Gunderson Anne, Menachemi Nir, Brummel-Smith Ken, Brooks Robert
Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, USA.
J Rural Health. 2006 Summer;22(3):224-8. doi: 10.1111/j.1748-0361.2006.00036.x.
Rural elderly patients are faced with numerous challenges in accessing care. Additional strains to access may be occurring given recent market pressures, which would have significant impact on this vulnerable population.
This study focused on the practice patterns and future plans of rural Florida physicians who routinely see elderly patients. Additionally, we examine those who provide services to a high volume of Medicare (HVM) patients.
A self-administered mailed survey was sent to rural physicians who identified themselves as practicing family medicine, internal medicine, psychiatry, general surgery, a surgical specialty, or a medical specialty. Questions examined changes in services offered by all rural physicians and among them, the HVM physicians. Impact of the professional liability insurance situation, satisfaction with current practice, and future practice plans on changes in service availability was also examined.
Overall, 539 physicians responded for a participation rate of 42.7%. Two hundred eighty eight (54.9%) of all physicians in the study indicated a decrease or elimination of patient services in the last year. HVM physicians, compared to low volume of Medicare providers, were significantly more likely to decrease or eliminate services overall (66% vs 45%, P =.001). Mental health services (47% vs 18%, P =.001), vaccine administration (39% vs 16%, P =.008), and Pap smears (41% vs 13%, P =.008) were more likely to be eliminated among the HVM physicians. HVM physicians were also significantly more likely to be somewhat or very dissatisfied (40% vs 23%, P =.012) with their practice.
Physicians in rural Florida report dissatisfaction with their practice and are decreasing or eliminating services that are important to the elderly. Given the aging population and increasing need for health care services, these trends raise concern about the ability for these patients to receive necessary care.
农村老年患者在获得医疗服务方面面临诸多挑战。鉴于近期的市场压力，获得医疗服务可能会面临更多困难，这将对这一弱势群体产生重大影响。
本研究聚焦于佛罗里达州农村地区经常诊治老年患者的医生的执业模式和未来计划。此外，我们还研究了那些为大量医疗保险（HVM）患者提供服务的医生。
向自认为从事家庭医学、内科、精神病学、普通外科、外科专科或医学专科的农村医生发送了一份自行填写的邮寄调查问卷。问题涉及所有农村医生以及其中的HVM医生所提供服务的变化。还研究了职业责任保险情况、对当前执业的满意度以及未来执业计划对服务可及性变化的影响。
总体而言，539名医生回复，参与率为42.7%。研究中的所有医生中有288名（54.9%）表示在过去一年中减少或取消了患者服务。与医疗保险患者数量少的提供者相比，HVM医生总体上更有可能减少或取消服务（66%对45%，P = 0.001）。HVM医生更有可能取消心理健康服务（47%对18%，P = 0.001）、疫苗接种（39%对16%，P = 0.008）和巴氏涂片检查（41%对13%，P = 0.008）。HVM医生对其执业也明显更有可能有点或非常不满意（40%对23%，P = 0.012）。
佛罗里达州农村地区的医生对其执业表示不满，并正在减少或取消对老年人重要的服务。鉴于人口老龄化和对医疗服务需求的增加，这些趋势引发了对这些患者获得必要医疗服务能力的担忧。
