Interview
Notes From the Field
Research
Review
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ABSTRACTS
Robert J. "Sam" Tessen, M.S., is the Executive Director of the new state agency, the Office of Rural Community Affairs. Previously he served as Executive Director of the state of Texas’ Telecommunications Infrastructure Fund and as the Executive Director of the Center for Rural Health Initiatives (the Texas State Office of Rural Health). His extensive background with rural communities includes work in rural health care frontline arenas such as community mental health, long-term care, and primary health care. Past experience includes service in a faculty associate position with the University of Texas Medical Branch in Galveston, Texas where he founded and developed a unique professional recruitment program called the Texas PRAIRIE DOC Program. He has gained extensive experience in rural telecommunications issues, including telemedicine applications and community networks. His experience also includes development of both federal and state policy and implementation of telemedicine applications. Mr. Tessen has been published in numerous journals, including Texas Medicine, the Archives of Family Medicine, and the Texas Journal of Rural Health. The National Rural Health Association recognized his contributions to rural health by awarding him the President’s Award in 1998 as did the Texas Academy of Family Physicians with their Patient Advocacy Award in 2000. Mr. Tessen was named a Fellow of the Texas A&M University’s Center for Distance Learning Research in 2002 and has also been selected as a Fellow of the Council of State Governments Henry Toll Fellowship in 2002. He has made numerous state and national presentations on a wide variety of health care, telecommunication, and policy matters. Mr. Tessen is a licensed professional counselor with a master’s degree in Psychology. LP: What are the two most pressing rural health policy issues in Texas right now? ST: First, access to the entire spectrum of health care for the broad cross-section of citizens in rural areas. Access to care is being affected by the absence of health care providers in rural areas including physicians, nurses, pharmacists, dentists, radiologic technicians, psychiatrists, psychologists, and social workers. Access to care is also being affected by transportation issues, or more accurately, the lack of transportation, particularly for vulnerable populations like the elderly and the poor. Other impacts on health care access include: the aging of many rural providers without reasonable chance of replacement and the aging of many health care facilities in rural areas. In addition, the fact that many rural communities are losing population makes it more difficult to attract health care providers. The maldistribution of existing providers is also a problem. Second, access to the financial resources necessary to sustain health care services in rural areas is sometimes limited. Reimbursement rates for health care services are failing to pay for the cost of the delivery of the services. The cost of medical liability coverage is rising dramatically to a point where many physicians can no longer afford to provide higher risk procedures. Other problems include: the lack of capital funds to pay for building improvements, new equipment, and the expansion of facilities; the lack of financial resources to educate and train new providers, such as nurses, to meet the needs of rural areas; the lack of funds to allow providers to keep up with the technological improvements and developments in the field of health care. Author Affiliations
Abstract Developing an educationally sound clinical experience in a rural setting can be a challenging undertaking for both instructors and students. Course objectives that allow for the development and application of the art and science of nursing requires creative thinking on the part of rural nurse educators. Transformation of experience is mandatory as the face of the Tarleton nursing student changes from non-traditional to traditional and he or she strives for a BSN in a rural setting. Learning about and caring for specific targeted rural groups demand dedication and ingenuity on the part of nursing students and their instructors. Key words: educators, nursing, rural Texas. (Texas Journal of Rural Health 2002; 20(2): 9-12) Author Affiliations
Abstract The intent of this study was to explore nursing home access in all Texas counties for people over the age of 65. Using the United States Census Bureau and Health Care Financing Administration data, it sought to identify areas with low and high nursing home availability in order to determine adequate access to long-term health care. Recommendations for access improvement in rural areas center on small facility growth and long-term health care service integration. Key words: census, elderly, nursing homes, rural health, Texas. (Texas Journal of Rural Health 2002; 20(2): 13-19) Author Affiliations
Abstract Australian rural and remote area nurses will have an opportunity to explore solutions to some of the current challenges facing the nursing workforce in rural and remote areas at the Rural and Remote Area Nursing Summit in July 2002. Delegates at the 6th National Rural Health Conference held in Canberra in March 2001 gave strong support for a national nursing summit. Its main aim will be to identify rural and remote nursing workforce issues and develop a national framework for action. For information about the National Rural Health Alliance, readers may wish to explore their website at http://www.ruralhealth.org.au/. Key words: AARN, Australia, nursing, rural health. (Texas Journal of Rural Health 2002; 20(2): 20-22) Author Affiliations
Abstract Rural counties in Texas were studied to investigate the relationship between the supply of medical resources in rural areas and mortality. None of the medical care resources variables were independently associated with the age-adjusted mortality or years of potential life lost. The limitations of mortality measures as indicators of population health are discussed. Key words: medical resources, mortality, rural health, Texas. (Texas Journal of Rural Health 2002; 20(2): 23-30) Author Affiliations
Abstract This research investigated economic, health, and medical insurance disparities among children in three ethnic groups in the Dallas, Texas metropolitan area (N = 1511). Minority children were significantly less likely to have medical insurance and medical homes than White children. Furthermore, Hispanic children were more economically at risk and more likely to lack medical insurance than either African-American or White children. Policy efforts to maximize children’s access to medical care must focus on income barriers, lack of insurance, and access to medical homes. Key words: children, ethnicity, health care. (Texas Journal of Rural Health 2002; 20(2): 33-41) Author Affiliations
Abstract The epidemiological paradox of poor socioeconomic status and favorable health indicators among United States/Mexico Border and Hispanic populations has been recognized for 30 years. Infant mortality and crude death rates among these populations are more favorable than among the general population. This study of recent census data from border counties in Texas confirms these observations. A review of the literature considers the factors that have been proposed to account for this phenomenon including under-reporting, the healthy migrant effect, favorable diet and lifestyles, genetic factors, acculturation, transitional epidemiology, and the "salmon bias." Not one of these proposed theories individually explains the phenomenon in a satisfactory way. Some factors such as acculturation and the healthy migrant effect appear to be more important. More specific and satisfactory explanations for the phenomenon should be sought through well-designed prospective studies. At the same time, the rates of costly chronic health problems are increasing more rapidly in this population, and living conditions include poor sanitation, inadequate access to health care services, and exposure to infectious diseases. Thus, it is important not to use the paradox as an argument against allocation of resources to improve health care access and disease prevention activities among affected populations. Key words: death rates, epidemiology, Hispanic populations, infant mortality, rural health, Texas-Mexico border, United States census (Texas Journal of Rural Health 2002; 20(2): 42-60) Author Affiliations
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