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URBA - RURAL DIFFEREn
URBA - RURAL DIFFEREn
URBA - RURAL DIFFEREn
ROBERT J. BUCHAA
Mississippi State University
ALEXA STUIFBERGE
University of Texas at Austin
BOIE J. CHAKRAVORTY
Tennessee State University
SUOJI WAG
Texas A&M University
LI ZHU
Texas A&M University System Health Sciences Center
MYUGSUK KIM
Texas A&M University
ABSTRACT
ITRODUCTIO
Methodology
The data presented in this study were collected in a
survey of 1,518 people with MS living in all 50 States. The
survey sample was identified using the membership of the
National Multiple Sclerosis Society (NMSS). This study
362 JHHSA WINTER 2006
Survey Sample
Initial contact was made with potential survey
respondents through a pre-notification letter that explained
the purpose of the study and included a toll free number for
respondents to call to participate in a computer-assisted
telephone interview. ZIP codes within the NMSS
membership data base were used to randomly select
potential survey respondents to receive pre-notification
letters until at least 500 participants completed telephone
interviews for each of the three geographic subgroups. The
survey process, which began in October, 2004 and was
completed in January, 2005, included mailing the pre-
notification letter to NMSS members in 10 sequential
waves until at least 500 participants completed telephone
interviews for each of the three geographic subgroups. A
total of 5,181 pre-notification letters were mailed, with 263
returned as undeliverable, and 1,518 NMSS members
completed the telephone survey (31 percent participation
rate). No respondent was barred from participating if 500
interviews had been completed for a geographic subgroup.
Telephone interviews were completed by 505
people with MS living in MSAs; 500 people with MS
living in rural areas, less than 50 miles from an MSA; and
513 people with MS living in rural areas more than 50
miles from an MSA. In the remainder of this paper we use
the term “urban” to refer to the MSA subgroup, “adjacent
rural areas” to refer to the rural areas less than 50 miles
JHHSA WINTER 2006 363
Survey Questionnaire
One section of the questionnaire focused on access
to health care, asking if there was one particular clinic,
health center, doctor’s office or other place that
respondents usually went if sick or needed advice about
their health. If there was not one place, respondents were
asked to explain why they did not have one usual source for
their medical care. The telephone interviewer then asked
about “the place you go most often for your routine or
regular medical care,” with a number of possible responses
(including “other”) provided by the interviewer.
The interviewer then asked people with MS about
“the place you go most often for your MS-focused medical
care,” with a number of possible responses (including
“other”) provided. The first option for a response provided
by the interviewer was “the same place I go for routine or
regular care.” The purpose of this question was to learn not
only where respondents went for their MS-focused care,
but also to determine any urban/rural differences in the
proportion of people with MS who received their MS-
JHHSA WINTER 2006 365
RESULTS
Table 1
Rural/Urban Comparisons of Health Care Locations
Routine Care*
Doctor's office or HMO 72.8% 67.7%a 55.3%a
General clinic/health center 17.2% 26.0% 37.4%
Hospital outpatient 6.4% 3.4% 3.5%
Hospital emergency room 1.0% 1.0% 1.6%
Other 2.6% 1.8% 2.4%
MS-Focused Care*
Doctor's office or HMO 43.2% 38.3% 32.0%a
Same place as routine care 22.4% 26.7% 34.2%
MS clinic/health center** 18.4% 17.9% 14.1%
Clinic or health center 6.1% 8.2% 10.7%
Hospital outpatient 6.1% 6.2% 4.6%
Other - neurologist 1.8% 0.8% 0.4%
Other - cannot Afford 1.2% 1.2% 3.0%
Other 1.0% 0.8% 1.0%
* For this survey question there were more than two possible responses. The
significance level reported in this table for this survey response resulted from a
Chi-square test that compared all possible categories for the survey response.
** Includes responses of "medical
university."
a
p <0.001; b p <0.01; c p <0.05
368 JHHSA WINTER 2006
Barriers to Care
The telephone interviewer also asked survey
participants if they had any difficulties getting health care
due to physical barriers in the environment, with the
responses given in Table 2. When asked about physical
barriers that interfered with access to health care facilities,
a significantly larger proportion of people with MS in
urban areas reported lack of accessible parking spaces (14.3
percent) compared to their counterparts in more remote
rural areas (8.4 percent). About 15 percent of respondents
in each geographic subgroup responded that they had
difficulty getting a health procedure because the medical
equipment did not accommodate their MS-related
impairments. For example, for those respondents who
reported these difficulties, more than 70 percent in each
geographic subgroup could not get on the exam table.
Access to Care
In addition, the telephone interviewer asked about
any barriers or obstacles experienced in obtaining needed
MS-related care. Table 3 shows that significantly smaller
proportions of people with MS in adjacent rural areas (44.9
percent) and more remote rural areas (43.6 percent)
reported no difficulty getting MS-related care than their
urban counterparts (52.9 percent). In contrast, people with
MS living in both rural subgroups were more than twice as
likely as people with MS in urban areas to report lack of
nearby or convenient facilities as a barrier to receiving MS-
related care. In addition, respondents from more remote
rural areas (26.8 percent) were significantly more likely to
report that lack of money was a barrier to MS-related care
than urban respondents (20.0 percent). The level of their
impairment was a barrier to MS-related care for a
significantly larger proportion of respondents in adjacent
rural areas (14.6 percent) compared to urban respondents
(10.2 percent).
JHHSA WINTER 2006 369
Table 2
Rural/Urban Comparisons of Physical Barriers to Care
Physical Barriers to
Health Facilities
No accessible parking 14.3% 11.0% 8.4%b
Doors too difficult to open 13.7% 16.0% 14.0%
Layout of facility difficult 10.3% 9.6% 8.4%
No transportation 9.7% 14.0%c 10.1%
Other barriers 7.9% 5.8% 5.7%
No ramp to building 5.9% 6.8% 8.6%
Other 8.9% 7.2% 7.0%
a
p <0.001; b p <0.01; c p <0.05
370 JHHSA WINTER 2006
Table 3
Rural/Urban Comparisons of Access to Care
a
p <0.001; b p <0.01; c p <0.05
JHHSA WINTER 2006 371
DISCUSSIO
REFERECES