Original Research

Geographic disparities associated with travel to medical care and attendance in programs to prevent/manage chronic illness among middle-aged and older adults in Texas

AUTHORS

name here
Matthew Lee Smith1
PhD, MPH, CHES, Co-Director, Center for Population Health and Aging; Associate Professor, School of Public Health *

Samuel D Towne2 PhD, Assistant Professor

Caroline D Bergeron3 DrPH, Director

Donglan Zhang4 PhD, Assistant Professor

Carly McCord5 PhD, Research Assistant Professor

Nelda Mier6 PhD, Assistant Professor

Heather H Goltz7 PhD, Associate Professor

AFFILIATIONS

1 Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA; Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA; and College of Public Health, The University of Georgia, 100 Foster Rd, Athens, GA 30606, USA

2 Department of Health Management & Informatics, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA; Disability, Aging & Technology Faculty Cluster Initiative, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA; and School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA

3 Research and Evaluation, Bexar County Community Health Collaborative, 3010 N. St. Mary’s Street, Suite 1101, San Antonio, TX 78212, USA

4 College of Public Health, The University of Georgia, 100 Foster Rd, Athens, GA 30606, USA

5, 6 Texas A&M University, Adriance Lab Road, College Station, TX 77843, USA

7 College of Public Service, University of Houston Downtown, One Main Street, Suite C345E, Houston, TX 77002, USA

ACCEPTED: 13 August 2019


early abstract:

Introduction: Accessing care is challenging for adults with chronic conditions. The challenge may be intensified for individuals needing to travel long distances to receive medical care. Transportation difficulties are associated with poor medication adherence and delayed or missed care. This study investigated the relationship between those traveling greater distances for medical care and their utilization of programs to prevent and/or manage their health problems. It was hypothesized that those traveling longer distances for medical care attended greater chronic disease management programs.

Methods: Thirty six thousand households in nine counties of Central Texas received an invitation letter to participate in a mailed health assessment survey in English or Spanish. A total of 5,230 participants agreed to participate and returned the fully completed survey. To investigate distance traveled for medical services and participation in a chronic disease management program, the analyses were limited to 2,108 adults aged 51+ with one or more chronic conditions who visited a healthcare professional at least once in the past year. Other variables of interest included residential rurality, health status, and personal characteristics. The data were first analyzed using descriptive and bivariate analyses. Then, an ordinal logistic regression model was fitted to identify factors associated with longer distances traveled to medical services.  Additionally, a binary logistic regression model was fitted to identify factors associated with attending a chronic disease self-management program.

Results: Among 2,108 adults, rural participants (P<0.001), those with more chronic conditions (P<0.001), and those attending a chronic disease program (P=0.037) reported traveling farther distances to medical services. Participants with limited activity (P<0.001), those from urban counties (P=0.017), and those who traveled more miles (P=0.030) were more likely to attend a chronic disease program.

Conclusions: While further distances to healthcare providers was found to be a protective factor based on the utilization of community-based resources, rural residents were less likely to attend a program to better manage their chronic conditions, potentially choosing to use the long distance travel to address urgent medical needs versus to focus on prevention and management of their conditions. Important policy and programmatic efforts are needed to increase reach of chronic disease self-management programs and other community services and resources in rural areas and to reduce rural inequities.