Journal article
Variation in Tertiary Prevention and Health Service Utilization among the Elderly: The Role of Urban-Rural Residence and Supplemental Insurance
Medical care, Vol.36(7), pp.965-976
07/01/1998
DOI: 10.1097/00005650-199807000-00004
PMID: 9674615
Abstract
Objectives. Tertiary prevention seeks to reduce chronic disease progression and illness-related dysfunction. Using the Aday-Andersen model, we evaluated the impact of predisposing, need, and enabling factors on tertiary prevention, hypothesizing that urban-rural geographic differences in delivery would be detected. Methods. A population-based telephone survey was conducted evaluating six common chronic indicator conditions: arthritis (n = 488), hypertension (n = 414), cardiac disease (n = 185), diabetes mellitus (n = 125), peptic ulcer disease (n = 125), and chronic obstructive pulmonary disease (n = 103). Subjects were 787 (70% women) home-dwelling elderly (age > 65 years) who had one or more of the indicator conditions and who resided in Iowa's 12 most rural and 10 most urban counties. Tertiary prevention measures included counseling for and/or treatment with: influenza and pneumococcal vaccination, smoking cessation, dietary modifications, exercise, drug side effects, chronic disease rehabilitation, aspirin/estrogen for cardiac disease, and foot/eye care for diabetes. Tertiary prevention scores were calculated to compare preventive services across disease categories and to examine relations, in particular, with enabling factors. Results. Education beyond high school, alcohol use, cigarette smoking, and medical specialist use were all significantly greater among urban residents, whereas home services use was greater among rural residents. Respondents with either health maintenance organization or fee-for-service supplemental coverage had higher tertiary prevention scores than respondents without supplemental coverage. After adjustment for the significant effects of the number of diseases, higher income, and place of residence, rural respondents having health maintenance organization supplemental coverage had higher (better) tertiary prevention scores than other respondents. Conclusions. In this community-based study of elderly, enrollment in an health maintenance organization plan, as opposed to a fee-for-service supplement to Medicare, increased tertiary prevention quality for rural but not for urban residents. This study emphasizes that additional research is needed to evaluate the importance of specific types of insurance coverage for preventive services among the elderly.
Details
- Title: Subtitle
- Variation in Tertiary Prevention and Health Service Utilization among the Elderly: The Role of Urban-Rural Residence and Supplemental Insurance
- Creators
- Kenneth G. Saag - University of IowaBradley N. Doebbeling - University of IowaJames E. Rohrer - University of IowaSheela Kolluri - University of IowaRachel Peterson - University of IowaMark E. Hermann - University of IowaRobert B. Wallace - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Medical care, Vol.36(7), pp.965-976
- DOI
- 10.1097/00005650-199807000-00004
- PMID
- 9674615
- NLM abbreviation
- Med Care
- ISSN
- 0025-7079
- eISSN
- 1537-1948
- Publisher
- J. B. Lippincott-Raven Publishers
- Language
- English
- Date published
- 07/01/1998
- Academic Unit
- Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984364411302771
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