Improving Access to Urologic Care for Rural Populations Through Outreach Clinics

Published on Dec 1, 2013in Urology1.924
· DOI :10.1016/J.UROLOGY.2013.08.053
Matthew A. Uhlman12
Estimated H-index: 12
(Roy J. and Lucille A. Carver College of Medicine),
Thomas S. Gruca23
Estimated H-index: 23
(UI: University of Iowa)
+ 2 AuthorsBradley A. Erickson27
Estimated H-index: 27
(Roy J. and Lucille A. Carver College of Medicine)
Sources
Abstract
Objective To determine the effect of outreach clinics on access to urologic care in a state with a large rural population. This is especially pertinent given the predicted shortage of urologists over the next decade and the trend toward practice in urban area. Methods We analyzed provider level data from urologic practices within the state of Iowa using information from 2 publicly available sources: (1) the Office of Statewide (Iowa) Clinical Education Programs, which collects detailed information on visiting consultant urologists (VCU), and (2) the Iowa Physician Information System, which tracks demographic and professional data on all active physicians in Iowa. Factors analyzed included percent of counties and Iowans served by urologists and travel distances/times for patients and physicians. Results Currently, 57% of Iowans are within 30 minutes of a urologist's primary office, increasing to 84% with VCU outreach clinics. Fifty-five urologists, including 40 of 69 (58%) of Iowa-based urologists, perform outreach within Iowa, accounting for 198 clinic days and 20,400 miles of travel per month. Conclusion Within Iowa, the lack of rural urologists has been mitigated, in part, by an extensive VCU network. However, improved access has required significant effort from urologists in both time and miles traveled. This study is the first to show how a rural state can effectively use physician outreach clinics to provide specialized urologic care to underserved, rural communities.
📖 Papers frequently viewed together
20131.92Urology
4 Authors (Raj S. Pruthi, ..., Erin P. Fraher)
72 Citations
76 Citations
7 Citations
References19
Newest
#1Roger Tracy (Roy J. and Lucille A. Carver College of Medicine)H-Index: 7
#2Inwoo Nam (CAU: Chung-Ang University)H-Index: 4
Last. Thomas S. Gruca (UI: University of Iowa)H-Index: 23
view all 3 authors...
Cancer is the second leading cause of death in the United States (Xu et al. 2010). The specialized resources for treating cancer are usually located in urban medical centers and a small number of rural areas with sizable populations (Baldwin et al. 2008). This geographical concentration of cancer treatment resources could have important implications for the 62 million Americans living in rural areas (Office of Rural Health Policy 2011) who report higher levels of cancer than their urban counterp...
12 CitationsSource
#1Will KirbyH-Index: 2
#2Jed FergusonH-Index: 2
Last. Erin P. FraherH-Index: 15
view all 11 authors...
5 CitationsSource
#1Christopher Gonzalez (NU: Northwestern University)H-Index: 31
#2Patrick H. McKenna (UW: University of Wisconsin-Madison)H-Index: 6
Objective To determine the most pressing issues facing academic urology training centers. The supply of urologists per capita in the United States continues to decrease. Stricter resident requirements, restriction of resident duty hours, and a Graduate Medical Education (GME) funding cap on resident education has led to significant challenges for academic centers. Methods A 32-question survey was sent to Society of University Urologists members. Respondents defined themselves as academic faculty...
19 CitationsSource
#1Simon Neuwahl (UNC: University of North Carolina at Chapel Hill)H-Index: 5
Last. Thomas C. RickettsH-Index: 33
view all 4 authors...
17 Citations
#1Thomas E. Williams (OSU: Ohio State University)H-Index: 23
#2Bhagwan Satiani (OSU: Ohio State University)H-Index: 23
Last. E. Christopher Ellison (OSU: Ohio State University)H-Index: 43
view all 3 authors...
Background The potential impact of shortages of the surgical workforce on both urban and rural hospitals is undefined. There is a predicted shortage of 30,000 surgeons by 2030 and the need to train and hire more than 100,000 surgeons. The aim of this study is to estimate the average recruitment needs in our nation’s hospitals for 7 surgical specialties to ensure adequate access to surgical care as the U.S. population grows to 364 million by 2030. Methods We used the census figure of 309 million ...
39 CitationsSource
#1Andrew J. Lightfoot (UI: University of Iowa)H-Index: 13
#2Henry M. Rosevear (UI: University of Iowa)H-Index: 16
Last. Chad R. Tracy (UI: University of Iowa)H-Index: 19
view all 4 authors...
Purpose: We assessed the need for academic urologists in 2010 and for the following 5 years.Materials and Methods: An 8-question survey was emailed to the 115 accredited academic urology residency programs recognized by the American Urological Association. Questions were related to the anticipated number of hires during the next 5 years, ideal minimum level of training, areas of expertise needed, current top need and allotted research time.Results: Of 115 chairs or division heads 91 (79%) respon...
15 CitationsSource
#1Anobel Y. Odisho (UCSF: University of California, San Francisco)H-Index: 16
#2Matthew R. Cooperberg (UCSF: University of California, San Francisco)H-Index: 74
Last. Peter R. Carroll (UCSF: University of California, San Francisco)H-Index: 141
view all 5 authors...
Purpose The surgical work force distribution at the county level varies widely across the United States, and the impact of differential access on cancer outcomes is unclear. We used urologists as a test case because they are the first care providers for urologic cancers, can easily be identified from available data sources, and are unevenly distributed throughout the country. The goal of this study was to determine the effect of increasing urologist density on local prostate, bladder, and kidney...
68 CitationsSource
#1Anobel Y. Odisho (UCSF: University of California, San Francisco)H-Index: 16
#2Vincent Fradet (UCSF: University of California, San Francisco)H-Index: 20
Last. Peter R. Carroll (UCSF: University of California, San Francisco)H-Index: 141
view all 5 authors...
Purpose: The adequacy of the urologist work force in absolute numbers and relative distribution is unclear. To develop effective policies addressing the needs of an aging population we must better understand the urologist work force. We assessed the geographic distribution of urologists throughout the United States at the county level and determined the county characteristics associated with increased urologist density.Materials and Methods: County level data from the Department of Health and Hu...
76 CitationsSource
#1Karen Albritton (Harvard University)H-Index: 23
#2Tim Eden (University of Manchester)H-Index: 27
Rapid diagnosis, timely initiation of optimal treatment and good supportive care should be the gold standard for all patients who develop cancer, irrespective of age and where they live. This article reviews the evidence that teenagers/adolescents and young adults may be disadvantaged with regard to access to care. Delays in diagnosis and the reasons for them (patient and professional), low enrolment into clinical trials, suboptimal treatment strategies and place of care are addressed. We must a...
72 CitationsSource
#1J L Colli (UAB: University of Alabama at Birmingham)H-Index: 1
#2Christopher L. Amling (UAB: University of Alabama at Birmingham)H-Index: 32
We hypothesized that prostate cancer screening and availability of urologists among states may be associated with reduced prostate cancer mortality in the United States. To test this hypothesis, state-specific prostate cancer mortality rates for white males were compared to urologist population densities and prostate-specific antigen (PSA) screening rates on a state-by-state basis. The urologist population density was calculated by dividing the number of urologists per state by the population. W...
15 CitationsSource
Cited By24
Newest
#1Wendelyn M. Oslock (UAB: University of Alabama at Birmingham)H-Index: 4
#2Bhagwan Satiani (OSU: Ohio State University)H-Index: 23
Last. E. Christopher Ellison (OSU: Ohio State University)H-Index: 43
view all 11 authors...
Abstract null null Background null We aimed to predict practicing surgeon workforce size across ten specialties to provide an up-to-date, national perspective on future surgical workforce shortages or surpluses. null null null Methods null Twenty-one years of AMA Masterfile data (1997–2017) were used to predict surgeons practicing from 2030 to 2050. Published ratios of surgeons/100,000 population were used to estimate the number of surgeons needed. MGMA median wRVU/surgeon by specialty (2017) wa...
Source
Refugees often face barriers to accessing health services, especially after resettlement. The aim of this study is to identify key elements of effective public health interventions that address barriers to health services for refugees. Key online databases were searched to identify studies published between 2010 and 2019. Six studies met the inclusion criteria: two qualitative, one quantitative and three mixed-methods studies. An adapted narrative synthesis framework was used which included them...
Source
#1Andrew J. Cohen (UCSF: University of California, San Francisco)H-Index: 13
#2Medina Ndoye (UCSF: University of California, San Francisco)H-Index: 5
Last. Benjamin N. Breyer (UCSF: University of California, San Francisco)H-Index: 40
view all 8 authors...
Author(s): Cohen, Andrew J; Ndoye, Medina; Fergus, Kirkpatrick B; Lindsey, John; Butler, Christi; Patino, German; Anger, Jennifer T; Breyer, Benjamin N | Abstract: OBJECTIVE:To assess an aging subspecialty workforce and growing population that portends challenges in meeting patient care needs. We hypothesized that rural physicians are retiring at higher rates than their urban counterparts in the United States and that this represents a bellwether for workforce challenges at large. METHODS:We ana...
7 CitationsSource
#1Charles J. Paul (UIHC: University of Iowa Hospitals and Clinics)
#2Thomas S. Gruca (UI: University of Iowa)H-Index: 23
Last. Bradley A. Erickson (UIHC: University of Iowa Hospitals and Clinics)H-Index: 27
view all 6 authors...
ABSTRACT Objective To determine whether selection of treatment modality for urinary stone disease differs between primary and outreach healthcare centers, and if patient rurality predicts treatment modality. Methods We retrospectively evaluated ESWL and URS procedural data from the Iowa Office of Statewide Clinical Education Programs (OSCEP) and Iowa Hospital Association (IHA) databases from 2007-2014. Geographical data was used to analyze travel metrics and patient proximity to sites of stone t...
Source
#1Severin Rodler (LMU: Ludwig Maximilian University of Munich)H-Index: 6
Last. Sven JungmannH-Index: 1
view all 7 authors...
INTRODUCTION: Erectile dysfunction (ED) is a highly common sexual dysfunction of men but often undertreated as patients experience high treatment barriers. AIM: The aims of this study were to characterize patients with ED using an online prescription platforms (OPPs) and determine treatment barriers that might prevent patients from seeking care in conventional health care settings. METHODS: Data from a German OPP were retrospectively analyzed with focus on patients suffering from ED with at leas...
4 CitationsSource
#1Patrick Michael (UK: University of Kentucky)H-Index: 1
#2Vi T. Tran (UK: University of Kentucky)H-Index: 2
Last. Andrew M. Harris (UK: University of Kentucky)H-Index: 5
view all 13 authors...
ABSTRACT Objective To examine urological transfers and rate of tertiary center interventions from four geographically distinct academic medical centers. Methods Four academic medical centers were selected for this study including Baylor College of Medicine (BCM), University of Alabama at Birmingham (UAB), University of Kentucky (UK), and University of Pennsylvania Hospital (Penn). BCM and Penn primarily service large metropolitan city centers and UK and UAB primarily service large rural populati...
1 CitationsSource
#1Conrad M. Tobert (UIHC: University of Iowa Hospitals and Clinics)H-Index: 13
#2Kenneth G. Nepple (UI: University of Iowa)H-Index: 22
Last. Bradley A. Erickson (UIHC: University of Iowa Hospitals and Clinics)H-Index: 27
view all 8 authors...
ABSTRACT OBJECTIVE To identify factors associated with nonmuscle invasive bladder cancer (NMIBC) American Urological Association (AUA) guideline compliance in a rural state, to evaluate compliance rates over time, and to assess the impact of patient and provider rurality on delivery of NMIBC care. METHODS We identified 847 Iowans in Surveillance, Epidemiology, and End Results-Medicare from 1992 to 2009 with high-grade NMIBC who survived 2 years and were not treated with cystectomy or radiation d...
5 CitationsSource
#1Ian Berger (UPenn: University of Pennsylvania)H-Index: 6
#2Marilyn Hopkins (UK: University of Kentucky)H-Index: 2
Last. Andrew M. Harris (UK: University of Kentucky)H-Index: 5
view all 7 authors...
AbstractIntroduction:Urological services are not available at all hospitals and the transfer of patients between medical centers provides an avenue to meet medical need. In rural areas patients oft...
1 CitationsSource
#1Jorge A. Whitley (Seattle Children's)H-Index: 1
#2Shruthie Gnaneswaran (UW: University of Washington)H-Index: 1
Last. Kathleen Kieran (UW: University of Washington)H-Index: 2
view all 6 authors...
Abstract Background Many families wish to have radiologic tests performed locally, especially when obtaining these tests in specialized pediatric centers would require long-distance travel with associated costs and inconveniences. The differential availability of specialized and common pediatric uroradiographic tests in rural and urban areas has not been described. We undertook this study to describe the availability of common radiographic tests ordered by pediatric urologists, and to identify d...
2 CitationsSource
#1Dayron Rodriguez (BMC: Boston Medical Center)H-Index: 3
#2Kai Li (Harvard University)H-Index: 1
Last. Ricardo Munarriz (BMC: Boston Medical Center)H-Index: 30
view all 4 authors...
Abstract Introduction The epidemiology of penile fractures in the emergency setting is not well described. Aim Examine the incidence, evaluation, management, risk factors predicting surgical repair or hospital transfer, and use of financial resources in patients presenting with penile fractures to the emergency departments (ED) nationwide in the Unites States. Methods ED visits with a primary diagnosis of penile fractures (International Classification of Diseases, Ninth Edition codes) between 20...
4 CitationsSource