The purpose of this project was to identify the current status of education/training of rural health care providers and identify gaps in training/education to better prepare rural providers to care for victims of disasters. A survey was conducted and distributed to 21 physicians, nurse practitioners, and physician assistants employed at rural clinic/critical access hospital. The survey consisted of quantitative and fill in the blank questions. The survey was distributed through the electronic survey engine “Qualtrics.” Participation in the survey was voluntary and responses were anonymous. The survey addressed/identified: basic demographic information, knowledge of disaster/emergency preparedness and care of victims as a first receiver, experience and education related to disasters/emergencies, perceptions of emergencies/disaster types most likely to impact their facility, future education/training preferences, and barriers to participation in disaster/emergency education/training. The survey also assessed the providers’ comfort level with suggested disaster/emergency core competencies put forth from professional emergency/trauma organizations. The response rate to the survey was 57.14%. Of those that responded 41.67% reported experience in caring for victims of disaster. Participation in previous disaster education/training was reported by 83.3% and these same respondents were familiar with their role according to the facility’s Emergency Operations Manual (EOM). The providers perceived that natural disasters were most likely to affect their community (83.33%) in relation to events from the facility’s Hazard Vulnerability Analysis (HVA). Respondents that reported having not participated in disaster education/training indicated a lack of time and new employment as barriers. For future training 66.66% of those that responded would prefer hands on training and were willing to spend one hour per year on disaster training/education. In regard to their ability to care for disaster/emergency victims, participating providers considered themselves novice (25%), advanced beginner (25%), competent (16.67%), proficient (25%) and expert (8.33%). Overall, results indicate that most respondents had experience and are currently participating in education/training. However, the majority still consider themselves novice or advanced beginner in their ability to care for disaster/emergency victims. Most felt that there was little likelihood for most disaster events to occur in their community other than natural disasters.

Interprofessional teamwork is being adopted as the best way to care for patients, but it is also important to determine how future healthcare providers view this model of patient care. What are their attitudes and beliefs after having the opportunity to work in an interprofessional team? The primary objective of this study was to determine changes in health profession students’ attitudes toward interprofessional collaboration through participation in a Remote Area Medical (RAM) event in rural Appalachia. Researchers hypothesized that working in interprofessional teams positively impacts students’ attitudes toward interprofessional practice. To explore these variables, RedCap was utilized to collect demographic information, generate a pre/post survey matching code, and administer previously validated interprofessional education (IPE) questionnaires to RAM clinic student volunteers (representing five ETSU health sciences colleges and various undergraduate programs) before and after the event. Students were allowed to voluntarily complete the pre-survey online prior to participating in the event or at sign-in and the post-survey at sign-out or online after the event. The Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 (SPICE-R2), which is validated for use in pre- and post-surveys, utilized 5-point Likert-type questions (strongly disagree to strongly agree) to evaluate students’ perceptions of their role on the team and the team’s impact on healthcare and patient outcomes. The Interprofessional Collaborative Competency Attainment Scale-Revised (ICCAS-R), which is only validated for use in post-surveys, required students to simultaneously evaluate their ability to perform tangible interprofessional team skills before and after the event using 5-point Likert-type questions (poor to excellent). At the event, students were placed into interprofessional teams to provide care to patients. Faculty members from a variety of professions provided leadership to the teams and guidance as needed. The pre-survey had 107 responses and the post-survey had 108 responses. However, after matching the pre- and post-surveys with student-generated codes, there were 70 valid matched responses. Data analysis was conducted using SPSS version 25. There were no statistically significant changes in SPICE-R2 IPE constructs from the pre-survey to post-survey. However, high pre-survey scores indicated that this student cohort already had a high level of appreciation for interprofessional teams, with mean scores of 4.5 out of 5 for teamwork, 4 out of 5 for roles and responsibilities, and 4.36 out of 5 for healthcare outcomes. The mean overall composite score on the ICCAS-R increased from 3.65 out of 5 on the pre-event portion to 4.03 out of 5 on the post-event portion (p < 0.001) , indicating that students increased their self-evaluated ability to perform tangible skills used in the interprofessional team through participation in the RAM clinic. Findings of this research may allow educators in both classroom and healthcare settings to better understand how hands-on IPE experiences influence students’ interprofessional attitudes and beliefs.

There are a number of factors which contribute to the economic conditions described in the preceding paragraphs. Among these are: much waste land, soil erosion, large numbers of tenant farmers with inadequate diet, lack of scientific method, no modern equipment, low income, lack of pure-bred stock, low purchasing power, uncooperative spirit, fear of venturing out into new areas of activities, unwillingness to give up old ideas and methods. Such a situation as the one described in the preceding pages created a crying need for professional help which has been sought from every available source. A truly effective small school must be standardized around such educational essentials as: (1) a teacher with specialized preparation and willingness to make rural community teaching her permanent occupation, (2) a school plant equipped to provide an education related to rural life and its needs, (3) a course of instruction and methods of teaching in accordance with the needs and nature of agricultural people. / Typescript. / "May, 1949." / "Submitted to the graduate council of Florida State University in partial fulfillment of requirements for the degree Master of Arts plan II." / Advisor: R. L. Eyman, Directing professor. / Includes bibliographical references.

Insulin is a necessary, life-changing medication for patients living with Type 1 or Type 2 Diabetes Mellitus. Yet, a recent study at an endocrinology clinic in New England indicated that one quarter of patients experienced cost-related suboptimal insulin use. A new study based out of a primary care clinic in the Appalachian region looked at the prevalence of cost-related suboptimal insulin use within this region. The hypothesis is cost-related insulin suboptimal use is higher in the Appalachian region than as reported in the New England area. Surveys were administered to patients who were 18 years of age or older, diagnosed with Type 1 or Type 2 Diabetes Mellitus, and who had been prescribed insulin in the last 12 months. The survey instrument used was adopted and modified from the previous New England study. The survey instrument included 28 items and was administered in person prior to the start of the COVID-19 pandemic from July 2019 to April 2020. Following the start of the COVID-19 pandemic, in person recruitment was suspended. Beginning November 2020, a revised telephonic recruitment began and continued through December 2021. Interested participants were mailed the survey and consent form along with a postage paid return envelope. After the COVID-19 outbreak, the original survey instrument was revised to include 12 additional items designed to measure the impact of COVID-19 on the participant’s diabetes management and on insulin utilization. The primary outcome was cost-related underuse of insulin within the past year. This was measured by a positive response in the questionnaire to at least 1 of 6 questions: did you… (1) use less insulin than prescribed, (2) try to stretch out your insulin, (3) take smaller doses of insulin than prescribed, (4) stop using insulin, (5) not fill an insulin prescription, or (6) not start insulin… because of cost? Descriptive analysis was conducted using SPSS software. The East Tennessee State University Institutional Review Board approved the study protocol. Ninety respondents completed the survey. The average age of respondents was 68 years. The majority were diagnosed with type 2 diabetes (83%), Caucasian race (99%), male (59%), retired or disabled (76%), and had Medicare Part D prescription benefits (63%). The average monthly out-of-pocket cost for insulin was $84.10 (range $0-$566). For the primary outcome, results indicate 44.4% of participants in the Appalachian Mountain community experience cost-related suboptimal therapy. Forty participants completed the revised survey measuring the impact of COVID-19 on their diabetes self-management. From this group, 85% of participants reported their income and job did not change during the pandemic. However, increased dosing of insulin (30%) and increased insulin cost (27.5%) was reported. Respondents also reported increased stress (57.5%), worsened diet (25%) and worsened exercise (40%) as a result of the pandemic. Overall, a higher proportion of people with diabetes in the Appalachian region reported cost-related suboptimal insulin use compared to a previous study. The COVID-19 pandemic also has reportedly contributed to increased insulin requirements in one-third of the surveyed participants.

This pilot study sought to describe the patterns of health risk factors and objective physical findings in well rural Appalachian women. A retrospective chart review was conducted of the records of 50 women who received a health history, physical examination, and appropriate laboratory testing as part of a rural community wellness project. The most prevalent risk factors found were past or present smoking, history of lung disease, physical inactivity, obesity, and hypercholesterolemia. Higher numbers of risk factors per person were correlated with lower levels of education. The most prevalent physical findings were systolic blood pressure greater than 140 and diastolic greater than 90, diastolic blood pressure greater than 90 with normal systolic, total cholesterol greater than 240, low-density lipoprotein levels greater than 130, and greater than 20% over ideal weight. This sample reveals a high prevalence of risk factors for the leading causes of mortality in middle-aged women, partially accounted for by low formal education levels, poverty, and limited access to health care.

Federal block grants are intended as non-competitive, formula grants mandated by the U.S. Congress that provide flexibility and increased capacity to state and local governments to provide services based on community need, including on such issues as social services and public health. It is unclear whether those resources are distributed in an equitable manner based on geography and other community characteristics. The population-based formulas that guide block grant distribution may make it difficult for sparsely populated states to distribute sufficient funds to less populated areas. Similarly, funding available through specific block grants may be insufficient to meet all community needs, placing rural communities at a disadvantage in resource prioritization. The purpose of the current study was to characterize distribution of five federal block grants to each of the 50 states based on state-level population and rurality. The study combined publicly available state-year-level data from 2018-2019 for all 50 states. Key data sources included funding amounts allocated to each state for selected block grant programs, American Community Survey data, and measures of rurality from the U.S. Census Bureau and the U.S. Department of Agriculture. Block grants considered included: 1) Preventive Health and Health Services (PHHS) Block Grant; 2) Community Services Block Grant (CSBG); 3) Child Care and Development Block Grant (CCDBG); 4) Substance Abuse Prevention and Treatment Block Grant (SABG); and 5) Community Mental Health Services Block Grant (MHBG). Analyses included descriptive statistics of distribution of block grants per 1,000 population and by three measures of state rurality. Mean funding amounts ranged from $614 per 1,000 to $5,562 per 1,000 people. Associations between measures of rurality and state block grant allocations were mixed in terms of direction and significance. For example, there was a significant positive relationship between percent of the population that lives in nonmetro counties and PHHS block grant allocations while there was a significant negative relationship between this measure of rurality and MHBG allocations. There was no significant relationship with the other three block grants. In contrast, there were significant positive associations between population density and allocation amounts for all block grants considered except for the CCDBG. Overall, our findings suggest that there are differences in how block grants are allocated to states based on their rurality both by the specific block grant and the measure of rurality considered. Importantly, these findings only assess state-level allocations based on state-level characteristics and do not directly measure amounts of funding that make it to rural communities within states. Findings provide insight on the implications of different block grant formulas and structures.

No description available.

No description available.

Typescript, etc. / Digitized by Kansas State University Libraries

Call number: LD2668 .T4 1938 F54