Graves Janessa M, Abshire Demetrius A, Alejandro Art G
College of Nursing, Washington State University, Spokane, WA, USA.
College of Nursing, University of South Carolina, Columbia, SC, USA.
Health Serv Insights. 2022 Jun 11;15:11786329221104667. doi: 10.1177/11786329221104667. eCollection 2022.
Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality.
Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design.
About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care ( < .001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality.
To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations.
农村地区居民在获得医疗服务时面临着地理和距离之外的障碍。本研究的目的是描述几种常用农村分类中的医疗服务获取障碍。
2018年6月至2019年12月期间，华盛顿州家庭居民完成了一项混合模式（纸质/在线）的医疗服务获取调查，该调查针对被分类为城市、郊区、大农村和小农村（四层方案）的邮政编码分层随机样本进行。为了进行分析，还根据邮政编码和县将农村地区分为两层方案（农村/城市）。受访者报告了医疗服务的可获得性以及获取服务的系统和个人层面的障碍。逻辑回归模型估计了在不同农村地区（四层和两层方案）获取医疗服务时报告系统或个人层面障碍的几率，对受访者特征进行了调整，并进行加权以考虑调查设计。
约617户家庭完成了调查（回复率为25.7%）。与城市居民（在所有三种方案中）相比，更多农村居民报告前往遥远的城市或城镇就医（<0.001）。农村地区与面临系统层面障碍的几率增加显著相关。与城市受访者相比，小农村地区的受访者在获得初级保健方面面临更大的障碍几率（比值比7.31，95%置信区间1.84 - 29.09），且没有初级保健提供者的几率也更高（比值比11.37，95%置信区间3.03 - 42.75）。个人层面的障碍与农村地区无关。
为了改善城乡范围内的医疗服务获取情况，政策制定者必须考虑农村人口面临的系统层面障碍。
