Current Projects

Changes in Access to Care During the Public Health Emergency: Examining Rural-Urban Disparities by Insurance Type

Using the Behavioral Risk Factor Surveillance System data, this study will compare key access to care indicators among adult beneficiaries residing in rural and urban areas before and after the Public Health Emergency by types of health insurance. We will explore state-level policy variations, such as the Affordable Care Act (ACA) Medicaid expansion and COVID-19-related Medicaid coverage for uninsured adults.

Principal Investigator

Ahmed A. Arif, PhD, CPH, FACE, Associate Professor of Public Health Sciences at UNCC

Evaluating the Impact of Inflation Reduction Act Provisions on Medicare Advantage Prescription Drug Costs

Using Merative MarketScan data, this study will evaluate changes in the affordability of prescription drugs for urban and rural Medicare beneficiaries before and after the recent Inflation Reduction Act (IRA). The primary outcome will be an assessment of whether the IRA succeeded in reducing costs and identifying any remaining health disparities.

Principal Investigator

Jeffery Talbert, PhD, Professor in the Department of Pharmacy Practice and Science, and Director of the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy

Rural Access to Opioid Treatment Program (OTP) Clinics and Certified Community Behavioral Health Clinics (CCBHC)

This project will identify all Certified Community Behavioral Health Clinics and Opioid Treatment Program Clinics in the U.S. and then present the number of rural and urban clinics in each state as frequency tables and map visualizations.

Principal Investigator

Jeffery Talbert, PhD, Professor in the Department of Pharmacy Practice and Science, and Director of the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy

Impact of High Deductible Health Plans on Rural Populations

Using data from Merative MarketScan insurance claims, this study will investigate utilization, spending, and care patterns of rural members enrolled in high deductible health plans (HDHP) compared to traditional plans. Trends in health outcomes before and after HDHP growth will be assessed to inform policy design tailored to rural residents.

Principal Investigator

Jeffery Talbert, PhD, Professor in the Department of Pharmacy Practice and Science, and Director of the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy

Rural/Urban Inequities in Drug and Alcohol Use Treatment

Using the National Survey on Drug Use and Health, this study will investigate rural vs. urban variations in treatment utilization for alcohol use disorder (AUD) and, separately, drug use disorder (DUD). It will yield prevalence estimates of any treatment receipt and sources of treatment among persons with past year AUD and DUD as well as the receipt of medication therapy among those treatable with medications.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Work Settings, Education, and Intent to Leave Practice among Rural vs. Urban Nurses

Using data from the 2022 National Nursing Workforce Survey, this project will describe rural/urban differences in nurses’ work settings, levels of education and licensure, demographic characteristics, income, and intention to retire or leave practice. Study findings could be applied to implement policies aimed at increasing nursing school output and attracting nurses to practice in rural areas.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Risky Substance Use among Rural and Urban Adults: An Update

Very little research has examined rural vs. urban differences in substance misuse and treatment access nationally. Using public and nationally representative data from the NSDUH, this project will 1) Estimate and compare alcohol use and binge drinking and 2) Estimate and compare drug use (marijuana, other illicit drugs, and non-medical use of other drugs) between non-metropolitan and metropolitan adults.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Review of Current Research on Rural/Urban Differences in Social Determinants of Health

• 2023 NRHA Health Equity Conference

Social determinants of health are social, economic, and community variables that influence health outcomes. This project will synthesize the extant literature on rural/urban differences in the social determinants of health, culminating in a comprehensive report that includes a summary of information gaps and further research needs.

Principal Investigator

Katie Youngen, MPH, Research Program Manager

Disparities in Screening, Prevention, and Management of Cardiovascular Disease in Rural and Urban Primary Care

• 2023 NAPCRG Annual Meeting

This study will use a large national primary care registry to compare cardiovascular disease (CVD) screening, prevention, and management quality measures between rural and urban primary care practices. It will also assess for disparities by patient composition (race/ethnicity, insurance) of the practice.

Principal Investigator

Lars E. Peterson, MD, PhD, Vice President at American Board of Family Medicine

Third Party Negotiated Pricing in Rural and Urban Hospitals

• 2022 ATRN Health Summit
• 2023 AcademyHealth Annual Research Meeting
• 2023 NRHA Annual Conference

We will use third party negotiated pricing information to compare prices in urban and rural hospitals, across a variety of common services. Because there has been poor compliance with the Centers for Medicare & Medicaid Services (CMS) requirement to publish third party negotiated pricing, we will also examine if the availability of this information differs for rural and urban hospitals.

Principal Investigator

Lindsey Hammerslag, PhD

Co-Investigator

Jeffery Talbert, PhD, Professor in the Department of Pharmacy Practice and Science, and Director of the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy

Availability and Characteristics of Outpatient and Residential Substance Use Treatment in Rural and Urban Areas

This study will look at: 1) the availability of residential and outpatient treatment centers in rural and urban counties, including identifying counties with no facilities; and 2) characteristics of services offered (e.g., residential, outpatient), demographics of persons treated, and insurance plans accepted by rural vs urban centers.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Co-Investigator

Jeffery Talbert, PhD, Professor in the Department of Pharmacy Practice and Science, and Director of the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy

Project Data Scientist-Statistician

Aaron P. Smith, PhD

Mental Health Treatment among Rural and Urban Adults at Risk for Suicide

This study will look at rural/urban disparities in 1) the receipt and sources of mental health treatment among adults with suicidal thoughts and attempts using data from the National Survey on Drug Use and Health (NSDUH); and 2) mental health follow-up visits among adults with a hospital admission or emergency department visit for self-inflicted harm using data from a national insurance claims dataset.

Principal Investigator

Tyrone F. Borders, PhD, Professor, College of Nursing

Co-Investigator

Jeffery Talbert, PhD, Professor in the Department of Pharmacy Practice and Science, and Director of the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy

Project Data Scientist-Statistician

Aaron P. Smith, PhD