Purpose
Rural populations in the United States have less access to cardiovascular care relative to their urban counterparts while bearing a higher burden of heart disease. To understand rural patients’ access to cardiovascular care services, we conducted a qualitative study investigating which cardiovascular services rural-serving primary care practitioners offered, how they adapted care, and what factors influenced cardiovascular scope of practice and adaptations among rural-serving primary care practitioners and cardiologists.
Methods
We conducted semi-structured interviews with rural-serving primary care physicians, advanced practice providers, and pharmacists, as well as cardiologists, in Alaska, Idaho, and Washington state.
Findings
Twenty health care practitioners participated in this study. We identified two themes characterizing cardiovascular services: expanded scope of practice (e.g., primary care physician prescribing a higher-risk anti-arrhythmic medication, dofetilide, for atrial fibrillation) and altered care (e.g., cardiologist ordering fewer cardiovascular imaging tests when needed technology was unavailable). Using a socio-ecological approach, we found factors affecting care adaptations at four levels: local communities; individual practitioners; local clinics and health systems; and the broader health care, law, and policy environment.
Conclusions
When caring for rural cardiovascular patients, primary care practitioners and referring cardiologists expanded their scope of practice and altered care. Multiple factors affected these shifts. Future research could address whether and how expansion of scope of practice (e.g., through team-based care) may improve access to cardiovascular care among rural populations.
- Rural-serving primary care practitioners' and cardiologists' care adaptations for cardiovascular services: A qualitative analysis
- Susan G Miller - University of WashingtonSigne Burchim - University of WashingtonKristin Beima-Sofie - University of WashingtonAngela G Spencer - University of WashingtonElena Wadden - University of WashingtonBrekken Selah - University of WashingtonAdiya Jaffari - University of WashingtonMonica Zigman Suchsland - University of WashingtonAllison Cole - University of WashingtonSteven Elrod - Providence ChehalisPeg Gehring - Kootenai Health St. Mary's Hospital (United States, Cottonwood)Ryan Gilles - Kootenai Clinic Coeur d'Alene Family Medicine Residency (United States, Coeur d'Alene)Charles G Jose - PeaceHealth Ketchikan (United States, Ketchikan)Kelly McGrath - Clearwater Valley Hospital and ClinicsRussell T Baker - University of Idaho, School of Health and Medical ProfessionalsChristopher T Longenecker - University of Washington
- The Journal of rural health, Vol.42(1), pp.1-10
- John Wiley & Sons
- 10
- #23HERNPRH1150364 / American Heart Association UL1TR002319 / NCATS NIH HHS
- 996891964301851
- © 2026 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.
- Institute for Modeling Collaboration and Innovation; WWAMI Medical Education Program; School of Health and Medical Professionals
- English
- Journal article