Distance is Relative: Unpacking a Principal Barrier in Rural Healthcare
Distance is Relative: Unpacking a Principal Barrier in Rural Healthcare
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DOI：
10.1007/s11606-011-1762-1
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发表时间：
2011-11-01
影响因子：
5.7
通讯作者：
Reisinger, Heather Schacht
中科院分区：
文献类型：
--
作者：
Buzza, Colin;Ono, Sarah S.;Reisinger, Heather Schacht
背景：距离医疗保健服务是一个已知的障碍。然而，距离在多大程度上是一个障碍并没有得到很好的描述。距离可能会影响不同的患者以不同的方式和介导的医疗need.OBJECTIVE的背景下：确定相关因素的距离，阻碍获得照顾农村veterinary.APPROACH：混合方法的方法，包括调查，深入访谈，并在15退伍军人健康管理局（VHA）在8个中西部州的初级保健诊所焦点小组。调查数据进行了汇编和采访转录和编码的专题contents.PARTICIPANTS：调查完成了96例患者和88供应商/工作人员。42名患者和64名供应商/工作人员完成了深入访谈。共召集了7个由提供者和工作人员组成的重点小组。关键结果：距离被患者，提供者和工作人员确定为农村退伍军人寻求医疗保健的最重要障碍。深入访谈揭示了护理障碍的具体例子，如长途旅行的共同诊断服务，常规专科护理和紧急服务。加重这些障碍影响的患者因素包括健康状况、功能障碍、旅行费用以及工作或家庭义务。供应商和工作人员报告的挑战，医疗服务，由于distance.CONCLUSIONS：距离作为一个障碍，医疗保健没有统一的定义。相反，其重要性是相对于病人的健康状况和资源，提供的服务的复杂性，以及所需服务的紧迫性。改善交通、灵活的收费服务、更有条理的沟通机制以及与社区资源的整合将改善农村退伍军人获得护理的机会和整体健康状况。
BACKGROUND: Distance to healthcare services is a known barrier to access. However, the degree to which distance is a barrier is not well described. Distance may impact different patients in different ways and be mediated by the context of medical need.OBJECTIVE: Identify factors related to distance that impede access to care for rural veterans.APPROACH: Mixed-methods approach including surveys, in-depth interviews, and focus groups at 15 Veterans Health Administration (VHA) primary care clinics in 8 Midwestern states. Survey data were compiled and interviews transcribed and coded for thematic content.PARTICIPANTS: Surveys were completed by 96 patients and 88 providers/staff. In-depth interviews were completed by 42 patients and 64 providers/staff. A total of 7 focus groups were convened consisting of providers and staff. KEYRESULTS: Distance was identified by patients, providers, and staff as the most important barrier for rural veterans seeking healthcare. In-depth interviews revealed specific examples of barriers to care such as long travel for common diagnostic services, routine specialty care, and emergency services. Patient factors compounding the impact of these barriers were health status, functional impairment, travel cost, and work or family obligations. Providers and staff reported challenges to healthcare delivery due to distance.CONCLUSIONS: Distance as a barrier to healthcare was not uniformly defined. Rather, its importance was relative to the health status and resources of patients, complexity of service provided, and urgency of service needed. Improved transportation, flexible fee-based services, more structured communication mechanisms, and integration with community resources will improve access to care and overall health status for rural veterans.