Our research team has identified topical areas warranting further investigation to inform federal and state health policy makers, health insurers, health system managers, and providers about how to more effectively organize, finance, and deliver care in highly impoverished/underserved and other rural areas across America.

Current Projects

Substance Use, Depression, and Suicide: What are the Individual and Policy-Modifiable Correlates amongst Metropolitan and Non-Metropolitan Adults?

Project Link: Rural Health Research Gateway

Very little research has investigated the associations between substance use, depression, and suicidal ideation amongst adults residing in rural and urban areas nationally. Using nationally representative data from the National Survey on Drug Use and Health (NSDUH), this study will a) estimate the prevalence of major depression and suicidal ideation and attempts in metropolitan, micropolitan, and other non-metropolitan areas nationally and b) investigate the individual-level (e.g., demographic, socioeconomic, region of residence, and health status) and policy-modifiable health care (e.g., insurance, access to a regular health care provider, and access to mental health and substance use treatment) correlates of depression and suicide indicators among metropolitan, micropolitan, and other non-metropolitan residents.

Principal Investigator

Tyrone F. Borders, PhD, Professor and Endowed Chair in Rural Health Policy, Department of Health Management and Policy in the UK College of Public Health

Mental Health Treatment Access: How do Mental Health Treatment Use and Unmet Treatment Need Vary among Rural and Urban Adults Nationally?

Project Link: Rural Health Research Gateway

Recent research indicates that residents of rural areas have similar rates and residents of semi-rural areas have higher rates of mental health illnesses than residents of large metro areas. Although rural residents on average need mental health services just as much as their urban counterparts, a dearth of research has investigated unmet mental health treatment need and treatment utilization amongst rural and urban residents with mental health problems. Using nationally representative data from the National Survey on Drug Use and Health, this study will a) estimate rates of unmet treatment need and treatment utilization and b) investigate the individual-level (e.g., demographic, socioeconomic, region of residence, and health status) and policy-relevant health care (e.g., insurance and access to a regular health care provider) correlates of unmet need and treatment utilization among metropolitan, micropolitan, and other non-metropolitan residents. In addition, we will repeat our analyses of rates and correlates of unmet need and treatment use amongst Native Americans/American Indians.

Principal Investigator

Tyrone F. Borders, PhD, Professor and Endowed Chair in Rural Health Policy, Department of Health Management and Policy in the UK College of Public Health

Lung Diseases among Coal Miners

Project Link: Rural Health Research Gateway

Coal mining is considered one of the most dangerous and hazardous occupations worldwide. In the U.S., rates of fatal and non-fatal injuries are substantially higher among coal miners as compared to those working in private jobs. Coal miners are at increased risk of both restrictive and obstructive lung diseases such as coal worker’s pneumoconiosis (CWP), progressive massive fibrosis (PMF), rapidly progressive pneumoconiosis (RPP), and COPD. Using the Medicare administrative claims data, Kentucky (KY) Medicaid claims data, and the National Health Interview Survey (NHIS), we propose to determine factors related to respiratory health effects among miners and non-miners, assess and compare health care utilization among patients with and without CWP across regions, and map health care utilization of CWP and other lung diseases relative to HRSA-funded Black Lung Clinics.

Principal Investigator

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

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

Predictors of Buprenorphine Prescribing by Family Physicians in Rural Areas Nationally

Project Link: Rural Health Research Gateway

Family physicians are the most prevalent physician specialty in rural America and can treat opioid use disorder (OUD) with buprenorphine if they complete training to obtain a special Drug Enforcement Agency license. However, the uptake of buprenorphine prescribing by family physicians has been low. This study will examine rural vs. urban and intra-rural variation in family physicians’ prescribing of buprenorphine nationally and will examine how physician and practice-level factors are associated with prescribing buprenorphine. To address these questions, we will conduct a multilevel logistic regression analysis of a nationally representative cohort of family physicians registering for the American Board of Family Medicine (ABFM) recertification examination.

Principal Investigator

Lars E. Peterson, MD, PhD, Research Director of the American Board of Family Medicine and Associate Professor of Family and Community Medicine at UK.


Previous Projects

Barriers and Disparities Associated with Pneumococcal Immunization among Rural Elderly Adults

Project Link: Rural Health Research Gateway
Infographics:
Presentations:

Vaccines offer a cost-effective means of preventing illnesses at the population level. However, very little research has investigated rural/urban variations in vaccine utilization. Our Center will conduct analyses of national survey data and unique insurance claims data sets (UK has a collaborative agreement with Humana) to identify how rurality of residence and key demographic (including race and ethnicity), social, and economic characteristics serve as barriers or facilitators to vaccination against pneumococcal disease, which is relatively common among older Americans.

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

Co-Investigator

Patricia (Trish) Rippetoe Freeman, PhD, Director of the Center for the Advancement of Pharmacy Practice, Clinical Associate Professor in the Pharmacy Practice and Science Department, and Faculty Associate in the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy

Project Data Scientist-Statistician

Aric Schadler, MS, Data Scientist Manager/Statistician in the UK College of Pharmacy.

Variation in Scope of Practice and Medical Services Available at Family Physician Practices within Rural Areas

Project Link: Rural Health Research Gateway

Family physicians are the foundation of medical care in many rural areas and, as such, are frequently required to have a broader scope of practice, defined as the ranges of services they provide, than their urban counterparts. A family physician offering the full scope of practice can provide ambulatory and urgent/emergent care, staff rural hospitals, and deliver all non-surgical care to a rural population. Despite the importance of family physicians to rural health care delivery systems, very little research has investigated their scope of practice in rural areas, particularly in socioeconomically disadvantaged areas. Using data collected during recertification examination registration of family physicians certified by the American Board of Family Medicine (ABFM), this project will examine variation in the scope of practice of family physicians and services available in the primary practice site by degree of rurality and within rural categories by community-level deprivation. Additionally, we will examine variation by Patient-Centered Medical Home (PCMH) status.

Principal Investigator

Lars E. Peterson, MD, PhD, Research Director of the American Board of Family Medicine and Associate Professor of Family and Community Medicine at UK.

The Impact of Medicaid Expansion on Rural/Urban Variations in Access to Substance Use Treatment

Project Link: Rural Health Research Gateway
Presentations:

Abuse of illicit drugs, such as cocaine and methamphetamine, as well as licit drugs, such as prescription opioids, is a substantial public health problem in many rural areas of the U.S. One explanation for these high rates of drug misuse is that some persons residing in impoverished areas use drugs to cope with hopelessness associated with poor prospects of employment and other opportunities. Regardless of the underlying causes of drug use, research indicates that substance use treatment access is insufficient in rural areas. With implementation of the ACA, substance use treatment funding has been expanded, particularly through Medicaid expansion in many states. However, it is not clear if and how Medicaid expansion has impacted substance use treatment in rural localities. We will make use of our rare access to restricted use NSDUH data to offer new insights about the impact of Medicaid expansion on access to substance abuse treatment among individuals with substance abuse disorders. We will conduct analyses of 13 years (2004-2016).

Principal Investigator

Hefei Wen, PhD, Assistant Professor in the Department of Health Management and Policy in the UK College of Public Health

Co-Investigator

Tyrone F. Borders, PhD, Professor and Endowed Chair in Rural Health Policy, Department of Health Management and Policy in the UK College of Public Health

Exploring the Impact of Rural Hospital Closures on Use of Emergency Medical Services

Project Link: Rural Health Research Gateway
Publication:

Since 2010 over 70 hospitals have closed their emergency department doors or the entire hospital. These closures have primarily occurred in the southern United States, but the closures are expected to broaden around the country and more than 250 hospitals are vulnerable to closure. In the wake of such closures, access to a hospital for real emergencies—and the distance and time to the next nearest hospital—could mean the difference between life and death. We expect to see increased reliance on Emergency Medical Services (both air and ambulance) to transport patients further distances at high cost. Rural, lower-income households, and older individuals tend to use the emergency department more than others; thus the impact of rural hospital closures will likely disproportionately affect these same populations. Additional considerations include the non-uniform geographic distribution of rural hospitals and how emergency transportation service resources in a community are affected by a rural hospital closure. Using a unique national database, The Enterprise Data Trust, we will explore pre- and post-closure emergency department use with specific emphasis on those who used public emergency medical transportation, testing for significant changes. This study will be the first to look at the impacts of rural hospital closure at the patient level.

Principal Investigator

Alison F. Davis, PhD, Professor in the UK Department of Agriculture Economics and Executive Director of the Community & Economic Development Initiative of Kentucky.