Rural Health
Research Gateway

Holly Andrilla, MS

Deputy Director, WWAMI Rural Health Research Center

Phone: 206.685.6680
Email: hollya@uw.edu

University of Washington
4311 Eleventh Ave. NE, Suite 210
Seattle, WA 98105

Current Projects - (8)

  • Access to and Provision of Child and Youth Behavioral Health Services in the Rural and Urban U.S.
    The need for behavioral health treatment for youth has been exacerbated by the COVID-19 pandemic. Little is known about the availability of youth behavioral health providers in rural areas. This study will investigate who provides behavioral health services to youth, how equitably the workforce is distributed, and gaps in service availability.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Children and adolescents, Health disparities and health equity, Health services, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Workforce
  • Changes in Buprenorphine Prescribing Following the Elimination of the Drug Enforcement Administration X Waiver Requirement
    The Drug Enforcement Administration requirement for an X waiver to prescribe buprenorphine for opioid use disorder was lifted in January 2023. This study aims to describe if and how this policy change has impacted the prescribing practices of clinicians and medication treatment access for patients with opioid use disorder.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Legislation and regulation, Mental and behavioral health, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce
  • Comparing Utilization and Quality of Home Health Care Between Medicare Fee-for-Service and Medicare Advantage Beneficiaries by Rural-Urban Status
    This project examines differences in home health use and quality by enrollment in Medicare Fee-for-Service (FFS) versus Medicare Advantage (MA) plans. Findings will include information on rural-urban and intra-rural variation in home health care to inform policies on access, payment, and quality for Medicare FFS and MA plans.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Allied health professionals, Health disparities and health equity, Health services, Healthcare access, Healthcare financing, Home health, Medicare, Medicare Advantage (MA), Post-acute care, Quality
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents: Exploring Changes in the Past 15 Years
    This project will describe the national supply of the rural and urban dental workforce and investigate whether rural adults, compared to urban adults, report lower dental care utilization, higher prevalence of dental disease or both. This study will also look at whether disparities in oral health care and supply have changed over the past 15 years.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Health disparities and health equity, Health services, Healthcare access, Oral health, Workforce
  • Specialist Physicians in the Rural and Urban U.S.: Supply, Distribution, and Access
    This project will describe the geographic distribution (rural/urban, regional, and intra-rural) of specialist physicians who care for patients experiencing conditions that account for the top four leading causes of rural mortality. It will also explore how patients in rural communities that lack these specialists obtain needed care.
    Research center: WWAMI Rural Health Research Center
    Topics: Cancer, Care management, Chronic diseases and conditions, Frontier health, Health disparities and health equity, Health services, Healthcare access, Physicians, Social determinants of health, Telehealth, Workforce
  • Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder Across the U.S.
    This study describes and compares the treatment that rural and urban patients with opioid use disorder (OUD) receive, documenting the workforce providing care, distance that patients travel to receive care, and cost of care. Findings will inform policies to ensure that rural patients with OUD have access to care from local healthcare providers.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Healthcare financing, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Telehealth
  • Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S.
    This project will analyze Medicaid claims data to compare the treatment that rural and urban patients with opioid use disorder receive, documenting the workforce providing care, the distance that patients travel to receive care, and the cost of care. Findings from this study can be used to improve policies regarding opioid use disorder treatment.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Healthcare financing, Legislation and regulation, Medicaid and CHIP, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Telehealth, Workforce
  • Understanding Changes in the Rural Marriage and Family Therapist and Mental Health Counselor Workforces Under New Medicare Reimbursement Policy
    Marriage and family therapists and mental health counselors are newly eligible as of January 1, 2024, for reimbursement to provide care for Medicare enrollees. This study will describe the change in these clinicians in rural vs. urban communities and seek to understand barriers and solutions to fully realize the benefits of this new reimbursed policy for rural populations.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Health disparities and health equity, Medicare, Mental and behavioral health, Workforce

Completed Projects - (9)

  • Do Rural Breast and Colorectal Cancer Patients Present at More Advanced Disease Stages than Their Urban Counterparts?
    Access to recommended cancer screening is more difficult for rural residents than their urban counterparts. This study used the Surveillance, Epidemiology and End Results Program (SEER) data to examine the extent to which rural residents present at more advanced disease stages for breast and colorectal cancer diagnosis than urban residents.
    Research center: WWAMI Rural Health Research Center
    Topics: Cancer, Health disparities and health equity, Health promotion and disease prevention, Health services
  • Overcoming Barriers to Providing Rural Obstetrical Training for Physicians
    Rural communities struggle to maintain obstetrical (OB) services, due in part to scarce rural training opportunities for obstetricians and family physicians. This study described the availability, characteristics, and output of residency and fellowship programs offering rural OB training and identified solutions to support this training.
    Research center: WWAMI Rural Health Research Center
    Topics: Healthcare access, Maternal health, Physicians, Women, Workforce
  • Palliative Care in the Rural U.S.
    This project described the availability of palliative care services in rural hospitals and community settings using data from the American Hospital Association Annual Survey, interviews with palliative care providers, and a survey of rural hospitals without palliative care services.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospice and palliative care, Hospitals and clinics
  • Supply of Physicians Waivered to Treat Opioid Addiction in Rural America: Policy Options to Remedy Critical Shortages
    This study will determine the extent to which a trained workforce exists in rural America that has received the necessary waiver to treat opioid addiction in outpatient settings with buprenorphine, a highly effective medication. It will identify areas with critical shortages and discuss policy options for expanding the supply of these qualified providers.
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Substance use and treatment, Workforce
  • Trends in Health Workforce Supply in the Rural U.S.
    Rural communities in the U.S. have struggled to recruit and sustain sufficient health professionals to ensure adequate access to care. This study used multiple sources of data to describe the geographic distribution (rural/urban, regional, and intra-rural) of numerous types of health professionals.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Oral health, Physician assistants, Physicians
  • Understanding the Prescribing Practices of Rural Nurse Practitioners and Physician Assistants with a DEA Waiver to Prescribe Buprenorphine
    This study investigated the extent to which nurse practitioners and physician assistants who practice in rural areas and have a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine as an office-based outpatient treatment for opioid use disorder are providing this treatment to their patients.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurses and nurse practitioners, Physician assistants, Substance use and treatment
  • What Are Best Practices for Providing Buprenorphine Maintenance Treatment in Rural Primary Care?
    Not all physicians with a Drug Enforcement Agency waiver to prescribe buprenorphine actually provide this treatment or fully utilize their waiver capacity. This project interviewed physicians successfully using their waivers to identify best practices for prescribing buprenorphine treatment for Opioid Use Disorder.
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Mental and behavioral health, Physicians, Substance use and treatment, Workforce
  • What Is the Geographic Distribution of the Workforce with a DEA Waiver to Prescribe Buprenorphine?
    This project updated statistics on the supply of providers (physicians, nurse practitioners and physician assistants) with a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine and examine supply trends over time and also established baseline numbers of other eligible providers (e.g., midwives, clinical nurse specialists).
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce
  • Who Treats Opioid Addiction in Rural America? Quantifying the Availability of Buprenorphine Services in Rural Areas
    This study will investigate the extent to which physicians who practice in rural areas and have a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine as an office-based outpatient treatment for opioid use disorder are providing this treatment to their patients. This study will also estimate the need for office-based opioid disorder treatment in rural locations.
    Research center: WWAMI Rural Health Research Center
    Topics: Chronic diseases and conditions, Mental and behavioral health, Pharmacy and prescription drugs, Substance use and treatment

Publications - (65)

2024

2023

  • Understanding and Overcoming Barriers to Rural Obstetric Training for Family Physicians
    Journal Article
    WWAMI Rural Health Research Center
    Date: 03/2023
    Family physicians are the most common health professional providing rural obstetric (OB) care, but the number of family physicians practicing OB is declining. This mixed-methods study aimed to inform policy and practice solutions to address the training landscape and inform sustainable initiatives for rural family medicine obstetrical training.

2022

2021

2020

2019

2018

2017

  • Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder
    Journal Article
    WWAMI Rural Health Research Center
    Date: 07/2017
    Opioid use disorder is a serious public health problem. Management with buprenorphine is an effective medication-assisted treatment, but 60.1% of rural counties lack a physician with a Drug Enforcement Agency waiver to prescribe buprenorphine. This national study surveyed all rural physicians who have received a waiver in the United States.
  • Changes in the Supply of Physicians With a DEA DATA Waiver to Prescribe Buprenorphine for Opioid Use Disorder
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 05/2017
    This project mapped the location of physicians with a DEA DATA 2000 waiver to prescribe buprenorphine for opioid use disorder in July 2012 and April 2016. The number of counties without a waivered physician and the ratio of waivered physicians per 100,000 population is reported by the rural/urban status of the county.

2016

  • Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2016
    Outcomes of care vary by region of the country for rural Medicare beneficiaries receiving home health services for high-risk conditions such as heart failure. Those in the East South Central and West South Central Census Divisions had lower rates of community discharge and higher rates of hospital readmission and emergency department use.
  • Do Residencies That Aim to Produce Rural Family Physicians Offer Relevant Training?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 09/2016
    Examines the rural-centric family medicine residencies, their training locations, and rurally relevant skills training provided. Rural training can promote rural practice, but the number of family medicine residencies with a rural focus, geographic distribution of training, and training content are poorly understood.
  • Supply and Distribution of the Behavioral Health Workforce in Rural America
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 09/2016
    This brief uses National Provider Identifier (NPI) data to report on the variability of the supply and provider to population ratios of five types of behavioral health workforce providers (psychiatrists, psychologists, social workers, psychiatric nurse practitioners, counselors) in Metropolitan, Micropolitan and Non-core rural areas across the U.S.
  • Graduates of Rural-centric Family Medicine Residencies: Determinants of Rural and Urban Practice
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 07/2016
    This study of graduates of family medicine residencies seeking to produce rural physicians identified influences on rural practice choice, including significant others, residency, and practice communities. Findings point to the need to sustain the preferences of physicians interested in rural practice and encourage this interest in others.
  • How Could Nurse Practitioners and Physician Assistants Be Deployed to Provide Rural Primary Care?
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2016
    New (2014) rural enrollees in the insurance plans on federal and state exchanges are expected to generate about 1.39 million primary care visits per year. At a national level, it would require 345 full-time equivalent physicians to provide those visits. This study examines how different mixes of physicians, PAs, and NPs might meet the increase.
  • Outcomes of Rural-Centric Residency Training to Prepare Family Medicine Physicians for Rural Practice
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2016
    Among those with eight or more weeks of rural training, no single program characteristic or model offered sustained advantages over any other type in producing high yields to rural practice.
  • Family Medicine Rural Training Track Residencies: 2008-2015 Graduate Outcomes
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2016
    This policy brief is the latest in a series tracking the rural practice outcomes of family physicians who have completed graduate medical education in Rural Training Track (RTT) residency programs.
  • Which Physician Assistant Training Programs Produce Rural PAs? A National Study
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2016
    The proportion of physician assistant (PA) graduates who enter practice in rural settings has dropped over the last two decades, though PAs still continue to enter rural practice at a higher rate than primary care physicians. This identifies the PA training programs that produced high numbers of rural PAs and the programs associated.
  • Nurse Practitioner Autonomy and Satisfaction in Rural Settings
    Journal Article
    WWAMI Rural Health Research Center
    Date: 01/2016
    Compares urban and rural primary care nurse practitioners (NPs) by practice location in urban, large rural, small rural, or isolated small rural areas by using analysis of the 2012 National Sample Survey of NPs.

2015

2014

2013

2010

2008

  • Access to Specialty Health Care for Rural American Indians in Two States
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2008
    Examines access to specialty services among rural Indian populations in Montana and New Mexico, based on a survey sent to primary care providers addressing access to specialty physicians, perceived barriers to access, and access to nonphysician clinical services.

2007

2002

1999