Emergency physicians in Michigan are advocating in a new study for the addition of a health care model in rural communities that is based on an emergency medicine/primary care partnership.

The proposal, published in Annals of Emergency Medicine, notes that emergency departments (EDs) have become the primary source of hospital visits in rural communities, and constantly experience unplanned cases that require primary care. It proposes a model in which EDs can connect admitted patients with primary care doctors, thereby making rural hospitals sources of emergency, primary and preventive care, as well as social services.

“In some rural communities, emergency departments may be the closest, most convenient and most accessible source of care,” Margaret Greenwood-Ericksen, the lead author of the study told HCB News. “So, by linking patient's portal into the health care system - EDs - to primary care, we have an opportunity to implement a model of care that places coordination of care between emergency medicine and primary care providers at the center.”

The study argues that people in rural areas face different challenges, compared to their city and suburban counterparts, and that the traditional urban model of health care fails to address these issues.

These include a lack of primary and emergency care physicians, increased chronic illness and mortality rates, large distances between them and providers, more uninsured residents, lack of financial investment in health care infrastructure and a higher chance of engaging in high-risk activities.

“Many rural hospitals are struggling to survive financially," Greenwood-Ericksen said. "Over 80 rural hospitals have closed in the last 10 years. This is putting the health of rural communities at risk along with an intractable shortage of primary care and specialist physicians in rural areas.”

The study based its findings on the Carolinas HealthCare System Anson in Wadesboro, North Carolina. The hospital was torn down and rebuilt with an emergency department and a primary care clinic enclosed in the same space. It performs screenings to determine the type of care a patient requires, offers van service rides, features additional spaces to connect patients with specialists, such as cardiologists or obstetricians, and works with schools, churches and the mayor’s office to determine the needs of the community.

To achieve a similar model of health care, the authors of the study assert that rural communities need to assess their needs, determine which ones fall under EDs and which fall under primary care, expand social services, and depending on their finances, bring in surgeons and medical experts.

Such a model could function under a classification system ranging between collocated emergency medicine/primary care in a hospital and closely-monitored emergency medicine and community primary care.

“To address the health care needs of rural communities, we need increased financial investment in rural health care infrastructure,” said Greenwood-Ericksen, “as well as novel approaches to tackle the issues of poor population health, access to primary/preventative care, maintained access to emergency care, and eventually improved rural economies.”

The proposal, though, would not a replace the current outpatient rural systems but instead offer additional services alongside these systems.

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