Updated: Feb 8
Primary care is the most basic and, along with emergency and public health services, the most vital service needed in rural communities. Primary care providers offer a broad range of services and treat a wide spectrum of medical issues.
The American Academy of Family Physicians characterizes primary care as follows:
“A primary care practice serves as the patient's first point of entry into the health care system and as the continuing focal point for all needed health care services…Primary care practices provide health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings.”
A 2005 Milbank Quarterly article, Contribution of Primary Care to Health Systems and Health, identifies the key roles primary care access plays in preventing disease and improving health. Primary care serves as a first entry point into the health system, which can be particularly important for groups, such as rural residents and racial/ethnic minorities, who might otherwise face barriers to accessing healthcare. Some benefits of primary care access are:
Preventive services, including early disease detection
Lower all-cause, cancer, and heart disease mortality rates
Reduction in low birth weight
Improved health behaviors
Access to Quality Health Services in Rural Areas – Primary Care: A Literature Review, a section of the 2015 report Rural Healthy People 2020: A Companion Document to Healthy People 2020, Volume 1, provides an overview of the impact primary care access has on rural health. Rural residents with limited primary care access may not receive preventive screenings that can lead to early detection and treatment of disease. A North Carolina Rural Health Research Program 2018 findings brief, Access to Care: Populations in Counties with No FQHC, RHC, or Acute Care Hospital, describes the scope of limited primary care access in rural areas in the U.S. and covers three facility types that provide primary care services to rural communities, including Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and acute care hospital outpatient departments. The findings brief found that there are 660,893 U.S. residents who live in rural counties without an FQHC, RHC, or acute care hospital
Efforts to Improve the Workforce
An adequate workforce is necessary to maintaining access to healthcare in a community. In order to increase access to healthcare, rural communities should be using their healthcare professionals in the most efficient and strategic ways. This might include allowing each professional to work at the top of their license, using new types of providers, working in interprofessional teams, and creative scheduling to offer clinic time outside of regular work hours.
RHIhub's Rural Healthcare Workforce topic guide discusses how rural areas can address workforce shortages, such as partnering with other healthcare facilities; increasing pay for staff; adding flexibility and incentives to improve recruitment and retention of healthcare providers; and using telehealth services. The guide also discusses state and federal policies and programs to improve the supply of rural health professionals, such as loan repayment programs and visa waivers.
Telehealth continues to be seen as a key tool to help address rural healthcare access issues. Through telehealth, rural patients can see specialists in a timely manner while staying in the comfort of their home or local facility. Local healthcare providers can also benefit from subspecialists' expertise provided via telehealth. However, the temporary changes to telehealth policy in response to the COVID-19 pandemic has made visible potential for unequal access to these services due to a lack of broadband internet access in some rural areas.