"We need to think about veterans who live in rural settings as a special population, and we need to carefully consider their needs when designing healthcare delivery systems," said study leader William B. Weeks, MD, MBA, a physician and researcher with the White River Junction VA Medical Center and Dartmouth Medical School. Senior author on the study was Jonathan B. Perlin, MD, PhD, VA's acting under secretary for health.
The study included 767,109 veterans who had used VA healthcare between 1996 and 1999. VA had then just begun setting up Community Based Outpatient Clinics (CBOCs) to provide primary care closer to home for rural veterans. Today there are nearly 700 CBOCs in VA's nationwide system, and recent recommendations from VA's Capital Asset Realignment for Enhanced Service (CARES) initiative call for the establishment of more than 150 additional CBOCs.
The new findings do not reflect the impact of existing CBOCs, said Weeks, but they do "validate that better access to care is needed in rural settings."
The new study is the first nationwide comparison of the health status of rural versus urban VA patients. The researchers used a questionnaire called the SF-36, which measures eight areas of physical and mental health. The average physical health score among rural veterans was around 33, compared to 37 for urban veterans. The disparity was somewhat less marked in mental health: Rural veterans scored 44.5, compared to 45.6 for urban veterans. The average score for all U.S. adults, young and old, is 50 for both the physical and mental component. Veterans tend to be in worse health than the general U.S. population, partly because on average they are older. The average age of VA patients in the study was 63.
The finding that rural veterans are in poorer health persisted even after researchers adjusted for socioeconomic factors that may tend to be different among rural and urban veterans, such as race, education or employment status.
Weeks said access to care may be a key factor in why rural veterans appear to be in poorer health. He said that in addition to establishing more clinics in rural areas, VA should consider coordinating services with Medicare or with other healthcare systems based in rural areas. He pointed out that while VA's CBOCs provide primary care, they may not fully address rural veterans' needs for specialty or hospital care.
EDITOR'S NOTE: Dr. Weeks' study appears in American Journal of Public Health, and is entitled, "Differences in Health-Related Quality of Life in Rural and Urban Veterans." October 2004, Vol. 94, No. 10. This study was funded by the Veterans Rural Health Care Initiative, White River Jct. VAMC and by the VA Outcomes Group Research, Health Services Research and Development.
Journal
American Journal of Public Health