Why Decentralized Clinical Trials Are So Important for Patients in “Healthcare Deserts”

Key Takeaways
  • Millions of Americans live in rural communities (or “healthcare deserts”) where they don't have access to essential healthcare services.

  • The makeup of rural populations across different U.S. regions is very intricate and directly influenced by government laws and policies over several decades.

  • The rural healthcare crisis is growing. As these populations continue to age, the hospitals that serve these communities are facing more challenges that put them at risk of closure.

  • Decentralized Clinical Trials help remove barriers to access and can ultimately provide better health outcomes to rural residents.

Regular and reliable access to healthcare [services] is critical for ensuring the health and wellness of a population, but rural residents often face barriers that limit their ability to obtain the care they need. This is an issue that has long preceded COVID-19, however, the pandemic put a bigger spotlight on the value of virtual, decentralized care for both patients and practitioners. By integrating decentralized methods, clinical trials can more effectively meet people where they are and reduce health disparities across healthcare desert communities.

What is a healthcare desert?

“Healthcare desert” is an umbrella term to describe areas across the U.S. where people lack adequate access to essential healthcare services, such as: primary care providers, hospitals, trauma centers, maternal health, pharmacies, and low-cost health centers. “Medical desert”, “hospital desert”, and “pharmacy desert” are other terms that may be used to describe a specific service that is extremely limited within a geographic radius.

A person’s [in]ability to access these essential health services can have profound effects on his or her:

  • Overall physical, social, and mental health status
  • Disease prevention
  • Detection, diagnosis, and treatment of illness
  • Quality of life
  • Ability to avoid preventable deaths
  • Life expectancy[1]

Though 1 in 5 Americans live in a rural community, fewer than 10 percent of physicians practice in these areas. The federal government has declared that 80 percent of rural America is considered “medically underserved”.[2]

Who is impacted by living in a healthcare desert?

There is a clear correlation between geographic isolation and health disparities.[3] Healthcare desert populations tend to be older, sicker, and uninsured with lower incomes. These communities also face more logistical challenges, such as needing to deliver care over further distances, or having limited access to broadband internet.[4]

Although rural America is proportionately less diverse than the country as a whole, it is not homogenous, and the distribution of people of color in these communities is complex and highly regionalized.[5] In the South, for example, Black Americans are the largest population of color in almost all of the rural lowland South. It’s not uncommon to come across historically black neighborhoods that are also low-access areas. This concentration of people is largely shaped by slavery and Jim Crow laws during the early to mid-20th century, which have had legacy effects on economic mobility and poverty.[6]

In other regions of the country, the makeup of rural populations looks completely different. Latino and Hispanic populations have grown rapidly – not only driving diversity, but also total population gains – along the Pacific Coast and throughout the midwest. Many of these residents immigrated to the United States and have blue collar jobs (e.g, work on farms, in meatpacking plants, or doing construction). Indigenous groups are the largest population of color in Southwestern rural regions and in Alaska. These groups are an important part of this nation’s fabric, and yet historic and systematic government policies have forced these populations to move to remote reservations lacking in natural resources, fertile soil, and economic opportunities.[7] Disparities are compounded by transportation burdens and limited access to quality healthcare.

Why Healthcare Deserts Are Becoming Increasingly Fragile

As America’s rural communities continue to age and become less affluent, the socioeconomic disadvantages and health disparities they face are becoming more prominent – especially when a rural hospital in a community is vulnerable to closure.

Since 2010, 138 rural hospitals in the U.S. have closed, and another 453 are at risk of having to shut their doors.[8] Low patient volumes of course aren’t new, but they are being exacerbated by new challenges:

  • Staffing shortages, especially for nursing positions, are forcing rural hospitals to scale back services. Also, fewer physicians want to work in remote areas.
  • Most rural hospitals operate on smaller budgets, which means they have more barriers to electronic health record (EHR) implementation. Using EHRs is an important aspect of the Affordable Care Act (ACA), which calls for improvements in the way laboratory test results are exchanged and transmitted.[9]
  • Expanded Medicaid coverage through the ACA requires rural hospitals to provide care even if someone does not have health insurance. This often results in significant revenue losses that cannot be recouped.
  • There are additional financial pressures stemming from the COVID-19 pandemic.

Clinical Trials Can Help Improve Patient Outcomes in Healthcare Deserts

Clinical trials have historically been conducted in urban medical centers, but they are becoming increasingly decentralized. This is in part due to advances in digital technology; the COVID pandemic also accelerated the adoption of remote practices to help keep clinical trials running. For rural residents, this means less time and money spent on transportation to an on-site facility, and a seamless experience from the comfort of their home. Decentralized clinical trials are also designed to be more accessible to everyone.

When addressing healthcare deserts, it’s important to remember: any friction to the patient is kryptonite for trials as it directly impacts enrollment, participation, and retention. An added consequence is a lack of representation in the data. It is incredibly important that clinical trials are inclusive; this is the only way to ensure that we obtain meaningful data about drug response, safety measures and efficacy – in everyone, but notably in under-represented and under-studied populations, including women, diverse ethnic and racial groups, children, and the elderly.

How Vault is Leveraging DCTs to Support Patients in Clinical Care Deserts

At Vault, we believe in increasing access to high-quality, personalized care. Our entrance into the clinical trial space is a continuation of that core mission: We leverage our technology to ensure that every participant touchpoint is seamless; that all participants who want to take part have access regardless of their socioeconomic status, age, location, or ability; and that the range and breadth of capabilities of the clinical trial staff and investigators are fully supported.

Here’s how we do it:

  • Nationwide clinical practice: Our medical group consists of over 1,200 licensed practitioners, some of whom already serve as clinical study staff and investigators. These practitioners are located all over the United States and are able to connect with clinical trial participants at home or virtually using Vault’s telehealth platform.
  • Improve participant enrollment and retention: Participants can meet with clinical staff virtually for scheduled visits or supervision while measuring vital signs or obtaining specimens. And when an in-person visit is necessary, our staff can visit clinical trial participants at home. Not only does this mean we’re more likely to retain existing participants, but it also enables us to cast a wider net in the first place—increasing the pool of potential clinical trial participants to build a more diverse, representative cohort.
  • Comprehensive technology platform: Our telehealth platform removes the most significant barriers when it comes to trial participation, enabling a more subject-centered approach to the trial at hand. What’s more, our technology stack offers efficient integrations, allowing us to seamlessly facilitate sample collection, clinical discussion, and clinical data collection—while also ensuring that samples get from point A to point B securely. We can also obtain and manage any additional data needed during a clinical trial.

Our modular approach tailored to the participants’ needs enable us to power rapid and seamless clinical trials. With our platform, clinical practice, and expertise, we can help these organizations build faster and more efficient trials suited for the post-pandemic participant population.

Visit this page to learn more about Vault’s clinical trials.

References

  1. Access to Health Services | Healthy People 2020. (2014). U.S. Department of Health and Human Services. https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Access-to-Health-Services
  2. Health Care Deserts: Nearly 80 Percent Of Rural U.S. Designated As ‘Medically Underserved.’ (2019, October 1). Kaiser Health News. https://khn.org/morning-breakout/health-care-deserts-nearly-80-percent-of-rural-u-s-designated-as-medically-underserved/
  3. (2019). Rural Report: Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-quality, Affordable Care. American Hospital Association. https://www.aha.org/system/files/2019-02/rural-report-2019.pdf
  4. Levine, D. (2021, June 23). Addressing Disparities in Rural Health Care. U.S. News & World Report L.P. https://www.usnews.com/news/national-news/articles/2021-06-23/addressing-disparities-in-rural-health-care
  5. Love, H., & Rowlands, D. W. (2021, November 2). Mapping rural America’s diversity and demographic change. Brookings. https://www.brookings.edu/blog/the-avenue/2021/09/28/mapping-rural-americas-diversity-and-demographic-change/
  6. Tung, E. L., Hampton, D. A., Kolak, M., Rogers, S. O., Yang, J. P., & Peek, M. E. (2019). Race/Ethnicity and Geographic Access to Urban Trauma Care. JAMA Network Open, 2(3), e190138. https://doi.org/10.1001/jamanetworkopen.2019.0138
  7. How the Government Can End Poverty for Native American Women. (2021, November 5). Center for American Progress. https://www.americanprogress.org/article/government-can-end-poverty-native-american-women/
  8. Rural Communities at Risk Widening Health Disparities Present New Challenges in Aftermath of Pandemic. (2021). The Chartis Group. https://www.chartis.com/resources/files/Chartis-Rural_Rural-Health-Disparities_21-07-07FNL.pdf
  9. Hinrichs, S. H., & Zarcone, P. (2013). The Affordable Care Act, Meaningful Use, and Their Impact on Public Health Laboratories. Public Health Reports, 128(2_suppl), 7–9. https://doi.org/10.1177/00333549131280s202

DISCLAIMER: This article is for general information purposes only, does not constitute medical advice and is not intended to be relied upon for medical diagnosis or treatment. If you are experiencing a medical emergency, dial 911 immediately.