains the same globally. All interventions were effective in enhancing rural health care providers’ medical emergency readiness, though the interventions were implemented at various durations of time and in different foci of medical emergencies. Results showed that the low-fidelity simulated manikins were the most cost-effective intervention to train rural healthcare professionals globally. Conclusion The review concluded that rural healthcare providers’ medical emergency readiness improved after the interventions. However, the limitations associated with the studies caution readers to read the results sensibly. Moreover, future research should focus on understanding the interventions’ behavioural outcomes, especially among rural healthcare providers in low to middle-income countries.