Smith Matthew Lee, Towne Samuel D, Bergeron Caroline D, Zhang Donglan, McCord Carly, Mier Nelda, Goltz Heather H
Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA; Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA; and College of Public Health, The University of Georgia, 100 Foster Rd, Athens, GA 30606, USA
Department of Health Management & Informatics, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA; Disability, Aging & Technology Faculty Cluster Initiative, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA; and School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
Rural Remote Health. 2019 Nov;19(4):5147. doi: 10.22605/RRH5147. Epub 2019 Nov 9.
Accessing care is challenging for adults with chronic conditions. The challenge may be intensified for individuals needing to travel long distances to receive medical care. Transportation difficulties are associated with poor medication adherence and delayed or missed care. This study investigated the relationship between those traveling greater distances for medical care and their utilization of programs to prevent and/or manage their health problems. It was hypothesized that those traveling longer distances for medical care attended greater chronic disease management programs.
Thirty six thousand households in nine counties of central Texas received an invitation letter to participate in a mailed health assessment survey in English or Spanish. A total of 5230 participants agreed to participate and returned the fully completed survey. To investigate distance traveled for medical services and participation in a chronic disease management program, the analyses were limited to 2108 adults aged ≥51 years with one or more chronic conditions who visited a healthcare professional at least once in the previous year. Other variables of interest included residential rurality, health status, and personal characteristics. The data were first analyzed using descriptive and bivariate analyses. Then, an ordinal logistic regression model was fitted to identify factors associated with longer distances traveled to medical services. Additionally, a binary logistic regression model was fitted to identify factors associated with attending a chronic disease self-management program.
Among 2108 adults, rural participants (p<0.001), those with more chronic conditions (p<0.001), and those attending a chronic disease program (p=0.037) reported traveling further distances to medical services. Participants with limited activity (p<0.001), those from urban counties (p=0.017), and those who traveled further (p=0.030) were more likely to attend a chronic disease program.
While further distances to healthcare providers was found to be a protective factor based on the utilization of community-based resources, rural residents were less likely to attend a program to better manage their chronic conditions, potentially choosing to use long distance travel to address urgent medical needs rather than focusing on prevention and management of their conditions. Important policy and programmatic efforts are needed to increase reach of chronic disease self-management programs and other community services and resources in rural areas and to reduce rural inequities.
对于患有慢性病的成年人来说，获得医疗服务具有挑战性。对于那些需要长途跋涉去接受医疗护理的人而言，这一挑战可能会加剧。交通困难与药物依从性差以及护理延迟或错过有关。本研究调查了那些长途跋涉就医的人与他们对预防和/或管理健康问题的项目的利用之间的关系。研究假设是，那些长途跋涉就医的人参加了更多的慢性病管理项目。
德克萨斯州中部九个县的36000户家庭收到了一封邀请信，邀请他们参加一项用英文或西班牙文邮寄的健康评估调查。共有5230名参与者同意参与并返回了完整填写的调查问卷。为了调查就医的行程距离以及参与慢性病管理项目的情况，分析仅限于2108名年龄≥51岁、患有一种或多种慢性病且在前一年至少拜访过一次医疗保健专业人员的成年人。其他感兴趣的变量包括居住的农村程度、健康状况和个人特征。数据首先使用描述性和双变量分析进行分析。然后，拟合一个有序逻辑回归模型，以确定与就医行程距离较长相关的因素。此外，拟合一个二元逻辑回归模型，以确定与参加慢性病自我管理项目相关的因素。
在2108名成年人中，农村参与者（p<0.001）、患有更多慢性病的人（p<0.001）以及参加慢性病项目的人（p=0.037）报告就医行程距离更远。活动受限的参与者（p<0.001）、来自城市县的人（p=0.017）以及行程更远的人（p=0.030）更有可能参加慢性病项目。
虽然基于社区资源的利用情况，到医疗服务提供者处的行程距离更远被发现是一个保护因素，但农村居民参加改善慢性病管理项目的可能性较小，他们可能选择长途跋涉来满足紧急医疗需求，而不是专注于疾病的预防和管理。需要做出重要的政策和项目努力，以扩大慢性病自我管理项目和其他社区服务及资源在农村地区的覆盖范围，并减少农村地区的不平等现象。
