Date of Conferral



Doctor of Nursing Practice (DNP)


Health Services


Amelia Nichols


The ability to access primary care services within the local community has a direct impact on the health and wellness of the community. Individuals living in rural settings face multiple challenges when attempting to access care. The purpose of this retrospective project was to identify barriers in 2 rural, underserved communities and make recommendations for process changes that could reduce these barriers. Data were gathered from 2 critical access hospitals and 2 rural health clinics located in rural, underserved areas in Iowa. Both hospitals identified access to health services as an issue within their communities. Administrative data were gathered on nonemergent use of the emergency department, which revealed peak use from 10 a.m. to 11 a.m., 12 p.m. to 1 p.m., and 4 p.m. to 5 p.m. Clinic data included patient demographics, staffing and scheduling patterns, and the number of patient visits. One site provided expanded hours, yet very little difference in the number visits to the emergency room for nonemergent care was identified. Both clinic sites reported the need for additional providers to meet the needs of their patients and provide more same-day appointments. Recommendations made to increase access were open scheduling, staggered staff schedules to increase appointments over peak demand times, and use of a dedicated case manager to improve communication and coordination of care. Increased use of technology would allow the provision of care outside the clinic setting, enhance care coordination, and promote patient participation in care. With increased knowledge regarding the barriers facing rural communities when accessing care, process changes can be implemented to reduce barriers. The overall goal is to improve health and wellness through increased access.