ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00767.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Adequate prenatal care is known to reduce the risks of low birth weight and neonatal death, yet nearly one quarter of all women giving birth in the United States receive delayed, inadequate or no prenatal care. This suboptimal use of prenatal care has contributed to rates of low birth weight and neonatal mortality higher than those in most other industrialized nations. This paper examines the relationships among race/ethnicity, residence, maternal sociodemographic and medical risk characteristics, and use of prenatal care in the United States. Using data from the National Maternal and Infant Health Survey, this study found important differences in prenatal care use by race/ethnicity and residence, as well as interactive effects of these variables. Single marital status, non metropolitan residence, poverty, low level of education, and no insurance were more strongly associated with inadequate prenatal care for whites and Hispanics than for blacks. Nonmetropolitan residents were more likely to receive inadequate care, regardless of race/ethnicity or sociodemographic characteristics. Predicted probabilities of prenatal care use by race/ethnicity and residence showed that, regardless of risk, nonmetropolitan Hispanic women had the highest probability of obtaining inadequate prenatal care. Results highlight the continued importance of race/ethnicity and rural residence in determining prenatal care use and the need to design interventions targeted to these populations.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00768.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:This investigation compares adults (65 and older) living in two different types of communities on the characteristics of the pharmacies they use and their patterns of communicating with pharmacists. Telephone interviews were conducted with a random sample (N=400) of respondents, half residing in six nonmetropolitan counties (containing no towns of more than 4,000) and the other half in a single city (population approximately 130,000) located within a metropolitan county. Elders living in the sparsely populated nonmetropolitan areas were more apt to purchase their medications from an independent neighborhood pharmacy than their counterparts who lived in the large city. These pharmacies, however, were more likely to be located in another town. Differences between residential groups were also observed in the communication patterns that older patients had with their pharmacists. Elders residing in sparsely populated areas reported more frequent conversation with their pharmacists about general topics, although not about medicines or other health‐related topics. The elders living in small and remote places also reported that they talked with their pharmacists longer, that communication about medications were more often initiated by the pharmacist, and that they were more likely to talk about their medications directly with their pharmacist rather than a non‐pharmacist employee. The overall greater frequency of contact and communication between nonmetropolitan elders and their pharmacists would seem to be precursors to establishing a positive provider‐client relationship and may increase the probability of more personal, medication‐related discussions. Further research is needed, however, to determine if these potentials are transformed into realities and if they lead to more positive medical outcomes for older

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00769.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The purpose of this study was to examine the prevalence of abnormal Pap smears in rural family practice, to compare this to the published literature, and to determine if the prevalence of abnormalities is higher in the younger age group (≤ 35 years of age). A retrospective chart audit was performed on all Pap smears from four rural family practice sites during a 12‐month period. Data collected were Pap smear result, patient's age, and interval since previous Pap smear. Statistical analysis was used to determine if the prevalence of abnormal Pap smears was consistent among the practices as well as similar to the three larger published studies. Also, chi‐square analysis was used to compare the prevalence of abnormal Pap smears in the younger (≤ 35 years of age) versus the older (>35 years of age) age groups. There were 2,891 Pap smears reviewed, with 782 (27%) recorded as abnormal. The prevalence of cervical intraepithelial neoplasia (CIN) (76 or 2.6%) was compared to the published literature and was found to be statistically significantly higher (chisquare=772.194, P=0.000). The prevalence of abnormal Pap smears was higher in the younger than age 35 group when compared to the older than age 35 group(chisquare=20.953, P=0.000). Pap smear interval and age varied between the four practice sites, but the prevalence of CIN was not statistically different(chisquare=3.154, P=0.368). The results of this study suggest that rural family physicians may encounter abnormal Pap smears at rates similar to those reported in the literature. This study also suggests that the prevalence of abnormal Pap smears may be higher in the younger groups in this pop

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00770.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Recent changes in the organization and delivery of physician services in rural areas suggest the need to update how physician availability is viewed and measured. The objective of this study was to empirically examine the effect of rural hospitals contracting with outside physicians for part or all of their emergency room coverage, and the use of urban specialists to staff outpatient clinics, on measures used to assess physician availability. Based on data from one rural state, the findings demonstrate the importance of adjusting for the importation of physician services into rural areas.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00771.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Despite the prevalence of disabilities among persons living in rural areas, scarce data exist on their health care needs. While rural residents generally experience barriers to access to primary health care, these problems are further exacerbated for people with disabilities. This article summarizes findings from the published literature on access to primary health care among people with disabilities living in rural locations. A comprehensive computerized literature search turned up 86 articles meeting the study criteria, focused on the following rural populations affected by disabilities: children and adolescents, working‐age adults, the elderly, the mentally ill, and people with AIDS.For each of these populations, substantial problems in accessing appropriate health care have been documented. The literature consistently emphasizes the failure of local health care systems in nonmetropolitan areas to adequately address the complex medical and related needs of individuals with disabilities. In the absence of specialized expertise, facilities, and primary care providers trained specifically to care for disabled persons, local programs rely heavily on the use of indigenous paraprofessionals and alternative models of care. Further research is needed to identify and test the efficacy of innovative service delivery strategies to improve health care access for this populatio

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00772.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The objective of the study was to identify factors that affected the implementation of an inpatient case management program in rural hospitals. The hospitals studied were from the Western New York Rural Health Care Cooperative. Five of the hospitals implemented the program in 1992. A qualitative evaluation was conducted by analyzing tape‐recorded inter‐views with nurses and chief executive officers to identify obstacles to and facilitators of program implementation. Many obstacles to implementation could be traced to workload and time constraints, physician autonomy concerns, and limited nursing staff and physician participation. Implementation was facilitated foremost by the effort and supportive attitudes of nursing leaders and hospital chief executive officers. This study concluded that it should be possible to successfully implement conceptually sound managed care and case management programs in rural hospitals, but it will require a relatively long period of support, especially from hospital administration and nursing lead

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00773.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

“Research Reviews” are a regular feature ofThe Journal of Rural Health,presenting current research on a particular them or topic of inter

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00774.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Book reviewed in this article:Mental Health and Rural America: 1980–1993, An Overview and Annotated bibliography, Morton 0. Wagenfeld, J. Dennis Murray, Dennis Mohatt, and Jeanne C. DeBruyn. Rockville, MDA Measure of Malpractice, Medical Injury, Malpractice Litigation, and Patient Compensation, Paul C. Weiler, Howard H. Hiatt, Joseph P. Newhouse, William G. Johnson, Troyen A. Brennan, and Lucian L. LeapeA Pocket Tour of Health and Fitness on the Internet, Jeanne C. RyerHealing Through Nutrition: A Natural Approach to Treating 50 Common Illnesses with Diet and Nutrients, Melvyn Werba

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00775.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1996.tb00776.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY