Critical Elements of Care Coordination for Older Persons in Rural Communities: An Evaluation of the Iowa Return to Community Service Demonstration.

We evaluated the Iowa Return to Community, a service demonstration designed to coordinate care and reduce preventable healthcare utilization among at-risk older persons living at home in rural communities. During 2021, 262 older persons elected to participate in the IRTC program. Individuals who participated were more likely to live in micropolitan areas (OR = 2.30, 95% CI 1.34-3.95) relative to metropolitan locations. Individuals who used recommended services were more likely to be men (OR 3.65, 95% CI 1.16-11.51) and more likely to live in rural (OR 17.48, 95% CI 1.37-223.68) and micropolitan areas (OR 3.17, 95% CI 1.00-10.05). However, prevention of health care use corresponded more with consistent and prolonged IRTC program engagement rather than volume of service use. The IRTC constitutes a population aging and rural health strategy to reduce unnecessary health care use while supporting individual preferences to remain at home.

Air Pollution and Socio-Economic Determinants of Chronic Obstructive Pulmonary Disease in Albania.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has become a global issue. The Global Burden of Disease Study reports a prevalence of 251 million cases of COPD in 2016, while it is estimated that 3.17 million deaths were caused by the disease during that period. In this paper we conduct an ecological study, to analyze the effects of socio-economic factors and air pollution on the COPD prevalence at the population level in Albania. METHODS: Group-level data from 61 municipalities in Albania was used to assess the relationship between environmental exposures, living conditions, and socioeconomic factors with the prevalence of chronic obstructive pulmonary disease. RESULTS: The regression analysis shows that for every percent increase in the concentration of PM2.5 in Albanian cities, a 32% increase in the prevalence of COPD was observed. Similarly, there was an increase in COPD prevalence associated with the increase of the urban population and the number of vehicles registered per city. It is worth mentioning that no statistically significant relationship was observed between the prevalence of COPD, smoking levels, and the Poverty Index. CONCLUSIONS: Within the limitations of an ecological analysis, these findings support an association between the prevalence of chronic obstructive pulmonary disease and environmental exposures, socioeconomic factors, and living conditions. However, there is a call to more individual-level analysis and more in-depth research to further investigate the extent of this association in Albania.