Dansky K H, Dirani R
Penn State University, University Park, PA 16802, USA.
J Rural Health. 1998 Spring;14(2):129-37. doi: 10.1111/j.1748-0361.1998.tb00614.x.
Current standards of health care support the view that diabetes can be managed in an outpatient setting, thereby preventing costly hospitalization. Yet, recent studies on access to care suggest that rural residents do not receive the same services for diabetes care as their urban counterparts. This study identifies differences in use for three types of services-hospital care, home health visits, and physician office visits--by geographical location. Using a sample of 6,698 Medicare beneficiaries, the authors performed multivariate analysis of variance to test the influence of geographical differences on each type of service use after controlling for the other types of service use and individual factors. Results showed significant differences among the geographical categories, with diabetic individuals in the most sparsely populated communities reporting fewer physician office visits and more home health visits than their urban counterparts. Because this pattern may have a negative impact on health outcomes, additional research is needed to determine the optimal array of services necessary to manage chronic diseases, such as diabetes, in rural areas.
当前的医疗保健标准支持这样一种观点，即糖尿病可以在门诊环境中得到管理，从而避免昂贵的住院治疗。然而，最近关于医疗服务可及性的研究表明，农村居民在糖尿病护理方面获得的服务与城市居民不同。本研究确定了地理位置在三种类型服务（住院护理、家庭健康访视和医生门诊）使用上的差异。作者使用6698名医疗保险受益人的样本，在控制了其他类型的服务使用情况和个体因素后，进行了多变量方差分析，以测试地理位置差异对每种服务使用类型的影响。结果显示，不同地理类别之间存在显著差异，人口最稀少社区的糖尿病患者比城市患者的医生门诊次数更少，家庭健康访视次数更多。由于这种模式可能对健康结果产生负面影响，因此需要进一步研究以确定在农村地区管理糖尿病等慢性病所需的最佳服务组合。
