Serious Mental Illness (SMI) is a severe and complex psychiatric condition with significant medical comorbidity. Although many patients with SMI utilize substantial healthcare resources, their healthcare outcomes are far worse than those of persons without SMI, often leading to early death. There are numerous barriers preventing these patients from obtaining optimal healthcare. The current study focused on available research emphasizing appropriate healthcare for persons with SMI who live in rural communities. The goals of the current study were to 1) to establish base rates of SMI presenting in rural primary care practices, 2) to identify and describe interventions to help individuals with SMI seek and adhere to appropriate treatment from their PCPs in rural areas, and 3) to investigate any existing interventions designed to educate or train primary care providers who serve patients with SMI, and to evaluate the effectiveness of such practices. This study involved a systematic review of the literature following the PRISMA guidelines. Results suggest that base rates of SMI in rural primary care settings have not been reported, and that there are few interventions available that are effective in increasing access to resources, adherence to treatment, and education for healthcare professionals working with patients with SMI. These findings have crucial implications for preventative healthcare screenings and medical and psychiatric interventions, yet more research is needed to determine whether these interventions could be feasible and successful for patients with SMI in rural community settings.

Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and their primary care providers.Purpose: This analysis describes rural primary care providers' perceptions of the full spectrum of breast cancer screening, treatment, and follow-up care for women patients, and it describes the providers' desired role in the cancer care continuum.Method: Focus group interviews were conducted with primary care providers in 3 federally qualified community health centers serving a lower income, rural population. Focus group participants (N = 26) consisted of 11 physicians, 14 nurse practitioners, and 1 licensed clinical psychologist. Data were generated from audiotaped interviews transcribed verbatim and investigator field notes. Data were analyzed using constant comparison and findings were reviewed with a group of rural health professionals to judge the fit of findings with the emerging coding scheme.Findings: Provider relationships were characterized as being with women with cancer and comprised an active behind-the-scenes role in supporting their patients through treatment decisions and processes. Three themes emerged from the interview data: Knowing the Patient; Walking Through Treatment With the Patient; and Sending Them Off or Losing the Patient to the System.Conclusions: These findings should be a part of professional education for rural practitioners, and mechanisms to support this role should be implemented in practice settings.

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Pulmonary function testing (PFT) is recommended by guidelines for the diagnosis of chronic obstructive pulmonary disease and the diagnosis and monitoring of asthma. Portable in-office tests offer rural patients and providers information previously more difficult to obtain because of hospital closures, transportation barriers, and cost. This article describes the successful implementation and measurement of in-office PFT in 3 rural primary care offices. Providers were more likely to order a PFT for patients with asthma (33%) than a patient with chronic obstructive pulmonary disease (9.7%). Recommendations include increased staff involvement and repeat education midimplementation.

Primary care providers have become the front line of treatment for mental health in the United States. Group interventions have been argued to be an effective way to treat more patients with fewer resources, which could reduce the burden of psychopathology on primary care settings. Group therapy faces many barriers to successful implementation in primary care, including site constraints, provider perceptions, population needs, and recruiting difficulties. A survey was developed to assess primary care providers’ perspectives on these areas and distributed via online survey to practitioners in Appalachia; 28 providers responded. No hypotheses were supported, likely a result of the small sample size. Analysis of quantitative and quantitative data elucidated some potential areas for future exploration. Respondents held generally favorable views of group therapy in primary care, and may be more responsive to the peer support and learning elements of group interventions than time or cost benefits. Respondents reported scheduling and a lack of mental health providers with group expertise to be a significant barrier to group interventions in primary care. Billing may not be a significant concern for primary care providers, as is typically reported. Discrepancies between psychopathology frequently seen in primary care settings and the demand on provider time and attention are also discussed.

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Depression is a serious public health concern and leading cause of global disability; in the U.S., it is estimated that over 35 million individuals suffer from depression. Health-related dysfunction, including impairment and poor quality of life, are often associated with depressive symptoms; however, little research has examined the interrelationships between these factors. Functional impairment, or the experience of difficulty conducting necessary activities of daily living, may contribute to emotional distress directly but may also impact perceived quality of life. Health-related quality of life (HRQL), which is conceptualized as a holistic and subjective perception of one’s physical and mental quality of life, is a wellestablished indicator of overall general health. Given the dearth of research examining the linkages between these variables, we hypothesized that greater levels of functional impairment would be positively related to depressive symptoms and that physical and mental HRQL would mediate this association, such that greater functional impairment would be associated with poorer mental and physical HRQL and, in turn, to greater depressive symptoms. Our sample (N=100; 70.3% female (N=71); 93% Caucasian (N=94); Mean Age = 42.18, SD = 12.83) was recruited from a rural, Southern Appalachian primary care clinic serving working and uninsured patients. Participants completed self-report measures: Instrumental Activities of Daily Living Scale, World Health Organization Quality of Life Scale - Brief, and the Center for Epidemiological Studies Depression Scale. Simple mediation analyses, consistent with Preacher and Hayes, were conducted covarying age, sex and ethnicity. In support of our hypothesis, the direct effect of functional impairment on depressive symptoms decreased but remained significant (DE=-1.39, SE=.66, p=.03) when mental HRQL was included as a mediator (IE lower 95% CI=-3.27, upper 95% CI=-.877), indicating partial mediation. In addition, the direct effect of functional impairment on depressive symptoms fell out of significance (DE=-1.18, SE=.33, p=.15) when physical HRQL was included as a mediator (IE lower 95% CI=-3.79, upper 95% CI=-.83), indicating full mediation. Our findings suggest that individuals experiencing functional limitations are less likely to report good mental and physical HRQL and, in turn, endorse higher levels of depressive symptoms. Our findings may have clinical implications; therapeutic enhancement of coping skills and problem-solving strategies may reduce psychological distress, whereas engagement with social and instrumental support networks may provide assistance with physical limits, thereby reducing risk for depressive symptoms in individuals experiencing functional impairment.