title: Rural residents with disabilities confront substantial barriers to obtaining primary care.
abstract: OBJECTIVE
  To learn about the health care experiences of rural residents with disabilities.
  
  
  METHODS
  Rural areas in Massachusetts and Virginia.
  
  
  METHODS
  Local centers for independent living recruited 35 adults with sensory, physical, or psychiatric disabilities to participate in four focus group interviews.
  
  
  METHODS
  Verbatim transcripts of interviews were reviewed to identify major themes.
  
  
  RESULTS
  Interviewees described the many well-recognized impediments to health care in rural America; disability appears to exacerbate these barriers. Interviewees reported substantial difficulties finding physicians who understand their disabilities and sometimes feel that they must teach their local doctors about their underlying conditions. Interviewees described needing to travel periodically to large medical centers to get necessary specialty care. Many are poor and are either uninsured or have Medicaid coverage, complicating their searches for willing primary care physicians. Because many cannot drive, they face great difficulties getting to their local doctor and especially making long trips to urban centers. Available public transportation often is inaccessible and unreliable. Physicians' offices are sometimes located in old buildings that do not have accessible entrances or equipment. Based on their personal experiences, interviewees perceive that rural areas are generally less sensitive to disability access issues than urban areas.
  
  
  CONCLUSIONS
  Meeting the health care needs of rural residents with disabilities will require interventions beyond health care, involving transportation and access issues more broadly.
authors.affiliation: Harvard Medical School, 330 Brookline Avenue RO-137, Boston, MA 02215, USA.
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Iezzoni
authors.forename: Mary B
authors.initials: MB
authors.lastname: Killeen
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: O'Day
mesh_terms: D000328:Adult; D006233:Persons with Disabilities; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D011320:Primary Health Care; D012424:Rural Population; D014768:Virginia