TEXAS JOURNAL OF RURAL HEALTH

PREVIOUS

ISSUE 18(4), 2000

TABLE OF CONTENTS
 
Editor’s Comments
James E. Rohrer, Ph.D.
FULL TEXT
 
Letter From the Managing Editor
Lee Ann Paradise
FULL TEXT

Interview

Interview with Gail Bellamy
Lee Ann Paradise
Texas Journal of Rural Health 2000; 18(4): 5-9
ABSTRACT

Notes From the Field

Small and Rural Hospitals Will Be Impacted Hardest by APCs
Lance S. Loria, CPA, CHE
Texas Journal of Rural Health 2000; 18(4): 10-15
ABSTRACT
Cultural Sensitivity: BaFa BaFa Cross-Cultural Simulation Exercise and its Implications for Rural Health Professionals
Jeffrey Joseph Guidry, Ph.D.
Texas Journal of Rural Health 2000; 18(4): 16-21
ABSTRACT
The National Rural Health Association's Migrant Health Care Fellowship Program
Rosemary McKenzie, Candace Kugel, M.S.
Texas Journal of Rural Health 2000; 18(4): 22-28
ABSTRACT

Policy and Law

The Texas Physician Bargaining Rules
Kevin A. Reed, J.D., Jennifer B. Claymon, J.D.
Texas Journal of Rural Health 2000; 18(4): 29-34
ABSTRACT

Research

Rural Residence, Hispanic Ethnicity, and Perceived Accessibility of Medical Care
Tyrone F. Borders, Ph.D., Ronald Warner, D.V.M., Ph.D.
Texas Journal of Rural Health 2000; 18(4): 35-47
ABSTRACT
The Relationship of Physical Activity to Psycological Health, Satisfaction with Life, and Limitation Due to Secondary Conditions in Adults with Physical Disabilities
Ann Szalda-Petree, Ph.D., Glen W. White, Ph.D., Gregory Heath, D.H.Sc., M.P.H.
Texas Journal of Rural Health 2000; 18(4): 48-60
ABSTRACT
Health-Related Quality of Life in the 1990s
Joyce Beaulieu, Ph.D., M.S., Mark Lancaster, M.S., Douglas Scutchfield, M.D., Carol Ireson, Ph.D., R.N., Kjell Johnson, Ph.D.
Texas Journal of Rural Health 2000; 18(4): 61-70
ABSTRACT

Review

On-Line Nursing Education for Rural Nurses: Potholes in the Information Highway
Sue Ellen Thompson, Ph.D., R.N.,Helen E. Miner, Ph.D., R.N.
Texas Journal of Rural Health 2000; 18(4): 71-79
ABSTRACT

ABSTRACTS

Interview with Gail Bellamy
Lee Ann Paradise
Texas Journal of Rural Health 2000; 18(4): 5-9

Gail R. Bellamy, Ph.D. is the President of the National Rural Health Association. She is the Director of Community Research and Program Development for Scott and White Memorial Hospital in Temple, Texas. Dr. Bellamy is the group leader for the Central Texas Partners in Health, an informal coalition of health and human service providers, employers, government officers, and educators.

LP: What are the two most serious problems you think rural communities face today?

GB: That's a hard question to answer due the enormous variability in rural communities across Texas and across the nation. However, in grossly oversimplified terms, I believe that the two most serious problems are the continuing threats to many already exceedingly fragile health delivery systems and redistricting.

Author Affiliations

  • Lee Ann Paradise, Managing Editor, Texas Journal of Rural Health, Texas Tech University Health Sciences Center, Lubbock, Texas

Small and Rural Hospitals Will Be Impacted Hardest by APCs
Lance S. Loria, CPA, CHE
Texas Journal of Rural Health 2000; 18(4): 10-15

Abstract

Rural hospital margins are thin and will be shrinking further from the effects of Ambulatory Payment Classifications (APCs). The impact on small and rural hospitals will be disproportionate to the impact on larger urban facilities. CEOs, COOs, and CFOs need an action plan for assessing readiness and implementing strategies to cope with the new Outpatient Prospective Payment System (OPPS).

While APCs are here to stay, don't overlook the potential benefits from Congressional pressure regarding a request from the burden of implementation costs, ongoing maintenance, and lower payments combined.

Key words: ambulatory payment classification, cost reduction, HCFA, payment systems, rural hospitals. (Texas Journal of Rural Health 2000; 18(4): 10-15)

Author Affiliations

  • Lance S. Loria, CPA, CHE, Partner, PricewaterhouseCoopers, Houston, Texas

Cultural Sensitivity: BaFa BaFa Cross-Cultural Simulation Exercise and its Implications for Rural Health Professionals
Jeffrey Joseph Guidry, Ph.D.
Texas Journal of Rural Health 2000; 18(4): 16-21

Abstract

This article reports the role of culture and its implications for service delivery with a focus on rural communities through the participation in a cross-cultural simulation exercise. The role of culture is defined as it relates to affecting behavior and the overall perception of providers. Key findings from the administration of the BaFa BaFa game and their relevance for rural health providers are addressed.

Key words: culture, simulation, rural communities, service delivery, BaFa BaFa. (Texas Journal of Rural Health 2000; 18(4) 16-21)

Author Affiliations

  • Jeffrey Joseph Guidry, Ph.D., Associate Professor, Department of Health and Kinesiology, School of Rural Public Health, Texas A&M University, College Station, Texas

The National Rural Health Association's Migrant Health Care Fellowship Program
Rosemary McKenzie, Candace Kugel, M.S.
Texas Journal of Rural Health 2000; 18(4): 22-28

Abstract

An estimated three to five million migrant and seasonal farmworkers travel the \'93migrant stream\'94 each year from Florida, Texas, and California. They follow the progression of the growing season, planting, picking, and cultivating America\'92s fruits and vegetables. Migrant farmworkers tend to be either newly arrived immigrants or individuals with limited skills or opportunities. Although American agriculture depends on the labor of these workers, employment is usually of short duration and requires frequent moves.

Migrant farmworkers are predominately Latino, but African-Americans, Caribbeans, Asians, and Caucasians are also represented. Almost half of the farmworkers have less than a ninth grade education and many speak little or no English. Children of migrant farmworkers often change schools several times a year.

Farm work is considered to be second only to mining in the rating of most hazardous occupations. There is a high exposure to pesticides through topical exposure, inhalation, and ingestion, which results in the highest rate of toxic chemical injuries of any group in the United States. Farm injuries, exposure to heat and sun, and poor sanitation in the fields are other factors that contribute to the dangers of this work.

Regulations attempt to provide decent living conditions, but housing often continues to be overcrowded, poorly maintained, and lacking in ventilation, bathing facilities, and safe drinking water.

Providing health care to the migrant farmworkers presents a number of unique challenges. This transient population is not only difficult to serve in the context of the traditional health care system, but the factors of poverty, mobility, and difficult living and working conditions all make farmworkers more at risk for illness and injury. Those who work with migrant farmworkers find that, not only do common conditions occur more frequently, but they are also more severe since they are allowed to progress to more advanced stages before accessing care.

Key words: fellowship program, health center, migrant farmworkers, rural, Texas. (Texas Journal of Rural Health 2000; 18(4): 22-28)

Author Affiliations

  • Rosemary McKenzie, Minority Affairs Director, National Rural Health Association, Kansas City, Missouri
  • Candace Kugel, M.S., C.R.N.P., C.N.M., Migrant Health Clinician, Keystone Health Center, Chambersburg, Pennsylvania

The Texas Physician Bargaining Rules
Kevin A. Reed, J.D., Jennifer B. Claymon, J.D.
Texas Journal of Rural Health 2000; 18(4): 29-34

Abstract

A major obstacle to individual physicians gaining bargaining power in negotiations with health plans has been the antitrust prohibition against competitors jointly setting or negotiating prices, known as "price fixing." However, an exception to antitrust enforcement exists for individuals acting under a clearly articulated state policy. A 1999 Texas statute attempts to use the state action exception to remedy the problem by allowing independent physicians to come together to bargain collectively with health plans. The Texas Office of the Attorney General (OAG) recently adopted regulations regarding the details of physician bargaining. These regulations are intended to give the OAG the authority to supervise and control the joint negotiation process so that participating physicians can receive state action immunity from federal antitrust liability. However, because of the level of supervision required, the process may prove too burdensome for many physicians.

Key words: antitrust, IPG, IPA, physician bargaining, Texas statute, Texas Attorney General, negotiations. (Texas Journal of Rural Health 2000; 18(4): 29-34)

Author Affiliations

  • Kevin A. Reed, J.D., Shareholder, Davis & Wilkerson, P.C., Austin, Texas
  • Jennifer B. Claymon, J.D., Associate, Davis & Wilkerson, P.C., Austin, Texas

Rural Residence, Hispanic Ethnicity, and Perceived Accessibility of Medical Care
Tyrone F. Borders, Ph.D., Ronald Warner, D.V.M., Ph.D.
Texas Journal of Rural Health 2000; 18(4): 35-47

Abstract

One indicator of health system performance is satisfaction with the accessibility of health services. Of particular concern in West Texas is the potential inadequate access among two historically vulnerable groups, rural residents and Hispanic-Americans. This study examined whether differences in satisfaction with several dimensions of accessibility exist between rural and urban residents as well as Hispanic, non-Hispanic white, and other racial/ethnic groups. Data were collected through a telephone survey of a random sample of residents of Odessa and eight surrounding rural communities. The findings suggest that rural residents are less satisfied with the accessibility of medical and hospital care, but no ethnic differences were found. Implications for health management and policy are discussed.

Key words: access, ethnicity, health status, Hispanic, Mexican ethnicity, rural health. (Texas Journal of Rural Health 2000; 18(4): 35-47)

Author Affiliations

  • Tyrone F. Borders, Ph.D., Assistant Professor, Department of Health Services, Research and Management, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
  • Ronald Warner, D.V.M., Ph.D., Associate Professor, Department of Family and Community Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas

The Relationship of Physical Activity to Psycological Health, Satisfaction with Life, and Limitation Due to Secondary Conditions in Adults with Physical Disabilities
Ann Szalda-Petree, Ph.D., Glen W. White, Ph.D., Gregory Heath, D.H.Sc., M.P.H.
Texas Journal of Rural Health 2000; 18(4): 48-60

Abstract

Disabilities are recognized as one of the nation's largest public health issues. According to recent Congressional estimates there are now more than 49 million Americans with disabilities. Many are sedentary and engage in behaviors which place them at risk for further disabling conditions. Path analytic techniques were used to examine the relationships between physical activity, life satisfaction, disability due to secondary conditions, and psychological health among 119 persons with severe physical disabilities primarily from rural areas. An explanatory model is presented testing the hypothesis that life satisfaction may be a linking variable between health (psychological health and disability due to secondary conditions) and physical activity. A recursive path model is also presented illustrating circular relationships leading to the development of potential interventions. Results suggest that future research should include larger numbers of participants and more measures of relevant health and psychosocial measures.

Key words: health promotion, physical disability, secondary conditions, prevention, path analysis. (Texas Journal of Rural Health 2000; 18(4): 48-60)

Author Affiliations

  • Ann Szalda-Petree, Ph.D., Project Director, Developmental Disabilities, Health Promotion Project, Rural Institute on Disabilities, University of Montana, Missoula, MT
  • Glen W. White, Ph.D., Research Director, Research and Training Center on Independent Living, University of Kansas, Lawrence, KS
  • Gregory Heath, D.H.Sc., M.P.H., Epidemiologist/Exercise Physiologist, Cardiovascular Health, Centers for Disease Control and Prevention, Atlanta, GA

Health-Related Quality of Life in the 1990s
Joyce Beaulieu, Ph.D., M.S., Mark Lancaster, M.S., Douglas Scutchfield, M.D., Carol Ireson, Ph.D., R.N., Kjell Johnson, Ph.D.
Texas Journal of Rural Health 2000; 18(4): 61-70

Abstract

The 1990s were a period of health reform in Kentucky. While the legislature attempted to rectify problems of health insurance coverage, providers began to treat more people who were likely to be insured through various forms of managed care, and the state initiated a managed care system for Medicaid-eligible persons.

The Kentucky Health Surveys conducted by the University of Kentucky (UK) Survey Research Center contained a battery of questions on health-related quality of life during the five years from 1993 through 1997. Each year approximately 650 adults were surveyed by telephone. This battery of 20 questions, known as the Medical Outcomes Study Short Form-20, or SF-20, allowed tracking of health-related quality of life (QOL) for different sub-groups of Kentuckians. Nationally-recognized researchers developed these measures for use in large-scale health outcome studies. Their reliability and validity have been well-documented, and the SF-20 has been used extensively for national studies of health outcomes (Ware, Sherburne, & Davies, 1992; Stewart, Hayes, & Ware, 1988; Stewart et al., 1989; Wells et al., 1989).

Using the data from the Kentucky Health Surveys, it was found that while the health-related QOL of Kentuckians did not change from 1993 through 1997, major deficits remained between subgroups of Kentuckians with less access to care.

Key words: Appalachian, Kentucky, quality of life, rural, survey. (Texas Journal of Rural Health 2000; 18(4): 61-70)

Author Affiliations

  • Joyce Beaulieu, Ph.D., M.S., Associate Research Professor, Center for Health Services, Management and Research, University of Kentucky, Lexington, Kentucky
  • Mark Lancaster, M.S., Biostatistician, Center for Health Services, Management and Research, University of Kentucky, Lexington, Kentucky
  • Douglas Scutchfield, M.D., Director, Center for Health Services, Management and Research, University of Kentucky, Lexington, Kentucky
  • Carol Ireson, Ph.D., R.N., Consultant, Center for Health Services, Management and Research, University of Kentucky, Lexington, Kentucky
  • Kjell Johnson, Ph.D., Biostatistician, Parke-Davis, Ann Arbor, Michigan

On-Line Nursing Education for Rural Nurses: Potholes in the Information Highway
Sue Ellen Thompson, Ph.D., R.N.,Helen E. Miner, Ph.D., R.N.
Texas Journal of Rural Health 2000; 18(4): 71-79

Abstract

This article describes the relevance of on-line education for nurses in rural settings. Key points addressed are issues in on-line education, overall on-line course development, faculty and student concerns, and successful implementation of on-line courses. While the challenges are great, requiring change and flexibility of both faculty and students, the rewards are also great. These experiences can be helpful to educators planning credit courses or continuing education for rural nurses.

Key words: access, internet, on-line education, rural nurses, web-based learning, web-course development. (Texas Journal of Rural Health 2000; 18(4): 71-79)

Author Affiliations

  • Sue Ellen Thompson, Ph.D., R.N., Assistant Professor, College of Nursing, University of Texas at Tyler, Tyler, Texas
  • Helen E. Miner, Ph.D., R.N., Center Director, Lake Country Area Health Education Center, Tyler, Texas
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