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 nation’s 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 0.32–0.82 <.01 Other race 0.89 0.44–1.78 .73 White non-Hisp ref Urban (vs rural) 0.85 0.63–1.16 .31

14. ADJUSTED ODDS OF HAVING PERSONAL MD OR NURSE AOR CI p Ethnicity Hispanic 0.63 0.45–0.88 <.01 Other race 0.69 0.44–1.08 0.10 White not Hisp ref urban (vs rural) 0.91 0.74–1.13 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.