The effects of geography and spatial behavior on health care utilization among the residents of a rural region
The effects of geography and spatial behavior on health care utilization among the residents of a rural region
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DOI：
10.1111/j.1475-6773.2005.00346.x
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发表时间：
2005-02-01
影响因子：
3.4
通讯作者：
Perin, J
中科院分区：
文献类型：
--
作者：
Arcury, TA;Gesler, WM;Perin, J
目标。在控制人口、社会、文化和健康状况等因素的情况下，确定了地理和空间行为在农村卫生保健利用中作为诱发因素和促进因素的重要性。数据源。对北卡罗来纳州阿巴拉契亚地区12个乡村县的1059名成年人进行了调查。研究设计。本横断面研究采用按县和种族分层的三阶段抽样设计。卫生服务利用的初步分析比较了过去12个月内定期检查、慢性护理和急性护理的卫生保健就诊次数的加权比例，涵盖了地理、社会人口、文化和健康变量。多变量logistic模型确定了卫生服务利用的独立相关因素。数据收集方法。受访者回答了标准的调查问题。他们确定了他们从事与健康有关的正常日常活动的地点；这些数据被输入地理信息系统进行分析。主要的发现。在双变量分析中，一些地理和空间行为因素，包括拥有驾驶执照、使用提供的交通工具和定期护理的距离，与定期检查和慢性护理的医疗保健利用显著相关。在多变量模型中，拥有驾驶执照和定期护理的距离仍然很重要，还有一些因素（年龄、性别、种族）、能力（家庭收入）和需求（身心健康措施、条件数量）也很重要。地理因素作为诱发因素和促成因素，与定期体检和慢性护理相关，但与急症护理访问无关。这些结果表明，地理和空间行为因素在农村卫生保健利用中的重要性。它们还表明，农村医疗保健利用方面持续存在的不平等现象，必须在公共政策中加以解决。
Objective. This analysis determines the importance of geography and spatial behavior as predisposing and enabling factors in rural health care utilization, controlling for demographic, social, cultural, and health status factors.Data Sources. A survey of 1,059 adults in 12 rural Appalachian North Carolina counties.Study Design. This cross-sectional study used a three-stage sampling design stratified by county and ethnicity. Preliminary analysis of health services utilization compared weighted proportions of number of health care visits in the previous 12 months for regular check-up care, chronic care, and acute care across geographic, sociodemographic, cultural, and health variables. Multivariable logistic models identified independent correlates of health services utilization.Data Collection Methods. Respondents answered standard survey questions. They located places in which they engaged health related and normal day-to-day activities; these data were entered into a geographic information system for analysis.Principal Findings. Several geographic and spatial behavior factors, including having a driver's license, use of provided rides, and distance for regular care, were significantly related to health care utilization for regular check-up and chronic care in the bivariate analysis. In the multivariate model, having a driver's license and distance for regular care remained significant, as did several predisposing (age, gender, ethnicity), enabling (household income), and need (physical and mental health measures, number of conditions). Geographic measures, as predisposing and enabling factors, were related to regular check-up and chronic care, but not to acute care visits.Conclusions. These results show the importance of geographic and spatial behavior factors in rural health care utilization. They also indicate continuing inequity in rural health care utilization that must be addressed in public policy.