Tackling Diabetes in Rural America: Health care can be a struggle for many Americans, but it can be even more so in rural locations where care can be more difficult to find. What can be done to provide quality care for diabetic patients in rural locations?
According to a new report from the American Diabetic Association (ADA), “Because of its widespread prevalence and potentially debilitating impact, diabetes has become an international and national priority area of health concern. Although the importance of addressing diabetes is well recognized, translating clinical, evidence-based management interventions for practical implementation has proven difficult, particularly for rural communities. Individuals living in rural communities often encounter difficulties obtaining appropriate health care because of distance from health clinics, financial limitations, cultural barriers, mistrust, communication issues, and high rates of health illiteracy.”
Rates in diabetes cases are 17% higher in rural areas, yet access to health care may be limited by many factors. The ADA report suggests, “Significant challenges such as small sample size, technology and staffing limitations, and data collection issues have made quality of care comparisons between rural and urban centers difficult at best. There is ample evidence, however, that rural communities grapple with system-level barriers such as high rates of poverty; limited access to insurance, specialty medical care, and emergency services; and minimal exposure to diabetes education, all of which exacerbate the associated complications of detecting and managing diabetes. For example, it is not uncommon for rural diabetes patients to have difficulty affording glucose meter strips for routine glucose self-monitoring or to have foregone screenings, such as eye examinations, that are crucial to the detection of diabetes-associated comorbidities. These system-level barriers may exert a more profound effect on rural racial and ethnic minorities, whose household incomes are 40-50% less than that of rural white households and 50-60% less than suburban white households.”
Technology is considered a front-runner in providing the support many rural diabetics may need. This includes online tracking as well as access to live support from qualified medical providers who can answer questions via the Internet or phone. For those who prefer a face-to-face visit with someone the ADA report suggests, “One increasingly popular approach to addressing diabetes care in remote or underserved communities is to involve trained lay individuals who understand their communities and who themselves have diabetes or are intimately familiar with its day-to-day management. Community Health Advisors (CHAs), “natural helpers” from the community who are trained to deliver health information and facilitate health care access, are increasingly involved in health-promotion strategies to reach underserved communities.”
To a greater or lesser degree these strategies are being used in various ways in multiple rural locations. The ADA report concludes, “Significant strides have been made toward addressing the diabetes epidemic in rural areas. However, there remains much work to be done to optimize self-management and improve outcomes for those living with diabetes in rural communities. Several strategies have been identified, including telemedicine, telephone help lines, Web-based interventions, and CHAs, each with its own set of strengths and limitations. Future research is needed to delineate which strategy or combination of strategies will be best suited for broad-based implementation.”
The development of a synergistic approach to health care in rural locations is going to be important as a means of maintaining a lifestyle consistent with rural living within the context of healthy outcomes using multiple resources to alter end results.