Navigating The Rural Healthcare Road During The Pandemic And Into The Future

By Dr. Nancy Dickey

Rural healthcare professionals have risen to the occasion during the COVID-19 pandemic. The challenges they face during this uncertain time coupled with continuing technological advancements in healthcare will undoubtedly change things—most likely for the better.

At the beginning of the COVID-19 pandemic, rural healthcare professionals faced different logistical demands and challenges than their counterparts in suburban and urban areas. Rural institutions, often under-resourced and financially struggling, acutely felt the shortages of personal protective equipment and testing supplies. This exposed shortcomings in rural supply chains and highlighted uneven competition with large hospitals systems for much needed supplies. Now leaders in rural hospital settings must tackle the unequal distribution of vaccines and monoclonal antibodies.

Rural hospital systems have been preparing for this scenario since the spring. Their committed staff members face an uphill battle when it comes to administering the vaccine. But too often, rural hospitals’ interests place second to urban and suburban institutions with greater population centers.

Cold storage needs for the first COVID-19 vaccine made large cities a priority for the first doses because of the false perception that rural areas didn’t have the storage capabilities. And vaccine suppliers packaged the supplies of vaccine in very large numbers more utilizable in a metropolitan area than in a more sparsely populated area. Rural communities were therefore asked to wait for the second vaccine, which was approved more than two weeks later. In the end, the many rural hospitals that could have accommodated the first vaccine were forced to wait unduly, as surge in rural infections and hospitalizations continued to take its toll.

The U.S. Department of Health and Human Services (HHS) has partnered with 19 large chain pharmacies to administer the COVID-19 vaccine, but more than 100 rural counties have no pharmacy and a larger number have no pharmacy affiliated with the HHS network.

Despite these roadblocks, rural hospital professionals have answered the call by taking on an increased number of higher-acuity patients, keeping patients on pre-ventilator care, accepting “step-down” patients who are not ready for discharge but no longer require intensive care level intervention and thereby reducing the load for tertiary hospitals, and engaging retired members of the healthcare workforce to assure adequate staffing for the increased patient load.

With all of this in mind it is easy to forget yet another very important fact of life faced by those who work in rural hospitals that their metropolitan counterparts may not: patients are often friends, neighbors and even family. The emotional toll of caring for this population was exacerbated when rural hospital systems were asked to wait for access to the second vaccine or as they struggled to care for patients whose status was deteriorating but beds in tertiary facilities were difficult or impossible to find. This heightened emotional challenge must be acknowledged in any discussion of rural healthcare.

It is my hope that there are insights and experiences that we can take from this difficult time that will change rural healthcare for the better.

In response to the pandemic, advancements in telehealth and improvements in broadband connectivity have altered the way rural providers deliver care. The relaxation of telehealth regulations has increased and improved access to care in rural areas and encouraged both national and local policymakers to recognize the need for expanding broadband coverage in non-metropolitan communities. Increased broadband access may also alleviate some of the struggle to attract healthcare staff to rural settings by allowing for more alternative work locations for their families. These solutions should outlive the virus and remain in place.

The healthcare professionals in rural areas reached out and developed regular communication with their tertiary referral facilities and through consultative discussions with colleagues, rural facilities increased their competence and comfort in caring for more challenging patients, tertiary facilities were able to reduce volume opening beds for patients in need, and patients were often able to continue their recuperation near home and family. This interchange and selection of the best possible place for patients at any given time in their illness is a cooperation that should continue long after this pandemic has gone away.

The road rural healthcare workers were on in 2020 was winding, bumpy, long and complicated, but these dedicated professionals found their way. What they learned will help pave the way for the future, and, I believe, a more sustainable one.

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