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UI study: Access, insurance affect treatment for rural elderly with
IOWA CITY, Iowa -- The frequency with which elderly people with chronic
illness receive recommended preventive medical treatment depends upon their
insurance coverage, and that differs among rural and urban residents, according
to findings by University of Iowa researchers.
A survey of people over age 65 with chronic medical conditions from
10 urban counties and 12 rural counties in Iowa found that, though the
elderly do not get all the recommended preventive care for chronic conditions,
those who had only Medicare received the lowest amount of preventive treatment.
The frequency of preventive treatment for chronic conditions was highest
among the elderly who had either a health maintenance organization (HMO)
or fee-for-service supplemental insurance plan. Those living in rural areas
who supplemented their Medicare coverage with an HMO received more frequent
preventive treatment than those with other types of coverage.
The researchers interviewed 787 elderly people who lived at home and
had at least one of six common chronic conditions: arthritis, hypertension,
heart disease, diabetes, peptic ulcer, and emphysema or chronic bronchitis.
Preventive medical treatment for chronic conditions is somewhat different
from other types of preventive medicine. It is designed to prevent further
complications from the condition rather than to prevent the condition.
An example of preventive treatment would be periodic foot and eye examinations
and testing blood glucose control for a diabetic, Doebbeling said.
It is a combination of treatment and prevention, said Dr. Bradley Doebbeling,
UI professor of internal medicine, one of the authors of the study. The
research team was led by Dr. Kenneth Saag, former UI professor of internal
medicine and currently at the University of Alabama in Birmingham.
These findings, published in the July issue of the journal Medical Care,
may be more a reflection of access to care than of a specific type of insurance
plan, Doebbeling said.
"Physician resources are more limited in rural areas," he
said. "Those doctors are very busy and may be more likely to focus
on acute medical problems and their management than preventive treatment
for the elderly. In urban areas there are more physicians, they may not
be quite as busy and they have the time to focus on preventive treatment
for elderly people with chronic conditions."
Doebbeling speculated that if there were adequate availability of physicians
in both rural and urban communities, there would be no difference between
groups in the amount of preventive treatment received.
When the number of physicians in an area is limited and elderly patients
don't have a specific complaint, busy physicians without a preventive treatment
system -- some sort of check list of tests to do -- may not consider preventions
such as an eye test or foot exam for a diabetic. HMOs and group practices
more often have that sort of system, Doebbeling said.
9"It is becoming increasingly apparent that the best way to deliver
preventive services is to have a good system in place and an information
system to track the services provided," he said.
"This study is one of the first to show that there is a gap in
preventive medical services recommended for elderly with chronic illness
and what they receive. It argues that there should be a system in place
to track the services provided to the elderly with chronic conditions,"
The rural Iowa counties included in the study were Adams, Calhoun, Decatur,
Fremont, Keokuk, Pocahontas, Ringgold, Sac, Taylor, Van Buren, Wayne and
Worth. The urban counties were Black Hawk, Dallas, Dubuque, Johnson, Linn,
Polk, Pottawattamie, Scott, Warren and Woodbury.