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A
study of more than 767,000 veterans by Veterans Affairs
researchers shows those in rural areas are in poorer health than
their urban counterparts. The findings validate recent and
ongoing VA efforts to expand health care for rural patients.
October 6, 2004 — A study of more than 767,000 veterans by Veterans
Affairs researchers shows those in rural areas are in poorer health than
their urban counterparts. The findings, reported in the October
American Journal of Public Health, validate recent and ongoing VA
efforts to expand health care for rural patients.
“We need to think about veterans who
live in rural settings as a special population, and we need to carefully
consider their needs when designing healthcare delivery systems,” said
study leader William B. Weeks, MD, MBA, a physician and researcher with
the White River Junction VA Medical Center and Dartmouth Medical School.
Senior author on the study was Jonathan B. Perlin, MD, PhD, VA’s acting
under secretary for health.
The study included 767,109 veterans
who had used VA healthcare between 1996 and 1999. VA had then just begun
setting up Community Based Outpatient Clinics (CBOCs) to provide primary
care closer to home for rural veterans. Today there are nearly 700 CBOCs
in VA’s nationwide system, and recent recommendations from VA’s Capital
Asset Realignment for Enhanced Service (CARES) initiative call for the
establishment of more than 150 additional CBOCs.
The new findings do not reflect the
impact of existing CBOCs, said Weeks, but they do “validate that better
access to care is needed in rural settings.”
The new study is the first nationwide
comparison of the health status of rural versus urban VA patients. The
researchers used a questionnaire called the SF-36, which measures eight
areas of physical and mental health. The average physical health score
among rural veterans was around 33, compared to 37 for urban veterans.
The disparity was somewhat less marked in mental health: Rural veterans
scored 44.5, compared to 45.6 for urban veterans. The average score for
all U.S. adults, young and old, is 50 for both the physical and mental
component. Veterans tend to be in worse health than the general U.S.
population, partly because on average they are older. The average age of
VA patients in the study was 63.
The finding that rural veterans are in
poorer health persisted even after researchers adjusted for
socioeconomic factors that may tend to be different among rural and
urban veterans, such as race, education or employment status.
Weeks said access to care may be a key
factor in why rural veterans appear to be in poorer health. He said that
in addition to establishing more clinics in rural areas, VA should
consider coordinating services with Medicare or with other healthcare
systems based in rural areas. He pointed out that while VA’s CBOCs
provide primary care, they may not fully address rural veterans’ needs
for specialty or hospital care.
EDITOR’S NOTE: Dr. Weeks’ study
appears in American Journal of Public Health, and is entitled,
"Differences in Health-Related Quality of Life in Rural and Urban
Veterans." October 2004, Vol. 94, No. 10. This study was funded by the
Veterans Rural Health Care Initiative, White River Jct. VAMC and by the
VA Outcomes Group Research, Health Services Research and Development.
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