Commentary

Partnership integration for rural health resource access

AUTHORS

name here
Teresa Sharp1
PhD, Associate Professor *

name here
Joyce Weil2
PhD, Associate Professor

name here
Audrey Snyder3
PhD, RN, ACNP, Associate Professor

name here
Kathleen Dunemn4
PhD, Professor

name here
Gwyneth Milbrath5
PhD, RN, MPH, Clinical Assistant Professor

Jeanette McNeill6 DrPH, RN, CNE, ANEF, Professor and Assistant Director of Graduate Programs

Elizabeth Gilbert7 EdD, Associate Professor

CORRESPONDENCE

*Dr Teresa Sharp

AFFILIATIONS

1, 7 Department of Community Health Education, Colorado School of Public Health, University of Northern Colorado, Campus Box 89, Greeley, CO 80639, USA

2 Gerontology Program, University of Northern Colorado, Campus Box 132, Greeley, CO 80639, USA

3 School of Nursing, University of North Carolina Greensboro, Greeley, CO 80639, USA

4, 6 School of Nursing, University of Northern Colorado, Greeley, CO 80639, USA

5 Department of Health Systems Sciences, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA

PUBLISHED

15 November 2019 Volume 19 Issue 4

HISTORY

RECEIVED: 14 February 2019

REVISED: 28 August 2019

ACCEPTED: 24 September 2019

CITATION

Sharp T, Weil J, Snyder A, Dunemn K, Milbrath G, McNeill J, Gilbert E.  Partnership integration for rural health resource access. Rural and Remote Health 2019; 19: 5335. https://doi.org/10.22605/RRH5335

AUTHOR CONTRIBUTIONSgo to url

ETHICS APPROVAL

This is a commentary that provides a framework for interdisciplinary care. No data were collected for this project.

This work is licensed under a Creative Commons Attribution 4.0 International Licence


abstract:

Increasing numbers of older adults are residing in rural areas of the USA. Many of these individuals experience greater rates of chronic diseases and lower income levels compared to their urban-residing counterparts. Aging in rural environments creates greater challenges in the provision of funding, staff and resources to meet the needs of these older adults, and contributes to immense health disparities and health inequities. Urban and rural older adult residents alike need healthcare, gerontological and public health resources to promote successful aging in place. Due to the nature of rural environments, many of these resources often exist great distances from these residents, which creates access challenges. There are also limitations in locally available facilities and trained practitioners, resulting in resource shortages for addressing chronic health conditions. The creation and use of interdisciplinary partnerships provides this much-needed support while addressing ever-increasing funding and staffing limitations.
This article provides an innovative conceptual interdisciplinary partnership model that combines nursing, public health and gerontology to address the health and social challenges that rural-residing older adults face.
Although well-trained practitioners who work within their discipline are an important contributor to assist with the needs of rural-residing older adults, this silo approach is expensive, inefficient, and clearly cannot support all of the needs for older adults in this type of environment. There is a need to blend the complementary skills provided by each of the presented disciplines so that the focus of the interdisciplinary partnership is on person-centered care addressing the health disparities and health inequities experienced by these older adults. To illustrate the integration of nursing, public health and gerontology disciplines, these disciplines are initially combined and presented as dyads, and are then incorporated into the full conceptual model. The dyads are public health and gerontology, public health and nursing, and gerontology and nursing. Steps are provided for the development of this (or any) interdisciplinary partnership. An example of the model’s use through clinical and non-clinical disciplines and a community engagement framework is also described.
Interdisciplinary approaches focused on person-centered care provide more well-rounded health and social support for rural older adults than any one discipline in isolation. Allocation of shared resources, roles, responsibilities and expenses allows practitioners engaged in interdisciplinary teams to provide superior economic and capacity efficiency. This efficiency is crucial at a time when many entities experience limitations in sustainable resources. Thus, practitioners and community agencies collaborating through interdisciplinary partnerships are better able to address the complex issues experienced by rural-residing community members.

Keywords:

aging, gerontology, health disparities, interdisciplinary, nursing, public health, USA.

full article:

Background

Rural populations are aging. In rural, non-metropolitan areas of the USA, 19% or more of the population is aged 65 years or more compared to 15% of those of the same age range in non-rural areas1. Rural areas also have a larger percentage of those aged 85 years and older2. Living in rural areas as one ages often means less availability of and access to medical services and a lack of healthcare providers1,3. The implication on rural-residing older adults is significant as they have higher rates of chronic conditions and frailty4. Additionally, these rural older adults have limited access to goods and services and often have lower incomes than urban-dwelling older persons5. This combination of increased numbers of rural-residing older populations1, along with greater chronic health conditions and limited health resource access, creates increased economic and workforce strain on those existing and limited support systems.

The aforementioned health disparities and inequities necessitate providers working together across disciplines. These multidisciplinary efforts are frequently used in practice, but often lack synergy and collaboration. Although ‘multidisciplinary’ and ‘interdisciplinary’ often used interchangeably, there are distinct differences between them6. Multidisciplinary practices focus on the dominance of each individual discipline. Interdisciplinary efforts are better suited to address rural health disparities and inequities due to a primary focus on person-centered care. Rather than being housed in individual disciplines, interdisciplinary partnerships can improve rural health resource access through practitioners working and learning from each other and thus blending the complementary skills of individual disciplines to increase care’s holistic nature7. By removing silos among health professionals, the impact of health resource shortages in rural areas can be reduced.

Purpose

Interdisciplinary teams are a way to address the complex issues of aging, and this approach is particularly critical to aging in rural places8. The goal of this commentary is to present a conceptual partnership model that integrates nursing, gerontology, and public health disciplines for support of rural-residing older adults. The importance of interdisciplinary approaches that ultimately enhance the quality of life of rural-residing older adults is described. Benefits of discipline pairings and total integration of these pairings provide a comprehensive overview of the strength of interdisciplinary partnership integration for improving rural health resource access.

Partnership integration

Interprofessional collaborations in health are inescapable in today’s increasingly complex healthcare environment. More work is needed to understand how disciplines can work together to address chronic disease, long-term complex health issues9, and transitions of care10. Researchers continue to define interdisciplinary models and analyze the health impact of such models, but this literature is limited to a small pool of interdisciplinary studies11.

In general, the steps toward interdisciplinary efforts begin with identifying the complementary nature of work provided within pairing of specific disciplines. An innovative model that expands and develops collaborative relationships with researchers, rural hospitals, area health education centers, and other public and private agencies outside of and within the aging network improves health resource access for rural-residing older adults. Public health, gerontology, and nursing disciplines presented as pairs/dyads are incorporated as a conceptual interdisciplinary model. This illustrates the integration of these types of disciplines, and their interactions with each other as well as how all three disciplines interact together. These descriptions can help health professionals apply the presented model to their own rural settings through the development of specific goals and objectives that leverage the strength of each discipline and interaction.

Public health and gerontology

This dyad illustrates the importance of prevention and education and an understanding of the aging process to promote health, reduce health disparities, and increase health equity in rural-residing older adults. Recognition of the influence of the environment upon the older individual and population is enhanced by field-based practice. Whereas public health includes a focus on social determinants of health, gerontology recognizes the impact of social support in healthy aging.

Public health and nursing

While the public health and nursing dyad also focuses on health-related prevention and education, this partnership addresses the healthcare needs of disadvantaged and rural populations through the provision of quality care within the complex practice-based environment of an evolving healthcare system. As older adults are often shuffled between their home and healthcare facilities, education, communication, and coordination of care during these transitions are critical to supporting older adults within the community through their interactions with the healthcare system. Public health and nursing partnerships are critical in accessing and coordinating community services for older adults and identifying gaps in services in rural areas.

Gerontology and nursing 

This dyad focuses on assessment, treatment, and rehabilitation for improved functioning and healthcare needs of older adults using a gerontological lens that includes the social, psychological, and environmental factors that influence the health of older people. Also, key focuses of this dyad are needs related to quality of care (ie health care and overall wellbeing) and quality of life in assisted living and skilled nursing facilities. Pairing these disciplines can also address social isolation, lack of public transportation, and even the lack of skilled nursing that may occur in many rural environments.

Interdisciplinary integration

There are clear benefits of using the dyadic approach. For public health and gerontology, community engagement is a crucial component of this dyad’s practice outcomes. Practice outcomes for public health and nursing include improving population health by emphasizing prevention and attending to multiple determinants of health. Gerontology and nursing practice outcomes utilize person-centered and strengths-based approaches for optimum health achievement12. Integrating all three of these disciplines provides rural-residing older adults with the expertise needed for person-centered and community-level health-related resource access, as shown in Figure 1. By integrating three complementary professions with different training and foci, practitioners can compound disciplinary strengths, cover weaknesses in knowledge and expertise, and provide smooth transitions for older adults through the continuum of care. This is especially critical in rural environments because personal, financial, and professional resources can often be scarce.

Interdisciplinary approaches provide more comprehensive health support for rural older adults than any one discipline in isolation. Reducing health disparities and increasing health equity for this population are strengthened through interdisciplinary knowledge and practice. Protecting and enhancing the health of populations through person-centered care are reinforced through knowledge exchange among nursing, gerontological, and public health practitioners.

table image Figure 1:  Partner integration conceptual model.

Steps for developing an interdisciplinary partnership

According to O’Sullivan, the development of interdisciplinary partnerships is a step-by-step process. Initially, community partners should be recruited and a needs assessment conducted. Depending upon the needs of the community, disciplines to be included in the integrated partnership can be determined. Disciplines would then work to move from disciplinary to cross-disciplinary to multidisciplinary to interdisciplinary approaches13.

Example of model use

There is wide recognition that individuals who live in rural environments that lack sufficient health-related resource access can experience significant health inequities14. The following example is of a project using a mixture of clinical and non-clinical disciplines to improve rural health resource access.

A community engagement framework was used to develop and evaluate the needs of rural residing older adults. Partnerships were developed with surrounding healthcare systems, community health centers, rehabilitation, extended care facilities, home health, and tele-health. To address the lack of knowledge or training in creating interdisciplinary teams, providers were educated about the importance and ways of developing interdisciplinary collaborations12. This required an investment in learning about the contribution of roles and skills by partnered disciplines, and teamwork. Education on the blending of disciplines’ philosophies, jargon, and techniques takes time, so advanced planning and full team engagement is essential for long-term success12.

Summary

Allocating shared resources, roles, responsibilities, and expenses provides more economic and capacity efficiency. This process of sharing is more crucial at a time when entities experience limitations in sustainable resources, especially in rural areas. The application of interdisciplinary teams enables practitioners to address the complex issues experienced in rural-residing communities.

references:

1 Cromartie J. Rural America at a glance. No. 265271. Washington, DC: United States Department of Agriculture, Economic Research Service, 2017.
2 Hash KM, Jurkowski ET, Krout JA. Aging in rural places: programs, policies, and professional practice. New York, NY: Springer, 2014.
3 Ponzetti J. Growing old in rural communities: a visual methodology for studying place attachment. Journal of Community Rural Psychology 2003; E6(1): 1-23.
4 Prasad S, Dunn W, Hillier LM, McAiney CA, Warren R, Rutherford P. Rural geriatric glue: a nurse practitioner-led model of care for enhancing primary care for frail older adults within an ecosystem approach. Journal of the American Geriatrics Society 2014; 62(9): 1772-1780. https://doi.org/10.1111/jgs.12982 PMid:25243682
5 Zanjani F, Rowles G. We don’t want to talk about that: overcoming barriers to rural aging research and interventions on sensitive topics. Journal of Rural Studies 2012; 28(4): 398-405. https://doi.org/10.1016/j.jrurstud.2012.03.005
6 Nancarrow SA, Booth A, Ariss S, Smith T, Enderby P, Roots A. Ten principles of good interdisciplinary team work. Human Resources for Health 2013; 11(19): 1-11. https://doi.org/10.1186/1478-4491-11-19 PMid:23663329
7 O’Reilly P, Lee SH, O’Sullivan M, Cullen W, Kennedy C, MacFarlane A. Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: an integrative review. PLoS ONE 2017; 12(5): e0177026. https://doi.org/10.1371/journal.pone.0177026 PMid:28545038
8 Young HM, Siegel EO, McCormick WC, Fulmer T, Harootyan LK, Dorr DA. Interdisciplinary collaboration in geriatrics: advancing health for older adults. Nursing Outlook 2011; 59(4): 243-250. https://doi.org/10.1016/j.outlook.2011.05.006 PMid:21757083
9 Bookey‐Bassett S, Markle‐Reid M, Mckey CA, Akhtar‐Danesh N. Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis. Journal of Advanced Nursing 2017; 73(1): 71-84. https://doi.org/10.1111/jan.13162 PMid:27681818
10 Magilvy JK, Congdon JG. The crisis nature of health care transitions for rural older adults. Public Health Nursing 2000; 17(5): 336-345. https://doi.org/10.1046/j.1525-1446.2000.00336.x PMid:11012996
11 Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. The Cochrane Library 2017; CD000072. https://doi.org/10.1002/14651858.CD000072.pub3 PMid:28639262
12 Weil J, Milbrath G, Sharp T, McNeill J, Dunemn K, Gilbert E, et al. Interdisciplinary partnerships for rural older adults’ transitions of care. Quality in Ageing and Older Adults 2018; 19(4): 232-241. https://doi.org/10.1108/QAOA-12-2017-0050
13 O’Sullivan R. CARDI: a model for working across disciplines, sectors and borders. Quality in Ageing and Older Adults 2012; 13(1): 6-15. https://doi.org/10.1108/14717791211213571
14 Telfair J. Delivering rural health care a persistent public health challenge. The Nation’s Health 2018; 48(8): 3.