Sanders Scott R, Erickson Lance D, Call Vaughn R A, McKnight Matthew L
1 Brigham Young University, Provo, UT, USA.
J Appl Gerontol. 2017 Apr;36(4):441-461. doi: 10.1177/0733464815602108. Epub 2016 Jul 9.
This study assesses the prevalence of primary-care physician (PCP) bypass among rural middle-aged and older adults. Bypass is a behavior where people travel beyond local providers to obtain health care. This article applies a precise Geographic Information System (GIS)-based measure of bypass and examines the role of community and non-health-care-related characteristics on bypass. Our results indicate that bypass behavior among rural middle-aged and older adults is multifaceted. In addition to the perceived quality of local primary care, dissatisfaction with local services, such as shopping, creates an effect that increases the likelihood of bypass, whereas strong community ties decrease the likelihood of bypass. The results suggest that the "outshopping theory," where respondents select services in larger regional economic centers rather than local "mom and pop" providers, now extends to older adult health care selection.
本研究评估了农村中老年人群中绕过初级保健医生（PCP）的现象的普遍性。“绕过”是指人们前往本地医疗服务提供者以外的地方获取医疗保健服务的行为。本文应用了一种基于精确地理信息系统（GIS）的“绕过”测量方法，并考察了社区及与医疗保健无关的特征在“绕过”行为中所起的作用。我们的结果表明，农村中老年人群中的“绕过”行为是多方面的。除了对当地初级保健质量的认知外，对当地诸如购物等服务的不满也会产生一种效应，增加“绕过”的可能性，而紧密的社区联系则会降低“绕过”的可能性。结果表明，“外出购物理论”（即受访者选择在更大的区域经济中心而非当地的“夫妻店”式提供者处接受服务）现在已延伸至老年人群的医疗保健选择。
