title: Realized access to physician services among the elderly in West Texas.
abstract: The purpose of this study is to identify populations in a sparsely populated region that are less likely to obtain medical care. We conducted a cross-sectional survey of more than 5,000 elderly persons who participated in telephone interviews after being identified through more than 65,000 calls to residential listings. Subjects were persons aged 65 years and older who resided in 108 counties in western Texas. The response rate was 72%. The probability of seeing a physician in the last 6 months for urban and rural residents was modeled using multiple logistic regression analysis. Among rural residents, characteristics that were significantly (p < 0.05) associated with not recently visiting a physician when health status is held constant included belief in home remedies, having less than a high school education, lack of health insurance, and low income. Among urban residents, Hispanic ethnicity and skepticism about medical care were negatively associated with having a recent visit, whereas being religious was positively associated. Despite the availability of Medicare coverage, several subgroups of the elderly population have impaired access to medical care in this sparsely populated region. Intensified outreach efforts are indicated.
authors.affiliation: Department of Health Services Research and Management, Texas Tech University Health Sciences Center, 3601 4th Street, Stop 8161, Lubbock, TX 79430, USA. jrohrer@ama.ttuhsc.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Rohrer
authors.forename: Gina
authors.initials: G
authors.lastname: Kruse
authors.forename: Tyrone
authors.initials: T
authors.lastname: Borders
authors.forename: Joel
authors.initials: J
authors.lastname: Kupersmith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013781:Texas; D014505:Urban Population / Q000706:statistics & numerical data*