The effect of place of residence on access to invasive cardiac services following acute myocardial infarction

Hassan, Ansar; Pearce, Neil; Mathers, Jim; Veugelers, Paul J.; Hirsch, Gregory M.; Cox, Jafna L.

doi:10.1016/s0828-282x(09)70062-5

Cited by 32 publications

(29 citation statements)

References 27 publications

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“…Our finding of decreased probability of in-person specialty pain care utilization as distance increases is consistent with those prior studies [15][16][17][18][19]. Among rural patients in North Carolina, increasing distance to care was conversely associated with regular and chronic care utilization, although not acute care utilization [19].…”

Section: Discussionsupporting

confidence: 90%

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Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

et al. 2016

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Abstract-In 2011, the Veterans Health Administration (VHA) implemented a pilot telementoring program across seven healthcare networks called the Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) for pain management. A VHA healthcare network is a group of hospitals and clinics administratively linked in a geographic area. We created a series of county-level maps in one network displaying (1) the location of Veterans with chronic pain, (2) VHA sites (i.e., coordinating center, other medical centers, outpatient clinics), (3) proportion of Veterans being seen in-person at pain specialty clinics, and (4) proportion of Veterans with access to a primary care provider participating in Pain SCAN-ECHO. We calculated the geodesic distance from Veterans' homes to nearest VHA pain specialty care clinics. We used logistic regression to determine the association between distance and Pain SCAN-ECHO primary care provider participation. Mapping showed counties closer to the Pain SCAN-ECHO coordinating center had a higher rate of Veterans whose providers participated in Pain SCAN-ECHO than those further away. Regression models within networks revealed wide heterogeneity in the reach of Pain SCAN-ECHO to Veterans with low spatial access to pain care. Using geographic information systems can reveal the spatial reach of technology-based healthcare programs and inform future expansion.

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Section: Discussionsupporting

confidence: 90%

“…Prior studies of utilization as a function of spatial access have focused on in-person specialty care [15][16][17][18][19]. Our finding of decreased probability of in-person specialty pain care utilization as distance increases is consistent with those prior studies [15][16][17][18][19].…”

Section: Discussionsupporting

confidence: 90%

Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

et al. 2016

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“…The geographic location of care for ACS also has been linked to barriers to timely access to evidence‐based medical care, to cardiac catheterization, and to increased mortality 9, 13, 14. This may be caused in part by concentration of specialty services and cardiac catheterization facilities in metropolitan centers 14.…”

Section: Introductionmentioning

confidence: 99%

“…This may be caused in part by concentration of specialty services and cardiac catheterization facilities in metropolitan centers 14. In addition, with wealth concentrated in metropolitan areas,15 the association of area median income with access to care and outcome of ACS may be modified by geographic location.…”

Section: Introductionmentioning

confidence: 99%

Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants

Fabreau

Leung

Southern

et al. 2016

JAHA

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BackgroundMetropolitan versus nonmetropolitan status and area median income may independently affect care for and outcomes of acute coronary syndromes. We sought to determine whether location of care modifies the association among area income, receipt of cardiac catheterization, and mortality following an acute coronary syndrome in a universal health care system.Methods and ResultsWe studied a cohort of 14 012 acute coronary syndrome patients admitted to cardiology services between April 18, 2004, and December 31, 2011, in southern Alberta, Canada. We used multivariable logistic regression to determine the odds of cardiac catheterization within 1 day and 7 days of admission and the odds of 30‐day and 1‐year mortality according to area median household income quintile for patients presenting at metropolitan and nonmetropolitan hospitals. In models adjusting for area income, patients who presented at nonmetropolitan facilities had lower adjusted odds of receiving cardiac catheterization within 1 day of admission (odds ratio 0.22, 95% CI 0.11–0.46, P<0.001). Among nonmetropolitan patients, when examined by socioeconomic status, each incremental decrease in income quintile was associated with 10% lower adjusted odds of receiving cardiac catheterization within 7 days (P<0.001) and 24% higher adjusted odds of 30‐day mortality (P=0.008) but no significant difference for 1‐year mortality (P=0.12). There were no differences in adjusted mortality among metropolitan patients.ConclusionWithin a universal health care system, the association among area income and receipt of cardiac catheterization and 30‐day mortality differed depending on the location of initial medical care for acute coronary syndromes. Care protocols are required to improve access to care and outcomes in patients from low‐income nonmetropolitan communities.

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“…1,[3][4][5] Urban-rural differences in mortality, morbidity, access to care, and cost of care have been studied in several clinical conditions, including diabetes, [7][8][9] prostate cancer, 10 stroke, 11 mental health, 12 and acute myocardial infarction. 13 …”

mentioning

confidence: 99%

Patterns of Care and Outcomes Differ for Urban Versus Rural Patients With Newly Diagnosed Heart Failure, Even in a Universal Healthcare System

Gamble

Eurich

Ezekowitz

et al. 2011

Circ: Heart Failure

104

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Background-Access to medical care differs between urban and rural residents, but the magnitude of these differences and whether they affect outcomes are unknown. We aimed to determine whether outcomes differ for patients with incident heart failure (HF) by urban-rural status. Methods and Results-This cohort study used administrative data from Alberta, Canada. Patients with incident HF were identified from April 1, 1999, to December 31, 2005, and followed for 1-year. Multivariable logistic regression was used to assess differences in 1-year outcomes after initial HF diagnosis in patients living in rural versus urban settings. We identified 72 043 patients with incident HF (mean age, 72Ϯ14; male sex, 50%) of whom 12 173 (17%) died and 29 074 (39%) were hospitalized within 1 year. Although crude all-cause 1-year mortality rates were higher in urban than in rural residents (17.3% versus 15.6%, PϽ0.001), after adjustment for comorbidities, no significant differences were observed (adjusted odds ratio [aOR], 0.95; 95% CI, 0.90 to 1.00). However, sex-specific analyses indicated that urban men had a significantly lower risk of mortality than rural men (aOR, 0.89; 95% CI, 0.83 to 0.96). In contrast, no difference was observed between urban and rural women (aOR, 1.02; 95% CI, 0.94 to 1.10). Urban patients were more likely to have office-based physician visits in the first year after HF diagnosis (aOR, 1.09; 95% CI, 1.02 to 1.17) and exhibited lower rates of hospitalization (aOR, 0.71; 95% CI, 0.68 to 0.74) and emergency department visits (aOR, 0.62; 95% CI, 0.60 to 0.65) than rural patients. Conclusions-Even within a universal healthcare system, there are differences in outcomes after HF diagnosis based on location of residence. Urban patients with HF are more likely to receive outpatient care and less likely to be hospitalized or present to the emergency department in the first year after diagnosis than rural patients with HF. (Circ Heart Fail. 2011;4:317-323.)

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The effect of place of residence on access to invasive cardiac services following acute myocardial infarction

Cited by 32 publications

References 27 publications

Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants

Patterns of Care and Outcomes Differ for Urban Versus Rural Patients With Newly Diagnosed Heart Failure, Even in a Universal Healthcare System

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