The National Nurse-led Care Consortium hosts this webinar highlighting the recently formed medical-legal partnership in East Tennessee. This session will focus on developing a Medical Legal Partnership (MLP) practice in a rural setting, where the distance between legal and health partners is up to five hours, and the availability of services for low-income patients is scarce. Using tele-technology to communicate between partners, and elevating the combined health and legal priority of children’s healthcare insurance access and optimization, the East Tennessee MLP has tackled some of the common challenges of rural MLPs, and brought new solutions to rural MLP practice. This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number and title for grant amount (under grant number U30CS09736, a National Training and Technical Assistance Cooperative Agreement (NCA) for $1,350,000, and is 100% financed by this grant). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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Indiana University-Purdue University Indianapolis (IUPUI)

Indiana University-Purdue University Indianapolis (IUPUI) / According to the US government, nearly 1 in 5 Americans live in rural areas. In general, rural Americans have poor health outcomes, including higher rates of chronic disease, mental illness and certain types of substance use. A variety of different methods are used to assess rurality in health services research, making it challenging to precisely quantify the prevalence of mental illness and substance use in this population, as well as compare study conclusions. As policymakers become increasingly interested in addressing health disparities between urban and rural populations, it is important to assess and evaluate the different methods used to define rurality itself and determine how those methods affect estimates of depression and substance use, so that true disparities can be accurately captured and addressed. This dissertation will identify current definitions and methods used to measure rurality among published studies and then employ various identified methods to quantify the effect of measurement choice on prevalence of mental illness and substance use in rural populations. The dissertation will follow a three publishable paper model that will include a literature review and two empirical studies using secondary data as described below. For Paper 1, I identify peer-reviewed studies from HSR journals that use any method to measure rurality in their analysis. I analyze whether geographic units and methods used to classify rurality differ by focus area including costs, quality, and access to care. For paper 2, I quantify the impact of different measurements of rurality have on estimates for hospitalizations for depression and substance use. Using 5 different measurements of rurality, I calculate the levels of agreement as well as examine how characteristics of patients with depression or substance use disorder differ based on the definition of rurality used. In paper 3, I examine differences in the relationship between unmet mental health need and subsequent drug use in individuals with a history of depression. Using the National Survey on Drug Use and Health and a pooled crosssectional study design, I examine drug use by alcohol, marijuana, and prescription opioid use. Additionally, I compare self-medication and substance use in individuals by geographic location.

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Whereas disability is a significant risk factor and contributor to various chronic conditions that lead to decline in the quality of life and to early death among older US Armed Forces veterans (> 64 years), little research exists focused on more granular levels of analysis to determine community level risk factors (such as rurality) associated with disability prevalence. A quantitative and cross-sectional design used 2010 – 2014 and 2015 – 2019 data sets from the United States Census Bureau American Community Survey. Results obtained have shown that disability is most prevalent among the older (>64) veteran population, overtime, rates are getting worse, rural areas are most affected, and primary care physicians are needed in areas where rates of disability is high. The findings help to improve our understanding of disability prevalence among older veterans and non-veterans and provide a foundation for the development and implementation of appropriate geographically targeted policy and program interventions to support the development and enhancement of services made at the federal, state, and local/community levels. Through effective interventions, the risk of having increased rates of poor health status, poor quality of life, and risk of death can be reduced substantially, particularly among older veterans in rural areas of the United States.

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