Rural patients with heart disease often have limited access to specialized care because most cardiologists practice in cities, so even routine office visits can be difficult and time consuming.
But a new study from the University of Iowa finds that the use of visiting consultant clinics (VCCs) in rural hospitals staffed by traveling cardiologists greatly increases access to cardiology care.
The study notes that rural cardiology care is especially important because rural populations are generally older and more at risk of developing heart disease. Rural residents also report increased high-risk behaviors, such as smoking, obesity, and inactivity.
Iowa is one example. While accessing cardiology care is difficult for rural residents, the state doesn’t lack for cardiologists. Iowa had 212 practicing cardiologists in 2014, which is near the national norm for a state of its population.
However, those cardiologists are concentrated in cities. Only 18 of Iowa's 99 counties are home to cardiology primary practices, and the average time it takes to drive to one of these clinics from a rural town is 44 minutes. From an isolated rural area, the average drive time is 53 minutes.
Tom Gruca, marketing professor in the Tippie College of Business and study co-author, says traveling such distances often is a significant hardship and may deter those who need care most from seeing a cardiologist.
But the study found that when VCCs are included in the tally, the number of counties with a cardiologist available to see patients at least one day per month jumps to 89, and the average drive time from small towns drops to 10 minutes. From isolated rural areas, the average drive time drops to 20 minutes.
“Due to cardiology VCCs, an additional 33 percent of the population, or about 1 million Iowans, lives within a 30-minute drive of a location where they can meet a cardiologist on at least a monthly basis,” Gruca says.
This access comes at a cost, however. The study estimates that travelling cardiologists spend $2.1 million annually on mileage and driving time alone, an expense that might deter others from considering similar arrangements. Gruca says that because VCCs clearly increase access to cardiology and other specialized care in rural areas, policy makers might want to consider methods that ease the financial burden on physicians to encourage greater participation.
Gruca’s study, “Providing Cardiology Care in Rural Areas Through Visiting Consulting Clinics,” was co-authored by Gregory Nelson of the Office of Statewide Clinical Education Programs in the UI Carver College of Medicine and Tae-Hyung Pyo of the State University of New York at New Paltz. It was published in the current issue of the Journal of the American Heart Association.