Getting Health Care In Rural Areas
Most people can access the health care we need within a short drive, train or bus ride. However, many Americans (about 1 in 5) live in rural areas of the country where access to a doctor, pharmacy or even an emergency department in a hospital could take hours—even a full day’s drive.
Regular check-ins with a physician are crucial for proper management. Emergency medical help may be life or death in the case of diabetic ketoacidosis (DKA) or a diabetic coma from a high or low blood sugar level.
Of course, medications also need to be regularly filled, so when a pharmacy is extremely far away, it can be inconvenient and unaccessible.
Rural health care is becoming more difficult to access
Over the past decade more than 100 rural hospitals have closed, and more than 600 (nearly 30% of all rural hospitals in the entire country) are at risk of closing in the near future.
Rural hospitals are at risk of closing because they receive inadequate reimbursement for the services that they provide (mostly due to low Medicaid reimbursement rates and provider fees). Many cannot continue to cover the rising costs of healthcare, expensive medications and labor.
Staffing shortages have also hit rural hospitals extremely hard, and low patient volume makes keeping doors open harder to achieve. The closure of rural hospitals is a dire threat to healthcare access for millions of Americans, some of whom receive all of their routine care from hospitals when local health clinics are sparse in some parts of the country.
Sadly, many pharmacies affiliated with these smaller, rural hospitals will also close when the hospitals shut their doors, cutting off prescription medication access too.
This leaves an important question for many people living with diabetes. What do you do when your local, rural hospital has closed and you cannot receive the care you need?
How to get healthcare in rural America
It isn’t realistic to expect people living in rural areas to drive hours to receive routine care. There are options available that can make managing your T1D or T2D easier.
If you live in a rural area and are having trouble accessing the diabetes care you deserve, try these strategies:
Non-traditional models of care
Both routine and emergency medical care do not just need to take place in a typical doctor’s office or hospital setting. See if your community has facilities such as freestanding emergency departments (FSEDs), community paramedicine facilities (which are usually staffed by emergency medical technicians EMTs) or patient-centered medical homes (PCMH).
Some smaller clinics may offer team-based care which often utilizes community health workers (CHWs), patient navigators (PNs) and promotoras. These practitioners can often meet the needs of people with diabetes, providing support and navigation through the health care system when a physician is not available or on-site.
Smaller clinics within larger systems or networks
Sometimes smaller clinics will have a physical space in a rural area even if they’re connected to a larger health network. This model makes it more affordable and sustainable to run a clinic in a smaller community without the threat of closure.
Kaiser Permanente, The Hospital Corporation of America (HCA), Ascension Health, SCL (Sisters of Charity of Leavenworth)/Intermountain Healthcare are some examples of large networks of providers that have smaller, rural-based clinic presence.
Telehealth and patient portals
Taking advantage of technology through the use of telehealth and patient portals is a great option if you have access to a telephone or the internet, and are looking to connect with your provider but they’re far away.
Telehealth can be utilized in many cases, including provider check-ins, chronic disease education, health interventions, monitoring of new or existing conditions and even remote referrals to specialists or admissions to a hospital.
Many times a telehealth appointment will have the same copayment as an in-person visit and many health insurance providers cover this type of care, especially since the pandemic.
Patient portals are ideal for quick questions, refill reminders for prescription medications and asking your doctor simple questions that wouldn’t merit an appointment. Many providers have their own patient portal that you can access from either a website or an app on your phone. Ask your doctor if they offer a patient portal.
Many pharmacies and insurances now offer a mail-order option where they will ship your prescription medications right to your front door. This is a great option if you live in a rural area without a nearby pharmacy.
Better yet, mail-order pharmacies will usually charge the copayment for two months’ worth of supplies while sending out three months’ worth.
Self-education and empowerment
Diabetes is largely self-managed outside of the clinic or hospital, whether or not you live in a rural area.
People with T1D and T2D can empower themselves by making smart decisions about their health on a day-to-day basis to decrease the likelihood that they’ll need emergency care, especially when living in rural areas far from their doctors.
In between doctor visits, people can use CGM data to make adjustments to insulin therapy, while utilizing patient portals to crosscheck any major changes with their physician.
Utilizing CGM data to drive insulin and other medication decisions can also help you to make informed choices in your diet and daily physical activity can keep you healthy between doctors’ visits.
If you’re ready to make positive changes, talk with your doctor about setting up or modifying your diabetes self-management plan—they can monitor your progress and recommend changes remotely along the way.
Editor’s Note: Educational content about health equity and access is made possible with support from Abbott, makers of the Freestyle Libre 3 system, an active partner of Beyond Type 1 at the time of publication. Editorial control rests solely with Beyond Type 1.