Living in a rural area with advanced chronic respiratory illness: “This is home to me”

1. Living in a rural area with advanced chronic respiratory illness: “This is home to me” Donna Goodridge, College of Nursing, University of Saskatchewan Donna Wilson, Faculty of Nursing, University of Alberta Carolyn Ross, Faculty of Nursing, University of Alberta Shelly Hutchinson, Master of Nursing Student, University of Saskatchewan

2. Rural Health Systems • Rural health care systems are: • generally less complex • possess more readily defined communities • have infrastructures more heavily based on relationships and communication than urban systems (Mueller & McKinney, 2006)

3. Effects of Rurality on Health Care Access • Rural residents have an increased risk of mortality associated with COPD • No differences in terms of: use of physician services, hospitalization rates, unmet health care needs, or number of days required to obtain appointments • Significant differences have been noted: • Rural residents are more likely to have a usual source of primary care, but have fewer visits to health care providers • Hospitalizations for ACSCs (including COPD) increase with greater rurality

4. Effects of Rurality on Health Care Access • Rurality complicates chronic illness self-management: • limited health care services • need to travel long distances for treatment • feelings of loneliness and isolation • Special challenges of rurality for persons with COPD: • Lack of access to peer support • Lack of access to pulmonary rehabilitation programs

7. Distance as an access barrier:“The miles we drive” “The worst part is travel. You’ve got appointments in [major city about four or five hours away], appointments in [larger town about two hours away]… So many people, city people, don’t realize the miles we drive. It’s amazing the miles we pile on.”

8. Relationships with providers:“More of a big family” “ People know people…it’s more of a big family…In the city, you’re a number as far as I’m concerned. Like if I get sent to the city…it’s just a quick go and then bye and that’s the end of it – you never hear from them again, where that isn’t like that here”. “He knocked on the door and here was the doctor…I said…you look like a guardian angel…He tested my chest and said ‘you go straight to the hospital’.” “As long as you got oxygen, what else do you need, really? I don’t know what the city can do that they can’t do here. What can they do other than give me air?”

9. Supportive community:“You can’t get that in the city” “There a neighbor up the street, she’ll say, ‘M. I’ll take you. You know that…you don’t get this in the city, you’re on your own.” “ I haven’t been out [of the house] for a year…I go through the flyers and order what I want and they [grocery store] deliver. For a dollar. You can’t get that in the city”.

10. Lack of education and support:“Nothing to offer” “The cities have a lot more options. Rural [province] has nothing to offer people who have COPD…I don’t think they educate you enough” “I wish there was little bit more ‘cause there’s a few of us around town…I should start a COPD society maybe.” “If you want information, you know, you’ve got to dig for it…there’s nothing offered to you in a small town.”

11. Sense of Place Web of relationships that characterizes environment Increasingly recognized as a factor that can over-ride inconveniences, even in terms of health