Rural communities experience entrenched disparities due to social determinants of health, poor access to healthcare, and barriers inherent to remote locations. Although varying across rural populations, urgent issues include:
- Shortages in the primary care workforce and poor retention.
- Lack of resources for population-specific needs.
- Threats to financial sustainability for rural practices.
Those working to strengthen the delivery of rural health services must span diverse geographic regions, administrative systems, and professional backgrounds. However, collaboration between medical education and community health initiatives offers an opportunity to maximize the benefits of scarce rural health resources.
The Texas College of Osteopathic Medicine, (TCOM) Department of Family Medicine began implementing an articulated Rural Family Medicine Track program in 1996 to address shortages of primary medical care services. The community-based curriculum prepares students for life and practice in rural and underserved communities. The program includes real-world experience of living and working in rural Texas with faculty from all specialties and, more recently, the provision of free, mobile clinic services. In addition, SaferCare Texas, a department at the University of North Texas Health Science Center, is currently partnering to develop rural CHW training initiatives. Expanded CHW resources may improve access to preventative care services, better engage citizens in health care decisions, and promote healthy living.
For this mapping project, an interdisciplinary team identified relevant public datasets to promote collaboration between these initiatives. ESRI ArcGIS software was used as a mapping platform to identify gaps in resources and opportunities for collaboration. Initial datasets included 1) Texas county boundaries obtained from the Texas Department of Transportation (TxDOT) with the designation of hospital districts; 2) Texas census tract Social Vulnerability Index (SVI), which is comprised of 15 Social Determinants of Health and developed by the Centers for Disease Control 3) location of Critical Access Hospitals and other clinical services, 4) Rural Family Practice preceptor and mobile, free clinic sites, 5) initial sites for CHW training.
The mapping project revealed that most ROME clinical training sites and identified Community Health Workers (CHW) are in areas with medium to low social vulnerability. Because medical preceptor sites require a board-certified physician, the increasing number of counties without a primary care physician restricts the training of students to meet the needs of highly vulnerable rural communities. Additionally, many areas with high social vulnerability not only lack ROME sites or identified CHW resources but also lack access to Critical Access Hospitals (CAH).
This mapping project has allowed partners to visualize gaps in services and will support collaborative planning as TCOM, SaferCare Texas, and CHWs work to meet the needs of rural Texans. Identifying areas with high social vulnerability and low access to healthcare will allow programs to synergize and maximize the benefit of the services they provide. Further work on this GIS project will add additional risk factors and social determinants of health, such as food deserts, to refine the definition of community needs. GIS is a promising tool to aid program innovation and research to address rural health disparities.
