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People living in rural areas are often at a disadvantage for receiving mental health services, because of longer distances from clinics, a lack of public transportation, and a scarcity of available services. Given the growing role of telepsychiatry in mental health care, and the barriers to access in rural areas, Health Services PhD alumna (‘08) Dr. M. Courtney Hughes wanted to examine whether hybrid care (offering telepsychiatry plus in-person care) might address the access gap between rural and urban populations. She had the opportunity to explore this question while working on a telepsychiatry and rural health project as a Senior Researcher at Relias Institute. 

Says Courtney, “We were fortunate to have access to medical utilization data from a patient population including members who both did and did not receive telepsychiatry services. Our study examined the effectiveness of delivering telepsychiatry to Medicaid-covered patients in Missouri using data from the largest telepsychiatry company in the U.S., Genoa Healthcare (acquired by UnitedHealth Group in 2018).”

Courtney and her team discovered that in fact, offering telepsychiatry to rural populations, particularly after an emergency department visit or inpatient admission, may indeed help increase mental health care access to this group. The team has published their findings in the January 2019 issue of Journal of Rural Mental Health. 

Courtney’s passion for addressing rural health disparities was sparked during her time in the Health Services PhD program when she worked with Drs. Donald Patrick, Jeff Harris, and Peggy Hannon to study health behavior, as well as disparities in health behaviors based on social factors. Courtney recalls, “Once I began researching health behavior change, it quickly became apparent to me how important it is for research to also address the social determinants of health. For me, this means including environmental factors, such as whether someone lives in an urban versus rural area.”

After graduating from the doctoral program at UW, Courtney has consistently incorporated the study of both health behavior disparities and the social determinants of health into her research. Another recent example is a study she published in the March 2019 issue of Preventive Medicine. Says Courtney, “Rural health disparities emerged as a critical issue in that study, too. My colleagues and I found that living in a rural area (versus a non-rural area) was associated with receiving less of all the clinical preventive services we examined. This effect of rurality was especially striking, given that the population we studied had both insurance and a health care provider, two factors that normally promote usage of health care.”

“Nearly 1 in 5 Americans lives in a rural area,” Courtney adds, “And yet there is so much we still do not know about meeting this population’s health care needs. Our work to date has real potential to help expand mental health care access to rural populations, but future work must help refine the target for interventions.” 

Courtney currently works as an Instructor for the graduate and undergraduate programs in the School of Health Studies at Northern Illinois University. She plans to continue her research on rural health care access disparities, by examining patient-specific characteristics, such as age and diagnosis, to better determine which patients benefit most from telepsychiatry.

To learn more about Courtney’s work, check out the full articles here:

Hughes, M. C., Gorman, J. M., Ren, Y., Khalid, S., & Clayton, C. (2019). Increasing access to rural mental health care using hybrid care that includes telepsychiatry. Journal of Rural Mental Health, 43(1), 30-37. http://dx.doi.org/10.1037/rmh0000110

Hughes, M. C., Baker, T. A., Kim, H., & Valdes, E. G. (2019). Health behaviors and related disparities of insured adults with a health care provider in the United States, 2015–2016. Preventive Medicine, 120, 42-49. http://dx.doi.org/10.1016/j.ypmed.2019.01.004

To learn more about National Public Health Week "Rural Health" Day on April 3, 2019, visit: http://www.nphw.org/nphw-2019/rural-health

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