ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00489.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Despite documentation that rural elderly have reduced access to both primary care and specialist physician services, there have been very few studies comparing rural and urban patterns of prescription drug use. This is unfortunate, because prescription drugs are the most commonly used type of health care by the elderly. This research merged claims data for a random sample of 18,641 enrolled elderly in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) for the years 1984 through 1988 with Medicare inpatient and outpatient health services records and with county‐level demographic and health services resources data bases to test several models of factors associated with prescription drug use. The Human Resources Profile County Code from 1980 census data (HRPCC80) in the Area Resource File provided a very detailed (10 levels) definition of rurality. Consistent with our hypotheses based on preliminary studies, neither rurality designations nor county‐level health care resource indices, nor interaction trans of health services resources with rurality were powerful predictors of prescription drug use. Use of health services (from Medicare data) and variables of longevity and continuity in the PACE program were consistently robust predictors of prescription drug use. Personal demographic characteristics were also strong predictors: white widowed women under age 85 with relatively higher incomes used more prescription dr

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00490.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

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

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00491.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:The use of nonphysician providers, such as nurse practitioners, physician assistants, and certified nurse midwives, in rural areas is critically important due to the continued primary care access problems. This study examines the major factors influencing the use of nonphysician providers in rural community and migrant health centers based on a 1991 national survey of the centers. This study demonstrates that the employment of nonphysician providers in rural community and migrant health centers is significantly influenced by both supply and demand factors. Among supply factors, there is a significant and positive relationship between the number of total staff and the number of nonphysician providers employed. There is a significant but inverse relationship between the number of physicians and the number of nonphysician providers employed, indicating nonphysician providers primarily serve as substitutes for physicians in rural community and migrant health centers. The supply of nonphysician providers, as measured by the number of affiliated training programs, is significantly related to the employment of nonphysician providers. The demand variable, geographic location, and the centers' staffing policies are also significant determinants of the use of nonphysician providers.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00492.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Debates about the accessibility, costs, and coverages of health care for the population at large have recently accelerated. This paper addresses some of the demographic, health, and fiscal ramifications of creating a preventive health care bridge to children in uninsured and underinsured families in two rural Wisconsin counties.The study findings revealed that the initial health status of children making a preventive health visit under a minimal copayment plan was noticeably worse than the status of those who had the free Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program available to them on a more or less continual basis. Upon their first visit, the children who did not have access to a free EPSDT program had a greater number of medical and dental health problems and fewer preventive dental care visits than their EPSDT contemporaries. Beyond a greater number of problems, however, we found no noticeable differences between the two groups in the types of health problems present (i.e. the clinical distribution of the problems was similar across the two groups). This paper also contrasts referral completion rates and rates of diagnostic confirmation of identified problems between the two groups. Finally, we provide estimates of the cost of coverage for each unprotected child.

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00493.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Teenage students are exposed to exceptionally high levels of risk from automobile accidents when (1) they drive under the influence of alcohol or drugs, (2) they are a passenger in a car when the driver is under the influence, or (3) they encounter another vehicle on the road driven by a person under the influence. This study examines the prevalence of risk from the first two of these situations among 6,938 rural junior and senior high school students in 11 Mississippi school districts. Data were collected through the Student Alcohol and Drug Use Survey System operated by the University of Mississippi. The percentage of students who had driven under the influence during the 30 days previous to the study ranged from 4.6 percent in the 7th grade to 26.5 percent in the 12th grade. The percentage of students who rode as passengers when the driver was under the influence ranged from 35.2 percent in the 7th grade to a high of 49.2 percent in the 10th grade. More than one third of 7th grade students and more than one half of the high school students had been at risk as a driver or passenger during the 30 days previous to the study. More male students than female students had driven under the influence or been at risk to DUI overall. Whites were more likely than blacks to report DUI behavior. Overall, 12.1 percent of the students indicated they had been in an automobile accident during the last year when the driver was under the influence of alcohol or drugs. Male students were more likely than female students to have been in an alcohol‐related accident. During the month previous to the test, 21.6 percent of the students indicated they had served as the designated driver. Males were more likely than females to have been a designated drive

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00494.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Stigma may be a particularly important barrier to mental health care in rural communities where lack of anonymity increases the probability that someone who seeks care will be labeled “crazy.” This study examined rural‐urban differences in the stigma associated with depressive symptoms and the stigma associated with seeking treatment for depressive disorders. In addition, the study compared how the stigma associated with seeking treatment predicted use of care in rural and urban residents with a history of depressive symptoms. Two hundred subjects from metropolitan and adjacent non‐metropolitan counties rated one of four randomly selected vignettes using 14‐point semantic differential scales. The findings indicated that rural residents with a history of depressive symptoms labeled people who sought professional kelp for the disorder somewhat more negatively than their urban counterparts. Logistic models controlling for sociodemographic characteristics demonstrated that the more negative the labeling, the less likely depressed rural residents were to have sought professional help. Labeling was not associated with use of care among urban people with depressive symptoms. We concluded that prospective studies are warranted to inform the development of interventions to decrease the stigma associated with seeking treatment for depressive disorders in rural co

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00495.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Although patient education has always been recognized as an essential function of a hospital, it was not until the health concerns of the nation focused on prevention that hospitals began to develop activities aimed at primarily healthy individuals. Hospital health promotion evolved from patient education about specific diseases to programs focused on modifying of lifestyle practices to prevent future debilitating conditions.Studies conducted in the early 1980s show hospital‐based health promotion programs increasing in number and including such target populations as senior citizens, children, business people, and hospital employees. However, the extent of involvement of the rural hospital in offering health promotion programs has not been clearly established. The current study was conducted to determine the status of health promotion programs in rural North Carolina hospitals. Elements considered were types of programs, target audiences, methods of financing, staff use, and availability of specialized facilities for health promotion programs.The results indicate rural hospitals do offer health promotion programs, but their primary focus is on hospital employees. Most programs are offered at low or no cost, making those offered for the community readily accessible. If input from the community is used and programming is aimed at specific health needs of rural populations, the rural hospital could make a significant contribution to an overall primary prevention strategy, lowering community health care cost

ISSN:0890-765X    

DOI:10.1111/j.1748-0361.1993.tb00496.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.tb00498.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.tb00499.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY