HISPANIC ETHNICITY, RURAL RESIDENCE, AND REGULAR SOURCE OF CARE

1
HISPANIC ETHNICITY, RURAL RESIDENCE, AND REGULAR
SOURCE OF CARE Rohrer JE, Kruse G, Zhang Y,
Journal of Community Health, Vol. 29,
No. 1, February 2004 Presentation by Professor
Rohrer
2
ABOUT DR. ROHRER

• Professor of health services research at Texas
  Tech
• Has published extensively in public health
• Author of a text on community health planning
  published by APHA
• Profiled as a pioneering author by Biomed
  Central

3
BACKGROUND

• Having a usual source-of-care helps facilitate
  use of medical care
• The Behavioral Risk Factor Surveillance System,
  the nations official survey for monitoring
  population health asks about usual source-of-care
  but not actual visits.
• Usual source-of-care has eclipsed the number of
  medical visits as a measure of access.

4
PURPOSE

• Identification of risk factors for not having a
  usual source-of-care (USC) is a public health
  responsibility because of its relevance to the
  access problem.
• Vulnerable populations such as residents of rural
  areas and Hispanics may be at risk for not having
  a USC
• The purpose of the study reported here was to
  test two hypotheses 1) that rural residence is
  associated with reduced odds of having a USC and
  2) that Hispanic ethnicity is associated with
  reduced odds of having a USC

5
Overview

• TT5000 Survey
• Sample of 5,000 elders residing in West Texas
• Survey of health status, demographics, health
  care accessibility and quality
• Including satisfaction with access to
  prescription drugs and specialists
• Relatively large of Hispanics and rural
  residents
• Key personnel
• James E. Rohrer, P.I.
• Ty Borders, Barbara Rohland, Tom Xu,
  co-investigators

6
TT5000 Methodology

• 65,000 household telephone listings
• 10 replications of 6,500 numbers
• Household screened for elderly person
• If more than 1, most recent birthday chosen
• Informed consent obtained
• MMSE used to screen for dementia

7
TT5000 Methodology, continued

• Participation rates
• Excluding eligible respondents who failed
  cognitive screener 72
• Accounting for 361 telephones not answered 75
• Potential biases
• Hispanics and other races potentially slightly
  under-represented
• Females probably slightly over-represented

8
BETWEEN HISPANIC AND NON HISPANIC WHITE

• YOUNGER
• LESS EDUCATION
• MORE URBAN
• LESS CHD, HYPERTENSION, ARTHRITIS, STROKE, COPD
• MORE DIABETES

9
THE SAMPLE

• About 40 were between 65 and 70 years old and
  slightly more than a quarter were between 71 and
  74 years old. Less than one fifth were over 75
  years of age.
• About 70 were female.
• About 65 were non-Hispanic white
• Slightly more than 10 were Hispanic
• Slightly less than half were living in urban
  counties

10
MORE DESCRIPTIVES

• Slightly more than 85 were on Medicare
• about 10 were on Medicaid
• About 30 had other insurance plans
• Just over 87 owned their homes
• income and educational levels were varied.
• About 50 were married.

11
MEDICAL SKEPTICISM

• One third believed that they could overcome most
  illness without help from a medical professional
• One third believed that home remedies were often
  better than drugs.
• Over 40 percent believed that their own behavior
  determines the rate of recovery from illness.
• Slightly more than half of the respondents
  believed that they understood their health better
  than doctors did.

12
USUAL SOURCE OF CARE

• PCT
  PCT
• YES
  NO
• Have a place to obtain
• medical services needed 94.32 5.68
• Have a personal doctor
• or nurse 86.96
  13.04

13
ADJUSTED ODDS USUAL PLACE

• Ethnicity AOR CI
  p
• Hispanic 0.51 0.320.82
  lt.01
• Other race 0.89 0.441.78
  .73
• White non-Hisp ref
• Urban (vs rural) 0.85 0.631.16
  .31

14
ADJUSTED ODDS OF HAVING PERSONAL MD OR NURSE

• AOR CI
  p
• Ethnicity
• Hispanic 0.63 0.450.88
  lt.01
• Other race 0.69 0.441.08
  0.10
• White not Hisp ref
• urban (vs rural) 0.91 0.741.13
  0.40

15
DISCUSSION

• Either a regular MD or a usual place can
  facilitate access to services.
• The number of medical visits and the number of
  clinical prevention services delivered are
  greater when people have a regular source-of-care
• Having a usual source of care may be more
  important than insurance coverage

16
DISCUSSION

• Medical skeptics were less likely to have a usual
  source of care
• Financially disadvantaged people were less likely
  to have a usual source of care

17
CONCLUSION

• Living in a rural county was not related to
  having a usual source of care.
• Hispanic seniors were less likely to have either
  a usual source of care than non-Hispanic Whites.
• Outreach efforts may be needed to establish and
  foster usual-care relationships between Hispanic
  seniors and clinics or other sources of care.