Rural Health Research Gateway

John C. Fortney, PhD

Phone: 501.257.1726
E-mail: fortneyjohnc@uams.edu

Medical Sciences
University of Arkansas - Little Rock
4301 W. Markham
Little Rock, AR 72205

Current Projects

Rural-Urban Differences In The Use, Type, And Quality Of Depression Treatment
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topics: Aging, Health disparities, Mental health, Minority health
As access to evidence-based treatment for affective disorders (major depressive disorder, dysthymia, and bipolar disorder) improves in urban areas, it is critical to monitor rural-urban differences in the use and quality of treatment over time to identify and address rural disparities, especially for vulnerable populations such as the elderly and ethnic minorities.

Completed Projects

Identifying At-Risk Rural Areas for Targeting Enhanced Depression Treatment, Lead researcher
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topic: Mental health
This project will identify characteristics of rural areas that are associated with increased risk of depression-related hospitalizations, and will identify high risk rural areas within the U.S. that should be targeted for early adoption of enhanced depression treatment models based on patient need.

Identifying At-Risk Rural Areas for Targeting Enhanced Schizophrenia Treatment, Lead researcher
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topic: Mental health
The goal of this project is to identify rural areas that should be targeted for early adoption of evidence-based schizophrenia treatment. This project proposes a scientifically-based method to identify counties in greatest need for quality improvement to inform national, regional, and local decision-makers about distributing scarce resources to areas which would most benefit from improved schizophrenia treatment.

Publications

  • Are Primary Care Services a Substitute or Complement for Specialty and Inpatient Services?
    Author(s): John C. Fortney, Diane E. Steffick, James F. Burgess Jr., Matt L. Maciejewski, Laura A. Petersen
    Research center: WICHE Center for Rural Mental Health Research
    Topic: Health services
    Citation: Health Services Research, 40(5, Part 1), 1422-42
    Date: 2005
    Change in distance to primary care was a significant and substantial predictor of change in primary care visits. Analyses indicated that an increase in primary care service use was associated with increases in the use of all specialty outpatient services and inpatient services, as well as increases in inpatient and outpatient costs. Results provide evidence that health systems can implement strategies to encourage their members to use more primary care services without driving up physical health costs.
  • Community-Level Risk Factors for Depression Hospitalizations
    Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Kathryn Rost
    Research center: WICHE Center for Rural Mental Health Research
    Topics: Mental health, Rural statistics and demographics
    Report Number: Working Paper
    Date: 09 / 2005
    Examines the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics.
  • Community-Level Risk Factors for Depression Hospitalizations (Fact Sheet)
    Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Stan Xu, Fran Dong, Kathryn Rost
    Research center: WICHE Center for Rural Mental Health Research
    Topics: Mental health, Rural statistics and demographics
    Date: 09 / 2005
    Overview of findings from a study to identify community-level risk factors for depression hospitalizations and geographic areas with elevated hospitalization rates.
  • Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients
    Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
    Research center: WICHE Center for Rural Mental Health Research
    Topic: Mental health
    Date: 09 / 2005
    Examined whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences any are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that enhanced care for depression improved mental health status over 18 months for urban primary care populations, but not rural patients. Full report available on request.
  • Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients
    Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
    Research center: WICHE Center for Rural Mental Health Research
    Topic: Mental health
    Citation: Journal of Rural Health, 22(4), 343-350
    Date: 2006
    Reports the results of a study that explored whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). The study found that depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients.
  • Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs?
    Author(s): John C. Fortney, Matt L. Maciejewski, J. Warren, James F. Burgess Jr.
    Research center: WICHE Center for Rural Mental Health Research
    Topics: Health services, Veterans
    Citation: Inquiry, 42(1), 29-42
    Date: 2005
    The Department of Veterans Affairs (VA) has been establishing community-based outpatient clinics (CBOCs) across the country to improve veterans' access to and use of primary care services, thereby decreasing the need for costly specialty outpatient and inpatient care. Using a quasi-experimental, pre-post study design, the authors examined whether the establishment of CBOCs has affected access, use, and costs for VA patients residing in their catchment areas. Most patients residing in CBOC catchment areas did not receive care at CBOCs, resulting in only small increases in primary care utilization. While CBOCs improved veterans' access, they had little impact on overall patterns of utilization and cost.
  • Identifying Community-Level Predictors of Depression Hospitalizations
    Author(s): John C. Fortney, T. Rushton, S. Wood, Kathryn Rost
    Research center: WICHE Center for Rural Mental Health Research
    Topic: Mental health
    Date: 09 / 2005
    This investigation demonstrated that: (1) rural counties have lower rates of depression-related hospitalization than urban counties, (2) rurality fails to predict depression-related hospitalization in models that control for community-level demographic, economic and health system risk factors, (3) community-level risk factors explain a respectable ~30% of the variance in depression-related hospitalization rates, and (4) while these risk factors identify high risk areas in the 10 states we studied, they cannot be used to identify high risk areas in other states. Full report available on request. Executive summary available online.
  • One Size Fits Some: the Impact of Patient Treatment Attitudes On the Cost-Effectiveness of a Depression Primary Care Intervention
    Author(s): Jeffrey M. Pyne, Kathryn M. Rost, Farah Farahati, Shanti P. Tripathi, Jeffrey Smith, D. Keith Williams, John Fortney, James C. Coyne
    Research center: WICHE Center for Rural Mental Health Research
    Topic: Mental health
    Citation: Psychological Medicine, 35(6), 839-854
    Date: 2005
    Reports the results of a study that estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention.
  • Role of Social Support and Stressful Life Events in the Effectiveness of Collaborative Care for Depression: A Rural-Urban Comparison
    Author(s): K. Albright, John C. Fortney, Scott J. Adams, Stanley Xu, F. Dong
    Research center: WICHE Center for Rural Mental Health Research
    Topic: Mental health
    Date: 2005
  • Rural-Urban Difference in Health Care Benefits of Community-Based Sample of At-Risk Drinkers
    Author(s): John C. Fortney, Brenda M. Booth, JoAnn E. Kirchner, Xiaotong Han
    Research center: WICHE Center for Rural Mental Health Research
    Topic: Substance abuse
    Citation: Journal of Rural Health, 19(3), 292-298
    Date: 2003
    Compares the cost-containment strategies used by health plans of insured at-risk drinkers residing in rural and urban areas.

This web site includes content provided by and adapted from the Maine Rural Health Research Center, University of Southern Maine under a Cooperative Agreement with the University of North Dakota.