The COVID‐19 pandemic impact on independent and provider‐based rural health clinics’ operations and cancer prevention and screening provision in the United States

The COVID-19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare-certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services ch...

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Published in:	The Journal of Rural Health Vol. 39; no. 4; pp. 765 - 771
Main Authors:	Zahnd, Whitney E., Silverman, Allie F., Self, Stella, Hung, Peiyin, Natafgi, Nabil, Adams, Swann Arp, Merrell, Melinda A., Owens, Otis L., Crouch, Elizabeth L., Eberth, Jan M.
Format:	Journal Article
Language:	English
Published:	England Wiley 01.09.2023 Wiley Subscription Services, Inc
Subjects:	Aged Breast cancer breasts Cancer Cervical cancer Clinics Colorectal cancer Colorectal carcinoma COVID-19 COVID-19 infection Cross-Sectional Studies Disease prevention Early Detection of Cancer Health services Humans Lung cancer lungs Medical screening Medicare Neoplasms pandemic Pandemics Patients Personal finance Prevention Prevention programs Protective equipment Rank tests Rural Health Safety equipment Services Stress Tests United States cancer prevention COVID-19 pandemic rural health clinics
ISSN:	0890-765X, 1748-0361, 1748-0361
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Abstract	The COVID-19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare-certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services changed pre- and peri-pandemic overall and by RHC type (independent and provider-based). We administered a cross-sectional survey to a stratified random sample of RHCs to assess clinic characteristics, pandemic stressors, and the provision of cancer prevention and control services among RHCs pre- and peri-pandemic. We used McNemar's test and Wilcoxon signed rank tests to assess differences in the provision of cancer prevention and screening services pre- and peri-pandemic by RHC type. Of the 153 responding RHCs (response rate of 8%), 93 (60.8%) were provider-based and 60 (39.2%) were independent. Both RHC types were similar in their experience of pandemic stressors, though a higher proportion of independent RHCs reported financial concerns and challenges obtaining personal protective equipment. Both types of RHCs provided fewer cancer prevention and screening services peri-pandemic-5.8 to 4.2 for provider-based and 5.3 to 3.5 for independent (P<.05 for both). Across lung, cervical, breast, and colorectal cancer-related services, the proportion of both RHC groups providing services dropped peri-pandemic. The pandemic's impact on independent and provider-based RHCs and their patients was considerable. Going forward, greater resources should be targeted to RHCs-particularly independent RHCs-to ensure their ability to initiate and sustain evidence-based prevention and screening services.
AbstractList	The COVID-19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare-certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services changed pre- and peri-pandemic overall and by RHC type (independent and provider-based). We administered a cross-sectional survey to a stratified random sample of RHCs to assess clinic characteristics, pandemic stressors, and the provision of cancer prevention and control services among RHCs pre- and peri-pandemic. We used McNemar's test and Wilcoxon signed rank tests to assess differences in the provision of cancer prevention and screening services pre- and peri-pandemic by RHC type. Of the 153 responding RHCs (response rate of 8%), 93 (60.8%) were provider-based and 60 (39.2%) were independent. Both RHC types were similar in their experience of pandemic stressors, though a higher proportion of independent RHCs reported financial concerns and challenges obtaining personal protective equipment. Both types of RHCs provided fewer cancer prevention and screening services peri-pandemic-5.8 to 4.2 for provider-based and 5.3 to 3.5 for independent (P<.05 for both). Across lung, cervical, breast, and colorectal cancer-related services, the proportion of both RHC groups providing services dropped peri-pandemic. The pandemic's impact on independent and provider-based RHCs and their patients was considerable. Going forward, greater resources should be targeted to RHCs-particularly independent RHCs-to ensure their ability to initiate and sustain evidence-based prevention and screening services. IntroductionThe COVID‐19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare‐certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services changed pre‐ and peri‐pandemic overall and by RHC type (independent and provider‐based).MethodsWe administered a cross‐sectional survey to a stratified random sample of RHCs to assess clinic characteristics, pandemic stressors, and the provision of cancer prevention and control services among RHCs pre‐ and peri‐pandemic. We used McNemar's test and Wilcoxon signed rank tests to assess differences in the provision of cancer prevention and screening services pre‐ and peri‐pandemic by RHC type.ResultsOf the 153 responding RHCs (response rate of 8%), 93 (60.8%) were provider‐based and 60 (39.2%) were independent. Both RHC types were similar in their experience of pandemic stressors, though a higher proportion of independent RHCs reported financial concerns and challenges obtaining personal protective equipment. Both types of RHCs provided fewer cancer prevention and screening services peri‐pandemic—5.8 to 4.2 for provider‐based and 5.3 to 3.5 for independent (P<.05 for both). Across lung, cervical, breast, and colorectal cancer‐related services, the proportion of both RHC groups providing services dropped peri‐pandemic.DiscussionThe pandemic's impact on independent and provider‐based RHCs and their patients was considerable. Going forward, greater resources should be targeted to RHCs—particularly independent RHCs—to ensure their ability to initiate and sustain evidence‐based prevention and screening services. INTRODUCTION: The COVID‐19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare‐certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services changed pre‐ and peri‐pandemic overall and by RHC type (independent and provider‐based). METHODS: We administered a cross‐sectional survey to a stratified random sample of RHCs to assess clinic characteristics, pandemic stressors, and the provision of cancer prevention and control services among RHCs pre‐ and peri‐pandemic. We used McNemar's test and Wilcoxon signed rank tests to assess differences in the provision of cancer prevention and screening services pre‐ and peri‐pandemic by RHC type. RESULTS: Of the 153 responding RHCs (response rate of 8%), 93 (60.8%) were provider‐based and 60 (39.2%) were independent. Both RHC types were similar in their experience of pandemic stressors, though a higher proportion of independent RHCs reported financial concerns and challenges obtaining personal protective equipment. Both types of RHCs provided fewer cancer prevention and screening services peri‐pandemic—5.8 to 4.2 for provider‐based and 5.3 to 3.5 for independent (P<.05 for both). Across lung, cervical, breast, and colorectal cancer‐related services, the proportion of both RHC groups providing services dropped peri‐pandemic. DISCUSSION: The pandemic's impact on independent and provider‐based RHCs and their patients was considerable. Going forward, greater resources should be targeted to RHCs—particularly independent RHCs—to ensure their ability to initiate and sustain evidence‐based prevention and screening services. The COVID-19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare-certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services changed pre- and peri-pandemic overall and by RHC type (independent and provider-based).INTRODUCTIONThe COVID-19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare-certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services changed pre- and peri-pandemic overall and by RHC type (independent and provider-based).We administered a cross-sectional survey to a stratified random sample of RHCs to assess clinic characteristics, pandemic stressors, and the provision of cancer prevention and control services among RHCs pre- and peri-pandemic. We used McNemar's test and Wilcoxon signed rank tests to assess differences in the provision of cancer prevention and screening services pre- and peri-pandemic by RHC type.METHODSWe administered a cross-sectional survey to a stratified random sample of RHCs to assess clinic characteristics, pandemic stressors, and the provision of cancer prevention and control services among RHCs pre- and peri-pandemic. We used McNemar's test and Wilcoxon signed rank tests to assess differences in the provision of cancer prevention and screening services pre- and peri-pandemic by RHC type.Of the 153 responding RHCs (response rate of 8%), 93 (60.8%) were provider-based and 60 (39.2%) were independent. Both RHC types were similar in their experience of pandemic stressors, though a higher proportion of independent RHCs reported financial concerns and challenges obtaining personal protective equipment. Both types of RHCs provided fewer cancer prevention and screening services peri-pandemic-5.8 to 4.2 for provider-based and 5.3 to 3.5 for independent (P<.05 for both). Across lung, cervical, breast, and colorectal cancer-related services, the proportion of both RHC groups providing services dropped peri-pandemic.RESULTSOf the 153 responding RHCs (response rate of 8%), 93 (60.8%) were provider-based and 60 (39.2%) were independent. Both RHC types were similar in their experience of pandemic stressors, though a higher proportion of independent RHCs reported financial concerns and challenges obtaining personal protective equipment. Both types of RHCs provided fewer cancer prevention and screening services peri-pandemic-5.8 to 4.2 for provider-based and 5.3 to 3.5 for independent (P<.05 for both). Across lung, cervical, breast, and colorectal cancer-related services, the proportion of both RHC groups providing services dropped peri-pandemic.The pandemic's impact on independent and provider-based RHCs and their patients was considerable. Going forward, greater resources should be targeted to RHCs-particularly independent RHCs-to ensure their ability to initiate and sustain evidence-based prevention and screening services.DISCUSSIONThe pandemic's impact on independent and provider-based RHCs and their patients was considerable. Going forward, greater resources should be targeted to RHCs-particularly independent RHCs-to ensure their ability to initiate and sustain evidence-based prevention and screening services.
Author	Stella Self Nabil Natafgi Whitney E. Zahnd Peiyin Hung Swann Arp Adams Allie F. Silverman Jan M. Eberth Melinda A. Merrell Otis L. Owens Elizabeth L. Crouch
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Snippet	The COVID-19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare-certified rural health clinics (RHCs) where... IntroductionThe COVID‐19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare‐certified rural health clinics... INTRODUCTION: The COVID‐19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare‐certified rural health clinics...
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SubjectTerms	Aged Breast cancer breasts Cancer Cervical cancer Clinics Colorectal cancer Colorectal carcinoma COVID-19 COVID-19 infection Cross-Sectional Studies Disease prevention Early Detection of Cancer Health services Humans Lung cancer lungs Medical screening Medicare Neoplasms pandemic Pandemics Patients Personal finance Prevention Prevention programs Protective equipment Rank tests Rural Health Safety equipment Services Stress Tests United States
Title	The COVID‐19 pandemic impact on independent and provider‐based rural health clinics’ operations and cancer prevention and screening provision in the United States
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