BACKGROUND
Rural communities face unique challenges including limited healthcare access, financial constraints, and health disparities. These challenges result in shortages of healthcare professionals, insufficient health literacy, socio-cultural dynamics, geographical isolation, transportation difficulties, economic constraints, and inconsistent doctor-patient relationships, collectively contributing to barriers to accessing healthcare in rural areas. However, interventional research focused on overcoming barriers to access healthcare services in rural areas remains limited.
OBJECTIVE
This study assessed the effectiveness of a multicomponent intervention in increasing the hospital arrival and treatment rate of anti-osteoporosis medication (AOM), and the risk factors leading to the refusal of therapy in a rural community.
METHODS
Overall, 567 patients were randomly assigned to three groups: multicomponent integrated care (MIC), osteoporosis care only (OC), and usual care (UC). Five interventions were implemented in the MIC and OC groups: medical professionals and specialists, enhancing disease knowledge, overcoming geographic barriers, peer support, and dedicated case managers. However, only medical professionals and specialists, enhancing disease knowledge and a portion of overcoming geographic barriers were included in the UC group.
RESULTS
In the MIC group, 116 patients were admitted to hospital, with 85 (73.3%) visiting and 68 (58.6%) receiving AOM after interventions. In the OC group, 153 patients were referred to the hospital, of whom 124 (81 %) visited and 106 (69.3%) received AOM after intervention. However, in the UC group, only six (4.1%) visited and received AOM, of the 146 participants recommended for hospital after our screening. Significant differences were found between the MIC and UC groups regarding the proportion of patients who visited the hospital (P<.001) and those who received AOM (P<.001). Significant differences were also observed between the OC and UC groups (P<.001, P<.001, respectively). Multivariable logistic modeling identified risk factors hindering hospital visits, including male sex (odds ratio (OR) 3.54; 95% CI 1.46–8.59; P=.005), low education (OR 2.46; 95% CI 1.14–5.32; P=.02), multiple disabilities (OR 2.18; 95% CI 1.05–4.51; P=.04), and osteopenia diagnosis (OR 2.3; 95% CI 1.15–4.61; P=.02).
CONCLUSIONS
Our findings underscore the importance of supporting patients in accessing rural healthcare services, in addition to integrating professionals and specialists, and improving disease knowledge. We emphasize the need for multiple interventions to enhance osteoporosis treatment rates in rural communities.
CLINICALTRIAL
ClinicalTrials.gov NCT05104034