Focus on access, health literacy to improve headache management in rural areas

Key takeaways:

• Rural areas face multiple obstacles to proper headache care and treatment.
• Clinicians can best aid rural patients with clear, simple instructions regarding testing and medications.

ORLANDO, Fla. — To properly address headache care gaps in rural areas, clinicians must focus on boosting access, improving health literacy and formulating simple but informative plans for medication usage, according to a speaker.

“For the rural population, there were about 40 ER visits out of 10,000 people compared to about 22 visits (per 10,000) in the non-rural population,” Kristina Lopez, MD, assistant professor at West Virginia University’s Neurology Clinic, told attendees during her presentation at the American Neurological Association annual meeting. “In the Appalachian rural [area], there were more ER visits: 44.9 compared to 37.9 (per 10,000).”

According to statistics cited by Lopez, roughly 90% of all land area in the United States can be classified as rural, with an estimated 20% of the U.S. population — 60 million individuals — residing in rural regions.

In West Virginia, Lopez said the average one-way distance to the WVU Headache Center is 70.1 miles, with 27% of patients having to travel more than 100 miles in one direction. Coupled with a cited rural poverty rate of 16.4% and heavy reliance on Medicaid and Medicare, headache care-related costs often cause financial strain.

Access to broadband, as a key component to telehealth, also lags in these areas, with an estimated 22.3% of Americans living in rural areas without reliable internet, compared with just 1.5% of residents in urban areas.

Along with a comparative increase in emergency hospital visits due to a paucity of population centers large enough to accommodate headache-specific treatment centers, rural areas contend with substance use disorders, Lopez added. With fewer treatment options and less health care education, rural populations comprise 14.6% of ED visits due to opioid use, compared with 8% of all non-rural encounters.

As a result of the above factors, Lopez continued, rural populations often have significant gaps in knowledge of proper preventive or acute care, testing and proper medication for headache.

These gaps can be eliminated by both the creation of more regional headache-specific centers, as well as by clinicians performing more “house call” like medical consultations where discussions about care options are clear, concise and simplified to a patient’s needs.

To improve communication with patients in underserved areas, one thing clinicians should keep in mind is “trying to have precise conversations” with patients about their situation and treatment options, “and having some clear printed instructions for every visit,” Lopez said. Try “to simplify things as much as possible,” she added.