The health status, health services utilization, and support networks of the rural elderly: a decade review.

Research from the 1980s on several dimensions of health and health care among the rural elderly is reviewed. Following a brief discussion of the demographic patterns and life conditions of the rural elderly, the current state of knowledge regarding health status, health services utilization, and the potential for informal and familial care of the elderly is examined. The review concentrates on studies that include comparisons between rural and urban populations and/or control for additional variables that are known to covary with residence. Such analyses permit the documentation of the effects of residential location on health indicators net of other factors. The review concludes that the rural elderly are relatively disadvantaged in terms of both health status and access to health care services, and have little if any advantage over the urban elderly in their access to informal sources of care. Following the review, an agenda for future research is identified.     

Access to and use of health services by rural elderly, Brazil, 1998 and 2003

We analyzed access to health services and the utilization of such services by elderly rural residents in Brazil in 2003, comparing the patterns to those of the urban elderly and the equivalent rural pattern in 1998, using data from the National Household Sample Survey. Access barriers were greater in rural as compared to urban areas. Health services utilization was less than in the urban elderly, even for rural elders who reported health problems. There was no difference in hospitalization rates among rural and urban elderly. Analysis of the health services that were used showed that there was limited access to services with intermediate complexity. The results suggest that access barriers increase even further with advancing age. Gender differences in utilization, generally favoring women, are more marked in the rural elderly. Financial barriers are also more evident. The health services supply should be expanded and adapted to the territorial, cultural, and social characteristics of the rural elderly.     

Implementing swing-bed services in small rural hospitals.

Since 1983, twenty-six small rural hospitals in five states have been developing models of the "swing-bed" concept as part of a coordinated national demonstration project. Based on the experiences of these hospitals, swing-bed programs use excess hospital capacity to provide short-term, post-acute care in rural communities where there are nursing home shortages, and, thus, help avoid the need for new nursing home construction. The availability of swing-bed services in rural hospitals has allowed the elderly patient to receive a full-range of long-term care services within the community to avoid transfer to a nursing home outside the community. Introduction of services also has improved patient care for all hospitalized elderly. Finally, the revenue from the swing-bed services has helped to stabilize small, rural hospitals faced with declining utilization. The demonstration has provided evidence that the swing-bed program has the potential to deliver a needed service to the rural elderly while contributing to the preservation of the small, rural hospital as a valuable community resource.     

Access to hospital services in rural Minnesota

A Minnesota Department of Health study on the financial condition of Minnesota's small, rural hospitals found that at least 12 hospitals were in precarious financial condition at the start of 1989, and many other hospitals were financially vulnerable. One-third or more of Minnesota's hospitals with fewer than 50 beds had negative net income in each year from 1984 to 1987. Using a standard of 30 minutes' maximum travel time for adequate access, the study revealed that about 19,000 Minnesotans in 14 counties currently have inadequate access to hospital services. Closing rural hospitals could leave additional Minnesotans without adequate access to hospital services. Given the financial condition of Minnesota's small, rural hospitals and the importance of maintaining access to hospital services in rural communities, the state may need to provide limited hospital subsidies to ensure access in geographically isolated areas.     

Financing rural health and medical services.

The provision and utilization of health care services in rural areas are tied directly to the structure of financing. The model of rural health care shaped by federal policies over three decades was significantly altered by changes during the 1980s. With reactions of third-party payers to health care costs rising faster than inflation, the difficulty of accommodating access to care and cost efficiency in provision became evident. This review begins with the literature on patient services and capital financing of rural hospitals, then continues with the financing of clinics, community centers, and other supply forms. Research during the 1980s provides insight into the effects of various financing policies on the supply of services. The demand for health care in rural areas is characterized by less generous third-party coverage, leaving residents paying a larger share of their incomes for care than do urban residents. As a consequence, access to care is especially difficult for low-income and elderly people, heavily dependent upon government financing. Third-party payers have severely reduced cost shifting as a mechanism for taking care of the health care needs of a sizable share of the population, thereby placing providers in an uncomfortable position. Several potential and more formalized financing options for replacing cost shifting are discussed. Several important changes will take place with rural-focused legislation enacted in the late 1980s. These are used to present a rural financing research agenda for the 1990s.     

Effects of a Nutrition Workshop on Paraprofessional Assignment of Geriatric Nutrition Services

The use of dietary assessment techniques by non-nutrition professionals is necessary if the nutrition component of elderly assistance programs is to be fully utilized to the client's advantage. This study examined the impact of a one day nutrition education workshop on community based assessor's evaluation of nutrition needs and services in the home-bound elderly. At the beginning and end of the workshop, changes in a case study nutrition assessment and assignment of services were evaluated. This same procedure was also followed before and three months after the workshop, using client charts from the field. In both the workshop case study and the field chart review there was a significant increase in the detection of nutrition related problems and assignment of services for these problems after the nutrition education workshop.     

Telepsychiatry: Challenges in Rural Aging

A significant health care dilemma for older individuals living in rural areas is that at a time in life when there is, predictably, a greater need for medical services, the ability to access those limited services is markedly reduced. Telepsychiatry presents an innovative and cost-effective strategy for the provision of improved local access to quality mental health services for the underserved rural elderly. Telepsychiatry has demonstrated the potential to improve access to mental health services, provide those services in an affordable and cost-effective manner and deliver those services at a quality nearly equal to traditional face-to-face services. Advances in telepsychiatry technology allow a core group of skilled mental health providers in a central location to provide timely local access to quality services for the rural elderly over a broad geographic area.     

Effects of a nutrition workshop on paraprofessional assignment of geriatric nutrition services

The use of dietary assessment techniques by non-nutrition professionals is necessary if the nutrition component of elderly assistance programs is to be fully utilized to the client's advantage. This study examined the impact of a one day nutrition education workshop on community based assessor's evaluation of nutrition needs and services in the home-bound elderly. At the beginning and end of the workshop, changes in a case study nutrition assessment and assignment of services were evaluated. This same procedure was also followed before and three months after the workshop, using client charts from the field. In both the workshop case study and the field chart review there was a significant increase in the detection of nutrition related problems and assignment of services for these problems after the nutrition education workshop.     

Urgent tasks of rural public health

The fundamental guidelines for the complex development of rural health services are suggested: enhancing the capacity of multidisciplinary central regional hospitals, development of district hospitals, rural medical ambulatories, feldsher-midwifery units, emergency care services; the installation of appointments for family and workshop physicians, the provision of favourable terms for physicians working in rural areas, the introduction of radical economic reform into the system of public health. All this would promote the successful realization of new agrarian policy of CPSU.     

Rural hospitals and Spanish-speaking patients with limited English proficiency

Between 1990 and 2000, the Latino population in the United States increased by 61 percent, becoming the largest minority group. Language differences contribute to patient safety and access to healthcare concerns for limited English proficiency (LEP) Latinos. The objectives of this research were to determine the techniques rural hospitals use to accommodate Spanish-speaking LEP patients, to identify strengths and barriers to providing language services, and to describe local approaches to language assistance services. Surveys were mailed to 841 hospitals in 544 rural counties with moderate to high Latino growth rates between 1990 and 2000. A total of 319 rural hospitals responded. Nearly all rural hospitals reported having tools to help patients communicate language needs. The most commonly used tools include brochures, language identification posters, and language identification cards. Strengths were institutional support for language assistance services, staff willingness to use interpreters, and access to telephone language lines. Principal barriers included lack of funding for interpreters, lack of local language training programs, and lack of state agency support. Hospitals that serve counties with higher Latino population growth rates reported higher demand for services compared with those counties with smaller Latino population growth rates. Several innovative approaches were also identified. Various language accommodation resources, tools, and strategies are available for hospitals to help them serve LEP clientele. Hospitals should routinely review their policies and procedures for language assistance services to ensure compliance with federal and Joint Commission standards.     

地区、城乡差异性对老年人医疗服务可及性影响研究——基于2014年CLHLS数据

目的基于2014年CLHLS数据,分析老年人地区、城乡差异对医疗服务可及性影响。方法采用描述性统计方法对样本基本情况进行简单描述,基于Logit回归研究不同地区、城乡老年人与医疗服务可及性间的关系。结果不同地区老年人与医疗服务可及性的回归系数均为负值;城乡老年人与医疗服务可及性的回归系数为正值。结论东部地区老年人医疗服务可及性优于中西部地区老年人,城市老年人医疗服务可及性优于农村老年人。     

Ancillary Community Pharmacy Services Provided to Older People in A Largely Rural and Ethnically Diverse Region: A Survey of Consumers in West Texas

Little is known about the quality of pharmacy services provided to the rural elderly population. This exploratory study examines rural/urban and ethnic differences in perceived access to ancillary pharmacy services among elderly people. Two telephone surveys were conducted using directory listings in West Texas to generate a longitudinal sample. Persons aged 65 years and older who were not cognitively impaired were asked to complete the survey. The number of participants in both rounds of the survey was 3,689. Seven ancillary pharmacy services were examined: delivery of medications, medication counseling, written medication information, blood pressure monitoring, blood glucose monitoring, osteoporosis screening, and immunization. The sample was stratified by county of residence (urban, rural, or frontier) and racial/ethnic background. Chi-square tests were performed to detect rural/urban and racial/ethnic differences in access to the seven ancillary services. The association between proficiency in English and access to the services was also examined. Rural residents were more likely than urban residents to report that their pharmacies provide delivery of medications, medication counseling, and immunization services, but they were less likely than their urban counterparts to report that their pharmacies provide blood pressure monitoring. Access to ancillary pharmacy services was reported as poorer by older Hispanic people compared with non-Hispanics. Deficiency in English was significantly related to inequality in reported access to ancillary pharmacy services. It is essential to consider the special needs of rural and Hispanic elderly people to ensure equitable access to ancillary pharmacy services.     

Rural Health Research Community Perceptions of the Effects of Rural Hospital Closure on Access to Care

The purpose of this case study was to ascertain the perceptions of health professionals who were located in six rural communities where hospital closure occurred, regarding the impact of closure on community residents. These health professionals were asked to respond to questions about effects of hospital closures on the availability of medical services such as emergency care, physician services, hospital services and nursing home care. To control for trends in medical services utilization that were unrelated to hospital closure, the study design included comparison areas where similar hospitals remained open. A standardized questionnaire was administered to three health professionals in each of the areas that experienced a hospital closure and also in the matched comparison areas. Interviews of the health professionals in closure areas provide evidence suggestive of some perceived negative effects of hospital closure on these communities. These negative effects include difficulty recruiting and retaining physicians, concern of residents about the loss of their local emergency room, and increased travel times to receive hospital services. The perceived effects of closure appeared to be mediated by the distance required for travel to the nearest hospital. Respondents perceived increased travel times to most significantly affect vulnerable populations, such as the elderly, the disabled and the economically disadvantaged. Respondents in the majority of comparison areas also reported access barriers for vulnerable populations. These barriers primarily center on problems of obtaining transportation and enduring the rigors of travel. Improvements in the availability of transportation to medical care may offer some stabilization to communities where hospitals closed; however, it also is the case that transportation improvements are needed to increase access to care in rural communities where hospitals remained open.     

Rural hospital closures and access to services

This article examines the implications resulting from the closure of 25 rural hospitals during 1990. The implications are evaluated by estimating travel distance and time to the nearest open hospitals. In addition, the types of services offered in the hospitals studied were measured to provide a view of potential change in access to services. The average travel distance and time to the nearest hospital after closure was 25.7 miles and 30.2 minutes, respectively. In most cases, the remaining hospitals offered a broader scope of services than did the hospitals that closed. A possible interpretation is that the hospital closures resulted in a tradeoff between breadth of services and rapid access for emergency conditions.     

Orthopedic surgery in rural American hospitals: a survey of rural hospital administrators

Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states located in communities that met the criteria for a rural town according to the Rural Urban Commuting Area codes were included. A survey with topics including community and hospital demographics, orthopedic surgical workforce and demand, surgical services, and the perceived benefit of orthopedic services was sent to the hospital administrators. Results: Of the 223 rural hospitals surveyed, 145 completed the survey. Of those completing the survey, 30% had at least one full‐time orthopedic surgeon, 25% did not provide any orthopedic surgical services, 65% never had an orthopedic surgeon on ER call, 33% were recruiting an orthopedic surgeon, 52% stated that it is more difficult to recruit an orthopedic surgeon vs a general surgeon, and 71% of the administrators acknowledged a need for additional orthopedic surgical services in their community. For those hospitals that did not have a full‐time orthopedic surgeon, members of those communities traveled a mean distance of 55 miles for emergency orthopedic surgical care as reported by the hospital administrators. Conclusions: There are many rural communities that have limited access to orthopedic surgical services. While many of the rural hospital administrators feel that there is a need for additional orthopedic surgical services in their communities, it is difficult to recruit orthopedic surgeons to these areas.     

How Does Degree of Rurality Impact the Provision of Surgical Services at Rural Hospitals?

ABSTRACT:  Context: Rural residents frequently have decreased access to surgical services. Consequences of this situation include increased travel time and financial costs for patients. There are also economic implications for hospitals as they may lose revenue when patients leave the area in order to obtain surgical services. Rural communities vary in size and distance from more populated centers. Since rural hospitals are located in varying types of rural communities, they likely differ with regard to the provision of surgical care. Purpose: To describe the differences between hospitals located in smaller versus larger rural areas regarding the provision of surgical care. Methods: A 12-item survey instrument based on one previously used in a pilot study was mailed to a national random sample of rural hospital administrators (n = 233). Rural location was determined using rural-urban commuting area codes. Findings: One hundred and eleven surveys were received, yielding a 48% response rate. Hospitals in larger rural areas had an average of 9 surgeons compared to 1 at hospitals in smaller rural areas. More administrators at hospitals located in larger rural areas viewed the ability to provide surgical care as very important to the financial viability of their hospital. Conclusions: Among rural hospitals located in communities of varying sizes there are significant differences in how surgical services are delivered and the financial importance of providing surgical care. Administrators at hospitals located in larger rural areas, more than in smaller ones, report financial reliance on their ability to offer surgical care and have significantly more resources available to do so.     

The use of market research to design healthcare offerings. A case study of a senior citizen community

With a growing elderly population, there is little argument that the healthcare system in the United States must understand the needs and wants of its elderly consumers. This is especially important in a rural community where services can be limited and access to these services is difficult for consumers. Marketing research is one way in which rural healthcare facilities can gain market information not only to enhance their product offerings, but also to ensure that proper and sufficient services are provided. This article presents a case study of a long-term healthcare facility using marketing research.     

Primary Care Practice Management in Rural and Urban Veterans Health Administration Settings

Limited access to specialty care in rural settings may result in more expectations of primary care providers and a higher demand for primary care. The authors used survey and administrative data from 1999 from the Veterans Health Administration (VHA) to compare primary care practice management and performance in 19 rural to 103 urban VHA hospitals nationally. Rural VHA hospitals were smaller, less likely to be academically affiliated, and had fewer integrated specialty care services. Primary care providers in rural settings were more likely to manage specialty care services, provide continuity across patient care settings, and have complete responsibility for a broader range of services. However, rural hospitals had more staff per patient allocated to primary care than did urban hospitals. Patients in rural settings received comparable quality care to those in urban settings, and they appeared to be more satisfied with the care they received. Within the VHA system, primary care providers in rural settings provided a broader range of services than those in urban ones. This increased breadth may be attributable to the lack of availability of integrated specialty care services in rural settings. Because of this broader range of responsibilities, the provision of primary care in rural settings may require higher staffing patterns and may be inherently more costly than in urban settings; therefore, researchers should be cautious when comparing primary care expenditures across rural and urban settings.     

Satisfaction with HMO Coverage: An Empirical Study of a Medical School's Faculty,Staff, and Administrators

With a growing elderly population, there is little argument that the healthcare system in the United States must understand the needs and wants of its elderly consumers. This is especially important in a rural community where services can be limited and access to these services is difficult for consumers. Marketing research is one way in which rural healthcare facilities can gain market information not only to enhance their product offerings, but also to ensure that proper and sufficient services are provided. This article presents a case study of a long-term healthcare facility using marketing research.