The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Handling the Challenges: Access to Certified Hand Therapy in Mississippi

Authors: Anna G. Boydstun, BA, Hannah G. Talbot, BE, Mary E. McMinn, BS, Emily E. Hecox, MD, Shelley R. Edwards, PhD, Katherine E. Baker, MS, Katherine C. Benedict, MD, Marc E. Walker, MD, MBA

Abstract

Objectives: Access to a certified hand therapist (CHT) plays a crucial role in enhancing postsurgical functional outcomes and reducing morbidity in complex hand surgery and trauma cases. Unfortunately, the availability of CHTs is uneven across regions, particularly in less populous states such as Mississippi. The financial and time-related burdens of traveling to a CHT to receive appropriate rehabilitation care affects patients recovering from hand surgery and hand trauma. This study investigated the accessibility of CHT services in Mississippi by analyzing physical proximity to CHTs and assessing the resultant economic implications, specifically focusing on transportation costs.

Methods: County-level distances to the nearest CHT were mapped and evaluated. The associated cost of personal vehicle transport was calculated using 2024 Internal Revenue Service standard mileage rates of $0.67/mi. Distance from a CHT and travel costs were stratified based on published 2023 Rural-Urban Continuum Codes.

Results: One-way analysis of variance revealed a significant difference in both the distance traveled to CHTs and the associated travel costs when stratified by Rural-Urban Continuum Codes (P < 0.05). On average, the distance to a CHT in Mississippi is 27.6 mi or 55.2 mi round trip, incurring a cost of $36.98 per visit. Residents of the farthest county from a CHT travel 86.4 miles or 172.8 miles round trip, however, resulting in a financial burden of $115.78 per visit to a CHT.

Conclusions: This heightened cost for individuals residing farthest away poses substantial geographic, economic, and time-related barriers to accessing CHT services. Moreover, these barriers have a pronounced impact on the well-being of patients and their families, considering the frequency of required visits for adequate rehabilitation and functional recovery, typically occurring once or twice per week over several months. This study emphasizes the urgency of addressing disparities in CHT access to ensure equity across the state.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Zubovic E, Van Handel AC, Skolnick GB, et al. Insurance status and disparities in outpatient care after traumatic injuries of the hand: a retrospective cohort study. Plast Reconstr Surg 2021;147:545–554.
 
2. Chen K, Duan GY, Wolf JM, et al. Health disparities in hand and upper extremity surgery: A scoping review. J Hand Surg 2023;48:1128–1138.
 
3. Horton TC, Dias JJ, Burke FD. Social deprivation and hand injury. J Hand Surg Eur Vol 2007;32:256–261.
 
4. US Census Bureau (2023). QuickFacts Mississippi. https://www.census.gov/quickfacts/MS. Accessed October 15, 2024.
 
5. Hand Therapy Certification Commission. The CHT credential. https://www.htcc.org/about-htcc/CHT-Credential. Accessed July 21, 2024.
 
6. Hand Therapy Certification Commission. Find a CHT. https://www.htcc.org/find-a-cht. Accessed August 26, 2023.
 
7. Internal Revenue Service. 2024 standard mileage rates. https://www.irs.gov/pub/irs-drop/n-24-08.pdf. Accessed 2024.
 
8. US Department of Agriculture. Economic Research Service. Rural-urban continuum codes. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes. Accessed July 22, 2024.
 
9. Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry. Social Vulnerability Index. https://www.atsdr.cdc.gov/place-health/php/svi/. Published June 14, 2024. Accessed July 9, 2024.
 
10. Hsia R, Shen YC. Possible geographical barriers to trauma center access for vulnerable patients in the United States: an analysis of urban and rural communities. Arch Surg Chic Ill 1960 2011;146:46–52.
 
11. Svenson JE, Spurlock C, Nypaver M. Factors associated with the higher traumatic death rate among rural children. Ann Emerg Med 1996;27:625–632.
 
12. Jarman MP, Castillo RC, Carlini AR, et al. Rural risk: geographic disparities in trauma mortality. Surgery 2016;160:1551–1559.
 
13. Hanlon AL, Pauly MV, Huang L, et al. Medical complexity mediates healthcare resource use in the socially vulnerable. J Healthc Manag 2022;67: 173–191.
 
14. Herrera-Escobar JP, Uribe-Leitz T, Wang J, et al. The Social Vulnerability Index and long-term outcomes after traumatic injury. Ann Surg 2022;276:22–29.
 
15. Bennett IM, Chen J, Soroui JS, et al. The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med 2009;7:204–211.
 
16. Hand Therapy Certification Commission. Certification. Deadlines/fees/refunds. https://www.htcc.org/certification/examination-information/deadlines-fees-and-Refunds. Accessed October 16, 2024.
 
17. Hand Therapy Certification Commission. Recertification. Deadlines and fees. https://www.htcc.org/recertification/recertification-by-professional-development/deadlines-and-fees. Accessed October 16, 2024.