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The relationships among gender, perceived financial barriers to care, and health status in a rural population

JOURNAL OF RURAL HEALTH 1996年第3期12卷 188-196页

作者： Beck, RW Jijon, CR Edwards, JB MILLIGAN COLL OFF RURAL & COMMUNITY HLTHMILLIGAN COLLTN 37682 MILLIGAN COLL COLL NURSINGMILLIGAN COLLTN 37682

This study examined the relationships among gender, perceived financial barriers to health care, and selected health status indicators in a randomly selected rural Appalachian sample. The data were gathered through the Johnson County Health Survey. The survey was conducted through personal interviews with 207 females and 178 males representing 197 households. The Duke Health Profile was used to measure the perceived health of the respondents. Analysis of variance, t tests, and descriptive statistics were used to analyze the data. Analysis of the data revealed that women perceive financial barriers to health care significantly more than men (P<0.01), even when living in the same household;women had significantly poorer health than men (P<0.01);and both women and men with perceived financial barriers experienced poorer health (P<0.01) than those who did not perceive such barriers. Conclusions from the study suggest that in this rural sample women were the most compromised by both gender and health status, and that they perceived that their health care needs were not being adequately met.

关键词：社区卫生中心/经济学社区卫生中心/利用卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据卫生服务需求卫生服务研究健康状况指标农村卫生/统计学和数值数据乡村卫生服务/经济学乡村卫生服务/利用性别因素社会经济因素田纳西女(雌)性人类男(雄)性

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Rural-urban comparisons of age and health at the time of nursing home admission

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JOURNAL OF RURAL HEALTH 1997年第2期13卷 118-125页

作者： Duncan, RP Coward, RT Gilbert, GH UNIV FLORIDA HLTH SCI CTRDEPT HLTH SERV ADMPOB 100195GAINESVILLEFL 32610 USA

This study re-examines the contention that rural elders admitted to nursing homes are younger and healthier than their counterparts who enter urban facilities. The analysis uses interview data gathered in both urban and rural nursing homes. Residents were interviewed at or near the time of admission regarding their health and circumstances immediately prior to entering the nursing home. The findings indicate few and modest differences between urban and rural residents. In those instances where differences are observed, there is ambiguity-some measures indicate lower health status in the case of rural residents, while others suggest that urban residents are more likely to report health impairments. The divergence of these findings from earlier research may be due to differences in the study populations, measurement differences, or, more likely, that policies and processes have changed over time.

关键词：日常生活活动年龄因素佛罗里达/流行病学老年人身心健康评价医护疗养所/利用病人入院/统计学和数值数据农村卫生/统计学和数值数据城市卫生/统计学和数值数据老年人老年人 80以上女(雌)性人类男(雄)性

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Two decades of experience in the University of Washington Family Medicine Residency Network: Practice differences between graduates in rural and urban locations

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Journal of Rural Health 1995年第1期11卷 60-72页

作者： Baldwin, L.-M. Hart, L.G. West, P.A. Norris, T.E. Gore, E. Schneeweiss, R. Department of Family Medicine School of Medicine University of Washington Seattle WA 98195 United States

This study describes how graduates of the University of Washington Family Medicine Residency Network who practice in rural locations differ from their urban counter-parts in demographic characteristics, practice organization, practice content and scope of services, and satisfaction. Five hundred and three civilian medical graduates who completed their residencies between 1973 and 1990 responded to a 27-item questionnaire sent in 1992 (84% response rate). Graduates practicing outside the United States in a specialty other than family medicine or for fewer than 20 hours per week in direct patient care were excluded from the main study, leaving 116 rural and 278 urban graduates in the study. Thirty percent of graduates reported practicing in rural counties at the time of the survey. Rural graduates were more likely to be in private and solo practices than urban graduates. Rural graduates spent more time in patient care and on call, performed a broader range of procedures, and were more likely to practice obstetrics than urban graduates. Fewer graduates in rural practice were women. A greater proportion of rural graduates had been defendants in medical malpractice suits. The more independent and isolated private and solo practice settings of rural graduates require more practice management skills and support. Rural graduates' broader scope of practice requires training in a full range of procedures and inpatient care, as well as ambulatory care. Rural communities and hospitals also need to develop more flexible practice opportunities, including salaried and part-time positions, to facilitate recruitment and retention of physicians, especially women.

关键词：卡方分布卫生服务研究实习医师和住院医师职务医疗事故医师家庭/统计学和数值数据医师女/统计学和数值数据专业业务/统计学和数值数据专业场所/统计学和数值数据问卷调查农村卫生/统计学和数值数据城市卫生/统计学和数值数据华盛顿女(雌)性人类

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A Descriptive Analysis of Health Insurance Coverage Among Farm Families in Minnesota

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The Journal of Rural Health 1992年第3期8卷 178-184页

作者： Kralewski, John E. Liu, Yuanli Shapiro, Janet China Studying Health Services Research Policy and Administration School of Public Health University of Minnesota United States Division of Health Services Research Policy of the School of Public Health University of Minnesota United States

This paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis‐St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problems. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：农业/经济学用户满意/统计学和数值数据成本及成本分析/统计学和数值数据数据收集卫生服务易得程度/统计学和数值数据保险健康/经济学保险健康/统计学和数值数据未参加医疗保险者/统计学和数值数据明尼苏达农村卫生/统计学和数值数据人类

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A Multivariate Assessment of the Effects of Residence on Infant Mortality

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The Journal of Rural Health 1991年第3期7卷 246-265页

作者： Clarke, Leslie L. Coward, Raymond T. Center for Health Policy Research J. Hillis Miller Health Sciences Center University of Florida Gainesville Florida 32610-0177 Box J-177 United States

ABSTRACT: This research examines the relationship between residence and infant mortality. The purpose of the study was to identify the effects of maternal residence on infant mortality, using a multivariate model which included both individual and county‐level variables known to be associated with suboptimal birth outcome. Data on all births in Florida during 1987 were drawn from birth and infant death certificates. In addition, information concerning county sociodemographic structure and medical resources were gathered and linked to the individual records. After examining the distributions of selected risk variables across a five‐category measure of residence (from most urban to most rural), a logit model was estimated to predict the odds of an infant death associated with maternal residence. At the bivariate level, rural residents were found to have increased odds of an infant death compared to residents of all other residence categories. Second, a logit model was estimated that controlled for the influence of important maternal, infant, and county risk characteristics. The results of this second, more fully specified model indicate that residence did not have an independent direct effect on infant mortality when the influence of the other risk factors was controlled. We conclude that although residence does not influence infant mortality directly, it does influence mortality indirectly through its association with key risk factors. In particular, because population characteristics and medical resources are differentially distributed across rural and urban areas, residence remains an important factor to be considered when predicting health outcomes. The implications of these findings for polcy‐makers and health planners, as well as for health services researchers, are also discussed. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：佛罗里达健康计划婴儿死亡率 Logistic模型母亲/统计学和数值数据多元分析居住特征/统计学和数值数据危险因素农村卫生/统计学和数值数据人类婴儿

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Consequences of Differential Residence Designations for Rural Health Policy Research: The Case of Infant Mortality

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The Journal of Rural Health 1993年第1期9卷 17-26页

作者： Farmer, Frank L. Miller, Michael K. Department of Agricultural Economics and Rural Sociology Agriculture Building University of Arkansas Fayetteville Arizona 72701 Room 222 United States

Abstract: In 1991, members of the rural caucus proposed numerous bills designed to attenuate the rural‐urban differences in health care delivery and health status. Implicit in the legislative process is the assumption that “rural America” differs systematically from “urban America.” However, research has consistently demonstrated that there is not a single rural America but rather, those areas outside of the major metropolitan areas represent a complex mosaic of varying social and environmental settings. Rural communities differ in meaningful ways along a number of socioenvironmental parameters, and accordingly, health status indicators also differ across rural communities. Thus, health outcome statistics averaged across rural communities will often mask important health disparities experienced by certain population groups. Policies based on these aggregate indicators may overlook the needs of the most disadvantaged. While a number of measures of rurality have emerged in the last decade, much of the information presented to policy‐makers is either too aggregated (i.e., metropolitan‐nonmetropolitan) to identify important differences across the range of communities, or it is gathered in agency‐specific categories that are not comparable. The central question under examination in the current context is the possibility of distorting the picture of infant health status by aggregating the diverse rural locales of the United States. Empirical results indicate that when considering infant mortality, any rural disadvantage is contingent upon how ‘rural’ and ‘urban’ have been defined. Further, the results indicate that conclusions must be conditioned on other important sociodemographic parameters such as region of the county and race. Copyright © 1993, Wiley Blackwell. All rights reserved

关键词：非洲裔美国人/统计学和数值数据阿肯色数据收集欧洲大陆世系人群/统计学和数值数据佛罗里达地理学卫生政策卫生服务研究/标准人类婴儿死亡率婴儿新生居住特征农村卫生/统计学和数值数据美国城市卫生/统计学和数值数据

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Cancer in Rural Versus Urban Populations: A Review

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The Journal of Rural Health 1992年第3期8卷 212-220页

作者： Monroe, Adele C. Ricketts, Thomas C. Savitz, Lucy A. 1 Monroe is a verterinarian with an interest in human and animal oncology and cancer models. She is currently completing a master's degree in public health epidemiology in the University of North Carolina at Chapel Hill School of Public Health through a National Cancer Institute Postdoctoral Fellowship. In 1991 Monroe was a research associate with the North Carolina Rural Health Research Program at the Cecil G. Sheps Center for Health Services Research where she completed several studies that examined access to cancer care for rural populations.2 Ricketts is the director of the North Carolina Rural Health Research Program and an assistant professor in the Department of Health Policy and Administration at the University of North Carolina at Chapel Hill School of Public Health. His research has focused on the problems of access to care for underserved populations and the potential for regional and interorganizational systems in health care delivery.3 Savitz is a doctorate student in the Department of Health Policy and Administration in the University of North Carolina at Chapel Hill School of Public Health. She is the coordinator of a project funded by the US. Agency for Health Care Policy and Research to develop a handbook of geographic applications in rural health services research and is a research associate with the North Carolina Rural Health Research Program.

Rural‐urban comparisons have identified higher age‐, race‐, and sex‐adjusted cancer incidence and mortality rates in urban populations for most anatomic sites, suggesting that rural populations are at lower risk from cancer. Conversely, findings that rural cancer patients are diagnosed at later stages of disease, that higher proportions of rural cancer cases are unstaged at diagnosis, and that rural cancer patients are at a more advanced stage of illness when referred to home health care agencies, suggest that rural cancer patients are disadvantaged when compared to their urban counterparts. This paper summarizes rural‐urban patterns of cancer mortality, incidence, and survivorship since 1950;outlines rural‐urban differences in utilization of health care services;questions the appropriateness of using rural‐urban comparisons of cancer mortality and incidence to evaluate access to cancer care;and suggests potential approaches to the question of whether rural residents have access to cancer care comparable to that available to urban residents. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：癌症医护设施/利用肿瘤/诊断肿瘤/流行病学肿瘤/死亡率危险因素农村卫生/统计学和数值数据美国/流行病学城市卫生/统计学和数值数据人类

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Patterns of Illness Behavior Among Rural Elderly: Preliminary Results of a Health Diary Study

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The Journal of Rural Health 1992年第1期8卷 13-26页

作者： Stoller, Eleanor Palo Forster, Lorna Earl State University of New York Plattsburgh New York United States Clinton Community College in Plattsburgh New York United States

This paper summarizes the responses of rural elderly people to a variety of symptoms experienced during a three‐week period. Responses to symptoms included causal attributions, consultation patterns, and intervention strategies. Data recorded in diaries during a three‐week period highlight the importance of lay care in the illnesses of older people. Most symptoms were managed by older respondents themselves. When symptoms were discussed with someone else, the consultant was most likely a family member or friend rather than a health care professional. Only one third of the respondents contacted any formal provider about any of their symptoms. The majority of respondents combined medical and nonmedical explanations in interpreting their symptoms. The most frequent response to a symptom was doing nothing. The next two most commonly reported interventions were over‐the‐counter medications and activity limitation. Analyses revealed few differences among residential categories in patterns of illness behavior. Rural‐urban differences often disappeared when controlling for demographic and socioeconomic background which covarv with residence. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：文献工作/统计学和数值数据老年人身心健康评价卫生服务需求健康调查病案纽约病人接受卫生保健的程度/统计学和数值数据回归分析农村卫生/统计学和数值数据自我护理/统计学和数值数据自我护理/利用自我投药法/统计学和数值数据自我投药法/利用疾病角色社会经济因素城市卫生/统计学和数值数据老年人女(雌)性人类男(雄)性

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Geographic Benefit from Decentralized Medical Education: Student and Preceptor Practice Patterns

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The Journal of Rural Health 1994年第3期10卷 193-198页

作者： Fryer, George E. Stine, Curtis Krugman, Richard D. Miyoshi, Thomas J. Department of Family Medicine of the School of Medicine at the University of Colorado Denver Colorado United States Department of Pediatrics School of Medicine University of Colorado Denver Colorado United States Department of Pediatrics of the School of Medicine University of Colorado Denver Colorado United States Department of Family Medicine of the School of Medicine the University of Colorado in Denver Colorado United States

The performance of area health education center (AHEC)‐stimulated programs and decentralized education for medicine is not well understood. The Statewide Education Activities for Rural Colorado's Health (SEARCW/AHEC project at the University of Colorado School of Medicine was examined to determine if the program had an effect on the practice location of its graduates. Practice location and specialty of graduates of the University of Colorado School of Medicine (UCSOM) classes 1980‐1985 were compared for students who had participated in decentralized SEARCH/AHEC experiences versus students who had not. The majority of the graduates were practicing out of state in 1990. Non‐Colorado doctors were more often practicing in rural (non‐metropolitan statistical area [MSA]) counties and in towns of fewer than 2,500, 5,000 and 10,000 residents, respectively. In addition, of the 251 active patient care physicians practicing in Colorado communities of fewer than 10,000 in non‐MSA counties in 1986, those who precepted UCSOM students on SEARCH rotations were more likely to have remained in their same practice location in 1992 (77.8% versus 62.1% for those who had not precepted students). This analysis of both student and preceptor practice patterns documents the value of decentralized medical education in addressing the geographic and specialty maldistribution of physicians. These results have important policy implications for funding medical education programs. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：地区卫生教育中心职业选择科罗拉多卫生服务研究医师/供应和分配导师制/统计学和数值数据专业场所/统计学和数值数据方案评价农村卫生/统计学和数值数据专业医学学生医科/统计学和数值数据

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The Process and Outcomes of Care for Major Depression in Rural Family Practice Settings

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The Journal of Rural Health 1995年第2期11卷 114-121页

作者： Rost, Kathryn Wherry, Jeff Jr., G. Richard Smith Department of Psychiatry University of Arkansas for Medical Sciences Little Rock Arizona 72205 4301 West Markham United States

Abstract: Although primary care physicians provide the majority of care for rural residents with major depression, little is known about the quality of the care they provide. The aim of this study was to characterize the process and outcomes of care for rural patients with major depression, and to examine the relationship between the process and outcomes of care in this population. Six hundred and thirty‐one patients in 21 primary care practices in small towns were screened;47 patients (7.4% of patients screened) meeting DSM‐III‐R criteria for current major depression were recruited into the study, and 38 (81.0% of patients recruited) were followed an average of five months later using the Depression Outcomes Module (Rost, Smith, Burnam, & Burns, 1992). While 24 (63.1%) of the 38 depressed subjects received a prescription for one or more antidepressants between the index visit and follow‐up, only 11 (28.9%) received pharmacologic treatment in concordance with the new Agency for Health Care Policy and Research (AHCPR) guidelines;26 (68.4%) of 38 depressed patients continued to meet criteria for major depression at five months. Those who received pharmacologic treatment concordant with AHCPR guidelines showed more improvement at follow‐up. The findings suggest that outcomes for major depression may be worse in rural family practice settings than in urban settings. The study also demonstrates that AHCPR guidelines define effective treatment for major depression in the study sample. The Depression Outcomes Module appears to be a reliable and valid instrument for monitoring the outcomes of care for major depression in family practice settings. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：阿肯色抑郁症/药物疗法药物利用/统计学和数值数据家庭医学/标准结果与过程评价(卫生保健)/统计学和数值数据可重复性结果农村卫生/统计学和数值数据美国美国卫生保健研究和质量评估署人类

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