Rural, Suburban, and Urban Differences in Factors That Impact Physician Adherence to Clinical Preventive Service Guidelines

Details

• Alternative Title:
  J Rural Health
• Personal Author:
  Khoong, Elaine C. ; Gibbert, Wesley S. ; Garbutt, Jane M. ; Sumner, Walton ; Brownson, Ross C.
• Description:
  Purpose
  
  Rural-urban disparities in provision of preventive services exist, but there is sparse research on how rural, suburban, or urban differences impact physician adherence to clinical preventive service guidelines. We aimed to identify factors that may cause differences in adherence to preventive service guidelines among rural, suburban, and urban primary care physicians.
  
  Methods
  
  This qualitative study involved in-depth semi-structured interviews with 29 purposively sampled primary care physicians (10 rural, 10 suburban, 9 urban) in Missouri. Physicians were asked to describe barriers and facilitators to clinical preventive service guideline adherence. Using techniques from grounded theory analysis, 2 coders first independently conducted content analysis then reconciled differences in coding to ensure agreement on intended meaning of transcripts.
  
  Findings
  
  Patient epidemiologic differences, distance to health care services, and care coordination were reported as prominent factors that produced differences in preventive service guideline adherence among rural, suburban, and urban physicians. Epidemiologic differences impacted all physicians, but rural physicians highlighted the importance of occupational risk factors in their patients. Greater distance to health care services reduced visit frequency and was a prominent barrier for rural physicians. Care coordination among health care providers was problematic for suburban and urban physicians. Patient resistance to medical care and inadequate access to resources and specialists were identified as barriers by some rural physicians.
  
  Conclusions
  
  The rural, suburban, or urban context impacts whether a physician will adhere to clinical preventive service guidelines. Efforts to increase guideline adherence should consider the barriers and facilitators unique to rural, suburban, or urban areas.
  
  
• Subjects:
  Article Female Guideline Adherence Health Disparities Humans Interviews As Topic Male Middle Aged Missouri Physician's Practice Patterns Practice Guidelines As Topic Preventive Health Services Primary Health Care Qualitative Research Rural Rural Health Services Suburban Health Services Urban Health Services

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• Source:
  J Rural Health. 30(1):7-16.
• Pubmed ID:
  24383480
• Pubmed Central ID:
  PMC3882340
• Document Type:
  Journal Article
• Funding:
  DP000060-04/DP/NCCDPHP CDC HHS/United States ; TL1 RR024995/RR/NCRR NIH HHS/United States ; TL1 TR000449/TR/NCATS NIH HHS/United States ; TL1RR024995/RR/NCRR NIH HHS/United States ; U48 DP000060/DP/NCCDPHP CDC HHS/United States ; U48/DP001903/DP/NCCDPHP CDC HHS/United States ; UL1 RR024992/RR/NCRR NIH HHS/United States ; UL1 TR000448/TR/NCATS NIH HHS/United States ; UL1RR024992/RR/NCRR NIH HHS/United States
• Volume:
  30
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:134a27803ed817be25cfc96ca113acb6eb57e9751c85f385debdc3e9854eaab8
• Download URL:
  https://stacks.cdc.gov/view/cdc/29818/cdc_29818_DS1.pdf
• File Type:
  [PDF - 177.24 KB ]