Developing Policies Responsive to Barriers to Health Care Among Rural Residents: WhatDo We Need to Know?

Slifkin, Rebecca T.

doi:10.1111/j.1748-0361.2002.tb00933.x

Cited by 34 publications

(27 citation statements)

References 28 publications

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“…Research in Australia also suggests that patients from rural areas are more at risk of an ACS admission than those not in a rural area, implying access to primary care is an issue [7,18]. Slifkin reports that health care seeking behaviour may also differ between rural and urban residents [19]. Kirby et al identified that the location of services, lack of transport to services and waiting times for services were barriers to accessing primary health care in rural areas [2].…”

Section: Discussionmentioning

confidence: 99%

Community based service providers' perspectives on frequent and/or avoidable admission of older people with chronic disease in rural NSW: a qualitative study

Longman

Singer

Gao

et al. 2011

BMC Health Serv Res

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BackgroundFrequent and potentially avoidable hospital admission amongst older patients with ambulatory care sensitive (ACS) chronic conditions is a major topic for research internationally, driven by the imperative to understand and therefore reduce hospital admissions. Research to date has mostly focused on analysis of routine data using ACS as a proxy for 'potentially avoidable'. There has been less research on the antecedents of frequent and/or avoidable admission from the perspectives of patients or those offering community based care and support for these patients. This study aimed to explore community based service providers' perspectives on the factors contributing to admission among older patients with chronic disease and a history of frequent and potentially avoidable admission.Methods15 semi-structured interviews with community based providers of health care and other services, and an emergency department physician were conducted. Summary documents were produced and thematic analysis undertaken.ResultsA range of complex barriers which limit or inhibit access to services were reported. We classified these as external and internal barriers. Important external barriers included: complexity of provision of services, patients' limited awareness of different services and their inexperience in accessing services, patients needing a higher level or longer length of service than they currently have access to, or an actual lack of available services, patient poverty, rurality, and transport. Important internal barriers included: fear (of change for example), a 'stoic' attitude to life, and for some, the difficulty of accepting their changed health status.ConclusionsThe factors underlying frequent and/or potentially avoidable admission are numerous and complex. Identifying strategies to improve services or interventions for this group requires understanding patient, carer and service providers' perspectives. Improving accessibility of services is also complex, and includes consideration of patients' social, emotional and psychological ability and willingness to use services as well as those services being available and easily accessed.

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Section: Discussionmentioning

confidence: 99%

Community based service providers' perspectives on frequent and/or avoidable admission of older people with chronic disease in rural NSW: a qualitative study

Longman

Singer

Gao

et al. 2011

BMC Health Serv Res

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“…This finding may be salient primarily in rural areas where travel distances are greater, pharmacies are fewer, and public transportation is scarce. 20 …”

Section: Discussionmentioning

confidence: 99%

“…18,19 For people living in rural areas, deciding whether to fill a prescription may entail the additional considerations of travel inconvenience and transportation challenges posed by greater distances to pharmacies, as to all services, in rural areas. 20 Rates of primary medication non-adherence and its causes have not been studied in rural populations, to our knowledge.…”

mentioning

confidence: 99%

Primary Medication Adherence in a Rural Population: The Role of the Patient-Physician Relationship and Satisfaction with Care

Wroth¹,

Pathman

2006

The Journal of the American Board of Family Medicine

121

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Introduction: Although correlates of overall medication adherence have been studied, little is known about primary medication non-adherence-patients' failing to fill a prescription provided by a practitioner-and whether it relates to how patients view their physician, satisfaction with their care, and how easy or hard it is for them to travel for care.Methods: This study uses telephone survey data from adults in 150 rural counties in 8 southeastern states. Bivariate and multivariable analyses were used to identify factors associated with adults' selfreports of delaying or not filling prescriptions.Results: Of the 3926 respondents who had received care in the previous year, 894 (21.6%) reported that they had delayed or did not fill a prescription over that time. In multivariate analysis, delaying or not filling prescriptions was more common among respondents who were under age 65, African American, reported incomes less than $25,000, and reported fair or poor health. Non-adherence was also more common among patients who reported transportation problems, a lack of confidence in their doctor's ability to help them, a lack of satisfaction with the concern shown them by their physicians, and a lack of satisfaction with how welcome and comfortable they are made to feel by office staff. Conclusions: Prescription primary non-adherence is prevalent in the rural

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“…As an explanation, they suggest that "social values and norms associated with rural life may discourage the use of preventive services" (p. 208). The reason is that rural residents may "link the need for health care services with an inability to carry out normal role functions" (Slifkin, 2002). The idea is that, relative to urban residents, rural residents may be less likely to seek out medical care if they believe their ability to perform their roles is not significantly impaired, but they obtain medical care when problems are considered to be severe.…”

Section: Beliefs and Values Of Rural Versus Urban Areasmentioning

confidence: 99%

A New Institutional Economics Perspective on the Relationship Among Societal Values, Governance Structure and Access to Rural Health Care Services

James

2007

SSRN Journal

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According to New Institutional Economics, transactional activities, governance structures, institutions and beliefs and values are related hierarchally. Williamson (2000) formalizes this framework to show that each governing level must be aligned with the adjacent level for transaction costs to be minimized. This framework is applied to the question of balancing costs and access in health care. Transaction costs in providing health care services can be minimized if all hierarchal functions are aligned. Examining the highest level associated with beliefs and values reveals that the beliefs of people might not be fully consistent with the institutions and governance structures expected or advocated in the area of health care, particularly in the context of rural health care services.

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Developing Policies Responsive to Barriers to Health Care Among Rural Residents: WhatDo We Need to Know?

Cited by 34 publications

References 28 publications

Community based service providers' perspectives on frequent and/or avoidable admission of older people with chronic disease in rural NSW: a qualitative study

Community based service providers' perspectives on frequent and/or avoidable admission of older people with chronic disease in rural NSW: a qualitative study

Primary Medication Adherence in a Rural Population: The Role of the Patient-Physician Relationship and Satisfaction with Care

A New Institutional Economics Perspective on the Relationship Among Societal Values, Governance Structure and Access to Rural Health Care Services

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