Prevention

Rural family practice clinics often provide more preventive services than similar urban and suburban clinics

Lower use of health services in rural areas has been attributed to lower access to care in these areas. People living in rural areas must travel further to care facilities, and rural areas have fewer hospitals and physicians per capita than urban areas. However, once rural patients enter a family practice clinic, they often receive more preventive care services than patients in urban and suburban clinics, according to a study supported by the Agency for Healthcare Research and Quality (HS08776).

For the study, principal investigator Benjamin Crabtree, Ph.D., and his University of Nebraska colleagues interviewed 40 physicians and directly observed 1,230 patient encounters to calculate how many of 25 preventive services eligible patients received at 16 family practice clinics in Nebraska. Clinics varied in type (solo vs. group and independent vs. system-affiliated) as well as geography, with seven clinics in rural areas, six in suburban locations, and three in urban areas. No significant geographic differences were found for blood pressure monitoring, tobacco counseling, mammography, or Pap smears. However, doctors practicing in rural areas were significantly more likely to provide clinical breast exams, ask about family history of breast cancer, and administer influenza immunizations than physicians in urban areas. Rural physicians also were much more likely to provide cholesterol screening than suburban physicians.

In fact, rural physicians generally delivered the most preventive services and urban physicians the least. Unlike more transient urban and suburban doctors, many rural doctors and clinics had been in place longer and perhaps knew their patients and families better. Thus, they could more easily identify who needed a physical exam or who had a family history of cancer and conduct appropriate preventive services. Also, rural patients did not object to waiting longer, as long as they had more time with the doctor, while urban and suburban patients wanted short waits. Finally, urban and suburban clinics were part of networks that promoted efficiency and perhaps had less time for providing preventive services, which was not a factor for rural clinics.

See "Rural, urban, and suburban comparisons of preventive services in family practice clinics," by Louis G. Pol, Ph.D., Jenine Rouse, M.S., L.M.H.P., Stephen Zyzanski, Ph.D., and others, in the spring 2001 Journal of Rural Health 17(2), pp. 114-121.

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