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Barriers and facilitators to use of services following intensive family preservation services

JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 1999年第1期26卷 39-49页

作者： Staudt, M Univ Tennessee Coll Social Work Knoxville TN 37996 USA

The primary caregivers of 101 families that used short-term, intensive home-based services were interviewed 2 months after the services to ascertain use of the recommended aftercare services, perceived barriers to service use, and perceived facilitators of service use. While 88% of the families accessed at least some of the recommended services, more than 50% failed to access all of the recommended aftercare services. The most often noted barriers to service use were enabling factors at the agency or community level. Yet, many of the services were used, and the respondents indicated that professionals played a role in helping them link to services. Researchers should continue to study the use of recommended aftercare services and the relationship between aftercare service use and critical outcomes.

关键词：情感症状/康复出院后医疗/利用行为疗法/统计学和数值数据儿童行为障碍/康复儿童福利/统计学和数值数据寄养家庭照护/利用卫生服务易得程度/统计学和数值数据家庭医疗保健服务/利用美国中西部青少年成年人儿童女(雌)性人类男(雄)性中年人

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Access to HIV services by the urban poor

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JOURNAL OF COMMUNITY HEALTH 1999年第5期24卷 331-346页

作者： Montoya, ID Trevino, RA Affiliated Syst Corp Houston TX 77027 USA

This paper examines the effect of HIV-health status and HN-transmission mode on access to HIV-related services among African Americans, Hispanics and White HIV+ individuals. Data were collected from 169 African Americans, 72 Hispanics and 253 White HIV+ individuals seeking 8 social and 6 medical HIV services at 29 public and community-based organizations in Houston, Texas. A total of 42 separate logistic regressions were estimated for each HIV service and for each race/ethnic group. The results showed significant differences in access to HIV social services based on HN-transmission mode among the three race/ethnic groups, but no significant differences were found in access to medical services based on either HIV status or HIV-transmission mode among the three race/ethnic groups.

关键词：社区卫生服务/统计学和数值数据社区卫生服务/利用大陆人口群人种群 HIV感染/病因学 HIV感染/传播卫生服务易得程度/统计学和数值数据健康状况保险健康 Logistic模型贫困性行为社会阶级物质滥用静脉内/并发症得克萨斯市区人口/统计学和数值数据青少年成年人老年人女(雌)性人类男(雄)性中年人

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Rural radiology: Who is producing images and who is reading them?

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JOURNAL OF RURAL HEALTH 1997年第2期13卷 136-144页

作者： Yawn, B Krein, S Christianson, J Hartley, D Moscovice, I UNIV MINNESOTA INST HLTH SERV RES 420 DELAWARE ST SE BOX 729 MINNEAPOLIS MN 55455 USA

The purpose of this study is to identify the local availability and trends in local availability of imaging technology and interpretation services in rural hospitals in the northwestern United States during the period between 1991 to 1994. Another objective is to describe hospital and community factors associated with the diffusion of image production and interpretation services. The information for this study was gathered through telephone surveys of rural hospital administrators in eight northwestern states in 1991 and 1994. The availability of magnetic resonance imaging (MRI) equipment, computed tomography (CT) scanners, ultrasonography equipment, and dedicated mammography equipment increased between 1991 and 1994. The increases in MRI units were primarily in mobile equipment, while ultrasonography and mammography equipment increases were primarily fixed hospital-based units. In 1994, image interpretation in the rural hospitals was provided by both primary care and radiology physicians. Forty-six (11.5%) of the rural hospitals had no on-site radiology services and only 73 (18%) had daily radiology services. Between 1991 and 1994, 12 hospitals gained at least once-a-week radiology services, but 24 lost all radiology services. Teleradiology availability more than doubled during the three years. Radiologic technology has diffused widely into rural communities in this region of the United States at differing rates for large and small hospitals. Radiologists are available to these hospitals only 46 percent of the days each year, with more days of availability in the larger hospitals and fewer days in the smaller hospitals. Teleradiology capability is increasing more rapidly in the larger hospitals that hn-Je radiologists more readily available.

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Effects of physician outreach programs on rural-urban differences in breast cancer management

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JOURNAL OF RURAL HEALTH 1997年第2期13卷 109-117页

作者： Howe, HL Lehnherr, M Katterhagen, JG DIV EPIDEMIOL STUDIES 605 W JEFFERSON STSPRINGFIELDIL 62761 USA

In 1986 to 1987, urban-rural differences in several breast cancer management practices were noted in Illinois data. Several intervention programs for physicians were initiated to improve rural patients' access to state-of-the-art breast cancer management to reduce these differences. This report compares an intensive rural oncology outreach intervention program with a lower intensity physician education program. Medical records from 1986 to 1991 were reviewed on 2,277 breast cancer patients in a 12-county study area. The care received by urban patients was compared with three groups of rural patients: those managed in rural hospitals with intensive oncology outreach programs beginning in 1988 (Rural Group 1), and in those rural hospitals with less intensive interventions using an audit with feedback strategy beginning in 1989 (Rural Group 2). Rural patients who traveled to one of the urban facilities also were included in the analysis because the less intensive interventions also took place in these facilities, and these patients showed unique patterns of care in the baseline analysis (Rural Group 3). The years 1986 to 1987 constituted the baseline, and 1990 to 1991 constituted the final evaluation period. Chi square and multivariate analyses were conducted to compare the effect of the two types of interventions on changing breast cancer management practices and reducing the urban-rural differences. By the final Evaluation period, the high intensity intervention was not more successful in reducing or eliminating the urban-rural differences than the low intensity intervention for many practices. However, often the frequency estimates were higher in Rural Group 1, which received the high intensity intervention. The changes noted in Rural Group 3 were not always the same Its in Rural Group 2, even though both received the same low intensity interventions, lending evidence to the observation that travel distance and other nonmedical factors affect the choices of manageme

关键词：抗肿瘤药激素/治疗应用乳腺肿瘤/治疗癌原位/治疗癌导管乳腺/治疗综合疗法/利用卫生服务易得程度/统计学和数值数据伊利诺伊/流行病学信息服务干预性研究医师诊疗模式/统计学和数值数据乡村卫生服务/利用市区卫生服务/利用成年人老年人女(雌)性人类中年人

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The role of race and residence in determining stage at diagnosis of breast cancer

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JOURNAL OF RURAL HEALTH 1997年第2期13卷 99-108页

作者： Amey, CH Miller, MK Albrecht, SL UNIV FLORIDA DEPT HLTH POLICY & EPIDEMIOL POB 100177 GAINESVILLE FL 32610 USA

Breast cancer kills more than 46,000 women each year. Previous research has found that minorities and those who reside in geographically remote settings are particularly vulnerable. However;virtually no research has been done on the potential ''double jeopardy'' faced by rural minority women. This research examines (1) the extent to which racial and residential differences contribute to differences in stage at diagnosis;(2) the existence of an interaction between race and residence, which may place black rural women at greater risk;and (3) the influence of both individual and structural characteristics on racial and residential differences. The findings indicate that rural black women are diagnosed with breast cancer much later than are black urban women or whites of either residence. A number of individual and structural variables were influential in predicting stage at diagnosis, yet none of these accounted entirely for racial differences.

关键词：非洲裔美国人/统计学和数值数据乳腺肿瘤/诊断乳腺肿瘤/死亡率乳腺肿瘤/病理学大陆人口群人口统计学卫生服务易得程度/统计学和数值数据肿瘤分期病人接受卫生保健的程度/统计学和数值数据居住特征危险因素农村卫生/统计学和数值数据时间因素美国妇女卫生成年人老年人女(雌)性人类中年人

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The effects of physician in-migration to rural Colorado (1992 to 1995)

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JOURNAL OF RURAL HEALTH 1997年第3期13卷 190-195页

作者： Fryer, GE Stine, C Vojir, C Miyoshi, T Miller, M UNIV COLORADO HLTH SCI CTRDEPT FAMILY MEDBOX B1551180 CLERMONTDENVERCO 80220 USA

This paper reports the results of an analysis of the American Medical Association Masterfile. The purpose of this study was to examine changes in health care accessibility in rural Colorado from 1992 to 1995, and to describe the pattern of in-migration of physicians to nonmetropolitan statistical area counties of the state during that period. The number of direct patient care providers increased from 532 to 700 (31.6%) during the three-year period vs. a growth of 11.2 percent in the general population of nonmetropolitan statistical area counties. Of the 700 physicians serving residents of Colorado's 52 rural counties, 308 (44%) had been practicing in their community since 1992. The rate of departure from nonmetropolitan statistical area practice sites in 1992 was 26.4 percent (140 of 532). Physicians new to their rural practice locations were younger and proportionally more female, but they were similar in primary medical specialty to doctors who had remained in their 1992 sites. Population to physician and to primary care physician ratios were much more favorable for 1995 than for 1992. Accessibility to care was most improveed in counties with fewer than 10,000 inhabitants.

关键词：美国医学协会职业选择科罗拉多卫生保健调查卫生服务易得程度/统计学和数值数据卫生服务易得程度/发展趋势缺医地区医师/统计学和数值数据医师/供应和分配专业场所/统计学和数值数据乡村卫生服务/人力乡村卫生服务/组织和管理美国女(雌)性人类男(雄)性

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Is health status related to residence in medically underserved areas? Evidence and implications for policy

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JOURNAL OF RURAL HEALTH 1996年第3期12卷 218-224页

作者： Kohrs, FP Mainous, AG UNIV KENTUCKY COLL MEDDEPT FAMILY PRACTICEKENTUCLY CLIN K 302LEXINGTONKY 40536 USA

This study sought to compare the health status of adult residents of medically underserved areas (MUAs) with adult residents of nonshortage areas (non-MUAs). A random digit dialing telephone survey was used. Respondents were subsequently classified by their county of residence as residing in an MUA or non-MUA. A sample of 421 adults (aged 18 years or older) residing in Kentucky during 1993 were included in the analysis. Health status was measured by the Medical Outcomes Study 20-item Short-Form Health Survey's (SF-20) six subscales. After controlling in the multiple regression for demographic variables there were no significant differences between residents of MUAs and non-MUAs for the physical functioning, role functioning, general mental health, self-perception of health, or pain subscales. The social functioning subscale was significantly related to the residence in an MUA. The demographic variable ''education'' was a consistent predictor of each of the health status subscales. Excepting the social functioning subscale, residents of MUAs do not have significant differences in health status when compared to residents of non-MUAs. Future policy may need to focus on other health services shortage area designators that are more highly associated with the health status of residents. Consideration should be given to including the education demographics of areas or populations in health services shortage designation criteria.

关键词：卫生保健调查卫生政策卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据健康状况指标肯塔基缺医地区回归分析社会经济因素成年人老年人女(雌)性人类男(雄)性中年人

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Selected comparisons and implications of a national rural and urban survey on health care access, demographics, and policy issues

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JOURNAL OF RURAL HEALTH 1996年第3期12卷 197-205页

作者： Edelman, MA Menz, BL IOWA STATE UNIV SCI & TECHNOL DEPT ECONHEADY HALLAMESIA 50011 USA

As the national health debate evolved over the past two years, a need to better understand the differential constraints of rural health delivery and popular attitudes toward policy initiatives became apparent. Selected 1994 and 1995 results of two national surveys designed to compare rural and urban household responses are reported. The average distance those living in rural households must travel to access medical providers and emergency care is nearly double that of urban household residents. Rural household resident responses show a higher level of acceptance of nonphysician health care providers such as physicians assistants and registered nurses. Means testing of Medicare programs and use of special indicators for providing more Medicaid funds to states with medically underserved and sparsely populated areas are examples of two policy initiatives that receive favorable responses from both urban and rural household residents, but would disproportionately benefit rural areas.

关键词：卫生保健调查卫生政策卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据 Medicaid/立法和法学 Medicaid/利用缺医地区 Medicare/立法和法学 Medicare/利用病人接受卫生保健的程度/统计学和数值数据乡村卫生服务/经济学乡村卫生服务/利用农村人口/统计学和数值数据社会经济因素美国市区卫生服务/经济学市区卫生服务/利用市区人口/统计学和数值数据

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

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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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Barriers to preventive health services for minority households in the rural South

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JOURNAL OF RURAL HEALTH 1996年第3期12卷 206-217页

作者： Strickland, J Strickland, DL GEORGIA SO UNIV COLL HLTH & PROFESS STUDIES CTR RURAL HLTH & RES STATESBORO GA 30460 USA

Health values, behaviors, and status are shaped by place of residence, region, race, and socio-economic status, among other social factors. Consequently, this article examines barriers to preventive health services for lower-income blacks in five rural counties in Georgia. Qualitative and quantitative data were collected through 281 household, 51 community leader, and six focus group interviews. Female respondents who had been pregnant were most likely to have received pregnancy-related services and all respondents least likely to have received vision and dental screenings. Six of the seven types of services inquired about were most likely to have been received in a private practice setting. Primary barriers to preventive service utilization included ability to pay, perception of need, service availability, accessibility of services, and the perception of racism. The relationship between structural and nonstructural barriers, their impact on preventive service utilization, and research recommendations also were developed and presented.

关键词：适应心理学非洲裔美国人/统计学和数值数据集中研讨小组佐治亚卫生保健调查卫生服务易得程度/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/统计学和数值数据少数民族/统计学和数值数据贫困/统计学和数值数据偏见产前保健/经济学产前保健/利用预防卫生服务/经济学预防卫生服务/利用乡村卫生服务/经济学乡村卫生服务/利用女(雌)性人类妊娠

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