Going the Distance: Understanding Barriers to Primary Care Access in Rural Communities

Academic Blog by: Cynthia O'Connor

Cynthia OconnorCynthia O'Connor is a junior from Minden City, Michigan earning her B.A. in Community and Global Public Health in the University of Michigan School of Public Health. Her research interests include access to healthcare, healthcare systems, and educational disparities both nationally and internationally. Ms. O'Connor is also passionate about minority health and understanding the history behind present day disparities to marginalized communities.

In comparison to my urban classmates, one characteristic of my life at home that stands out the most is undoubtedly my lack of healthcare. Growing up in rural Michigan, I never had a primary care physician, and neither had my parents. It was something so normal for my area; yearly check-ups were not a part of the communities' regimen, and if they were, it often meant traveling far outside the county to make appointments. For me, it truly felt like an unfixable part of rural living, but does that mean it could not have been addressed?

Urban and rural areas have many differences, but access to healthcare should not be one of them. Access to quality primary preventive care is a key component to preventing disease, and it is also a continuous challenge for rural communities. As analyzed by the CDC, rural Americans have higher mortality rates for five leading causes of death when compared to urban citizens, four of which result from chronic conditions. Many barriers exist in rural communities to access primary care and often encompass more than shear geography. Addressing regionally specific barriers and creating innovative and effective solutions to primary care access in rural areas is needed to close the gap between urban and rural mortality rates.

Because of my personal ties to rural life, I wanted to explore what barriers are present across rural communities, what interventions are taking place, and most importantly, what improvements we can make when it comes to accessing care. This qualitative meta-analysis identifies institutional, cultural, and geographical factors as key barriers limiting rural communities' access to care. Issues like geography affect residents in terms of distance to travel, but they can also be exacerbated by factors like access to transportation and weather conditions. Rural areas additionally suffer from physician and healthcare service shortages. This can not only worsen travel distances to see the few services available, but it also complicates referrals for specialized care and limits educational opportunities for rural communities to better their health.

Addressing these issues of primary care access in rural communities has largely focused on increasing the numbers of physicians in those communities. This has notably been employed through rural-based medical training, and the increasing amount of medical students choosing to practice in rural communities appears promising. However, other culturally specific obstacles, like language barriers, poor physician-patient relationships, and lack of insurance in diverse rural regions, coincide with general geographic and healthcare challenges.

From this research, expanding medical practices through rural-based training is notably needed to bring more healthcare services to rural communities, but addressing other specific barriers is also needed to ensure quality of the care being provided. More physicians can combat shortages and physical distance to receive care, but more research needs to be conducted to understand cultural barriers to healthcare that overlap with the shortage of physicians.

In addition to understanding these barriers, community-based participatory research approaches should be implemented in rural communities. Rural areas can vary by race/ethnicity, region and topography, income, and age, so blanket solutions do not address complex, intertwined barriers affecting multiple rural populations. Going into communities and listening to their concerns will be key to providing them care that fits their specific needs. Interventions need to think beyond geography and numbers and understand the uniqueness of rural communities to effectively help with healthcare access.