Distance is Relative: Unpacking a Principal Barrier in Rural Healthcare

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.

Key results

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.

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Acknowledgements

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region (VRHRC-CR), and the VA Health Services Research and Development (HSR&D) Service, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) (HFP 04–149). Dr. Reisinger is supported by Research Career Development Award from the Health Services Research and Development Service, Department of Veterans Affairs (CD1 08-013-1).

The views expressed in this article are those of the authors and do not necessarily represent the views or policy of the Department of Veterans Affairs or the United States Government. This research was presented at the annual meeting of the Society of Applied Anthropology, March 2010, Merida, Mexico. The authors have no conflict of interests to report.

Author informationAuthors and Affiliations

VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR), Iowa City VA Medical Center, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246–2208, USA

Colin Buzza MSc, Sarah S. Ono PhD, Carolyn Turvey PhD, Stacy Wittrock MA, Matt Noble MPH, Gautam Reddy MPH, Peter J. Kaboli MD, MS & Heather Schacht Reisinger PhD

The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246–2208, USA

Sarah S. Ono PhD, Carolyn Turvey PhD, Peter J. Kaboli MD, MS & Heather Schacht Reisinger PhD

Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA

Carolyn Turvey PhD

Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

Peter J. Kaboli MD, MS & Heather Schacht Reisinger PhD

AuthorsColin Buzza MScView author publications

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Sarah S. Ono PhDView author publications

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Carolyn Turvey PhDView author publications

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Stacy Wittrock MAView author publications

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Matt Noble MPHView author publications

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Gautam Reddy MPHView author publications

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Peter J. Kaboli MD, MSView author publications

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Heather Schacht Reisinger PhDView author publications

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Correspondence to Heather Schacht Reisinger PhD.

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Buzza, C., Ono, S.S., Turvey, C. et al. Distance is Relative: Unpacking a Principal Barrier in Rural Healthcare. J GEN INTERN MED 26 (Suppl 2), 648 (2011). https://doi.org/10.1007/s11606-011-1762-1

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Published: 12 October 2011

DOI: https://doi.org/10.1007/s11606-011-1762-1