ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00521.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:The health care environment in rural areas changed dramatically in the 1980s. Policy‐makers are concerned that these changes have reduced access to care among residents of rural areas. This study measures adequate access to Medicare home health services and determines whether it differs for urban and rural beneficiaries.Adequate access to care is measured by whether a patient with a specific health condition received a level of skilled services predetermined as appropriate for that condition. The predetermined levels of care were developed in an earlier study and were found to correlate with adverse outcomes. This study focused on patients with diabetes mellitus and surgical hip procedures to concentrate on access to skilled nursing services and physical therapy services.To conduct the analysis, a data base was constructed that included both patient utilization and health status data, drawing on three different data sources: Medicare hospital claims data, Medicare home health bill record data, and home health plan of treatment data from patients' utilization review forms (forms 485 and 486). The analysis samples consisted of 404 patients with diabetes and 876 patients who had surgical hip procedures.Significant differences were found between urban and rural areas in access to home health services. The largest differences were found in access to physical therapy services, but differences in access to skilled nursing services also exist. The data suggest that the availability of skilled care services may cause these difference

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00522.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:This paper presents the results of a longitudinal analysis of differences between urban and rural elderly persons in the use of hospital, nursing home, and physician services. Multivariate logistic and Tobit utilization models were estimated with data from the National Center for Health Statistics' Longitudinal Study of Aging (a national survey of more than 5,000 elderly, 70 years of age and older) and health resource data from the Bureau of Health Professions' Area Resources File. The research investigated the independent effect of residential location on both the frequency of service use and the likelihood of using a service over the period 1984–1986. Under a trichotomous definition of urban/rural residency and controlling for differences in predisposing, enabling, and need characteristics, the analysis revealed that the utilization pattern of hospital, nursing home, and physician services was unrelated to either rural or urban residential location or the availability of health resources in those area

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00523.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Americans without health insurance constitute a significant public policy concern. Previous research has demonstrated that rural Americans are more likely to be without coverage. Beyond documenting this comparative disadvantage, however, current research has two specific deficiencies: studies have not examined whether the factors that predict the receipt of employer‐sponsored health insurance are equivalent across residence categories, and few studies have used a multivariate framework to examine the predictors of the receipt of health insurance, Using data from the 1987 National Medical Expenditure Survey, the influence of residence is examined along with other variables known to be associated with an increased likelihood of receiving health insurance from an employer (specifically, seven employee and six workplace characteristics). At a bivariate level, an individual's place of residence did affect the probability of receiving health insurance from an employer, with nonmetropolitan workers least likely to receive such benefits. The influence of the employee and workplace characteristics on receipt of insurance, however, did not vary significantly by place of residence. In a multivariate model, six employee and six workplace characteristics were identified as significant predictors. These findings do not refute the existence of important residential differences in health insurance coverage, rather, they suggest that the differences are due to identifiable population and workplace characteristics that vary in their distribution by residenc

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00524.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:The incidence of AIDS in rural areas is increasing rapidly. However, historically it has been overshadowed by AIDS in the epicenters. From 1991–1992 the increased percentage of cases was higher in nonmetropolitan areas than in any other areas of residence. The rate per 100,000 also increased at almost the same rate in rural areas as in the largest metropolitan areas, defined by the Centers for Disease Control (CDC) as having a population of more than 500,000, and in other metropolitan areas of 50,000 to 500,000 population, as designated by CDC.To date, the epidemiology of AIDS in rural areas has not been defined. This information is necessary to developing effective policies and programs. The research presented here reviews the literature on AIDS in specific areas and populations at risk as a basis for generating hypotheses for further study. The first wave of the epidemic, primarily affecting homosexual or bisexual men, is strongly evident in many rural locations. The second wave of the epidemic is strongly evident in the South and can be seen among high‐risk groups such as black women, adolescents, migrant and seasonal farm workers, people who abuse alcohol, intravenous drug users, and users of crack cocaine, including those who trade sex for drugs. Poverty is a common characteristic of the second‐wave population. Proximity to interstate highways as well as metropolitan areas may also be associated. A national study of the epidemiology of AIDS in rural America is imper

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00525.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractRural residents differ from individuals living in urban areas in their views about health and health behavior, their socioeconomic status, and their access to health care services. Such differences may have implications for health policy and the focus and design of health care services, including educational interventions. This paper reports findings from a comparative analysis of rural and urban chronic obstructive pulmonary disease (COPD) patients' smoking cessation experiences. The study's aims were to determine whether rural COPD patients differed from their urban counterparts in smoking patterns, smoking cessation attempts (i.e., number of quitting attempts, methods used, withdrawal symptoms, professional and personal supports for quitting smoking), and smoking cessation outcomes. Forty‐eight rural and 86 urban COPD patients were interviewed by telephone using a pretested questionnaire.The rural and urban samples did not significantly differ in demographic characteristics, disease severity, functional status, smoking patterns, reasons for smoking, perceived benefits of smoking cessation, or withdrawal symptoms. However, the rural COPD patients used fewer smoking cessation methods and had fewer persons supporting their smoking cessation attempts. Rural patients' support networks for smoking cessation primarily consisted of family members, whereas those of urban patients were more varied. Similar percentages of rural and urban patients had been abstinent from smoking for at least six months at the time of the interview, controlling for age and disease severity. Logistic regressions were used to identify predictors of current smoking for the rural and urban samples. For the rural sample, less educated individuals were more likely to be current smokers. Spouse smoking predicted current smoking in the rural sample but was only marginally significant (P=0.054). In the urban sample, use of daily medication for breathing (a proxy measure of disease severity) had a significant negative effect on current smoking. Smoking due to stress was a significant positive predictor of current smoking. Findings from this exploratory study suggest the existence of rural/urban differences in COPD patients' smoking cessation patterns that warrant further investigatio

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00526.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:The purposes of this study were to: (1) describe both the urban and rural clients who received services from the Indiana Children with Special Health Care Needs program (CSHCN) including both demographic and clinical characteristics; (2) conduct a health care needs assessment of the CSHCN program clients in both urban and rural areas; and (3) measure the perceived quality and adequacy of the CSHCN program services.A survey instrument was developed and mailed to all 6,459 families who participated in the Indiana CSHCN program from July 1,1990 to June 30,1992. Of the 2,722 questionnaires used in the analysis, 1,624 clients (59.7%) resided in urban counties and 2,098 (40.3%) resided in rural counties.The most frequently noted conditions for program eligibility were asthma, ear infections, hearing impairments, heart defects, and convulsions and seizures. Asthma had greater prevalence among the urban clients while cleft lip/palate, epilepsy, and heart defects were more common among the rural clients.The majority of program clients perceived their medical needs as being met. However, significant numbers of clients perceived unmet needs for mental health services, support groups, information about community services, resources to pay for uncovered medical expenses, and respite care. Of the 23 listed services, five were reported at significantly lower rates by rural clients as not being met: regular medical care, recreation, child care/day care, parent support group services, and speech therapy.Quality of medical services was generally perceived as being “excellent or good,” while services related to information about community programs, child's rights in school, resources available to pay for uncovered medical expenses, as well as communication between the treatment center and the child's school were more often rated as “fair or poor.” A smaller proportion of rural clients rated physician care and availability of staff nurses as fair or poor. A larger percentage of the rural group reported that access to treatment center location was fair or poor, compared to the urban group.Overall, the evaluation of the Indiana CSHCN program has shown that the non‐medical care component seems to be in need of change, especially in the area of information and communication. Attention needs to be focused on providing more family support such as respite or child care and support groups, better information and communications, and improved availability of mental health services to better enable the CSHCN program to meet its o

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00527.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

This section ofThe Journal of Rural Healthis intended to assist readers in their efforts to keep current with the research literature relevant to rural health. In monitoring the journals from neighboring disciplines, we attempt to alert readers to new research and scholarly debate. The scope of this section is, for the most part, limited to publications from the United States. Inclusion of a publication does not represent an endorsement of the research or the validity of the conclusions reported.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00528.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Book reviewed in this article:Deadly ConsequencesDeborah Prothrow‐Stith with Michaele Weissman.Health Care and GenderCharlotte F. Muller.Curing the Crisis: Options for America's Health CareMichael D. Reagan. BoulderRural Health Care: LaVonne A. Straub and Norman Walzer. (Eds.).Regional and Local Economic Analysis for Practitioners: Avrom Bendavid‐Val. (4th Ed.).Health Care Systems and Their Patients—An International Perspective: Marilynn M. Rosenthal and Marcel Frenkel. (

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00529.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00530.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY