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Access to Care

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Lack of health care options in rural communities poses substantial barriers to care for rural disabled adults

Many rural communities are designated "health professional shortage areas." They typically suffer from clinician shortages, few specialists, and fragile financial footing for existing providers. Also, many rural hospitals lack the professional and financial resources to care effectively for people with complex disabilities. The lack of health care options in rural communities poses substantial barriers to care for rural disabled adults, concludes a new study. A team led by Lisa I. Iezzoni, M.D., M.Sc., of Beth Israel Deaconess Medical Center, analyzed transcripts of focus groups in rural areas of Massachusetts and Virginia that included 35 disabled adults. These adults had sensory, physical, or psychiatric disabilities that ranged from blindness, limb amputation, and spinal cord injury to stroke, extreme obesity, and bipolar disorder.

Participants perceived rural areas to be generally less sensitive to disability access issues than urban areas. For example, they had substantial difficulties finding physicians who understood their disabilities. They also felt that they had to teach their local doctors about their underlying conditions. In addition, physicians' offices were sometimes located in old buildings that did not have wheelchair ramps, automatic doors, or other accessible equipment.

Many focus group participants said they needed to travel periodically to large medical centers to obtain necessary specialty care. However, many participants could not drive and rural public transportation was often inaccessible and unreliable. Participants were generally poor and either lacked health insurance or had Medicaid coverage, which complicated their search for primary care doctors willing to treat them. The study concludes that interventions addressing transportation and physical access are required to serve this population's health care needs. The study was supported by the Agency for Healthcare Research and Quality (HS10223).

See "Rural residents with disabilities confront substantial barriers to obtaining care," by Dr. Iezzoni, Mary B. Killeen, M.A., and Bonnie L. O'Day, Ph.D., in the August 2006 HSR: Health Services Research 41(4), pp. 1258-1275.

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