Excerpt

Approximately 3 million veterans, slightly more than one-third of all veterans enrolled in the Department of Veterans Affairs (VA) health care system, live in rural areas. This pattern is likely to continue, as a comparable proportion of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans are from rural areas. The Rural Veterans Care Act of 2006 was signed into law to improve care for rural veterans. Ensuring that the health care needs of rural veterans are met has become a top priority for VA, resulting in a considerable expansion of community based outpatient clinics (CBOCs), inclusion of rural health/access as a research priority, and creation of the VA Office of Rural Health (ORH) in 2006.

Although there have been reports comparing health quality of life (both physical and mental) for rural and urban veterans, it remains unclear whether the observed lower health quality of life in rural veterans is due to disparities in health care, differences in disease prevalence, or other population differences. This systematic review examines the evidence regarding potential disparities between rural and urban areas in health care provision and delivery, and how differences in health care may contribute to disparities in health outcomes. Differences in rural-urban prevalence rates of diseases and other health conditions are beyond the scope of this review. Because veterans who use VA health care have been found to use more non-VA health care overall, we expanded the focus of this review to include comparisons of rural vs. urban health care in non-VA health systems.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
  • FUTURE RESEARCH
• INTRODUCTION
  • BACKGROUND
  • DEFINITIONS OF RURALITY
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • PREVENTIVE CARE/AMBULATORY CARE SENSITIVE CONDITIONS
  • CANCER CARE
  • DIABETES/END STAGE RENAL DISEASE
  • CARDIOVASCULAR DISEASE
  • HIV/AIDS
  • NEUROLOGIC CONDITIONS
  • MENTAL HEALTH
  • PROCESSES OR STRUCTURE OF CARE
• SUMMARY AND DISCUSSION
  • CONCLUSIONS AND RECOMMENDATIONS
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • RESEARCH IMPLICATIONS AND RECOMMENDATIONS
• REFERENCES
• APPENDIX A DATA ABSTRACTION FORM
• APPENDIX B PEER REVIEW COMMENTS AND AUTHOR RESPONSES
• APPENDIX C EVIDENCE TABLES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center, Minneapolis, MN, Timothy J. Wilt, MD, MPH, Director

Suggested citation:

Spoont M, Greer N, Su J, Fitzgerald P, Rutks I, and Wilt TJ. Rural vs. Urban Ambulatory Health Care: A Systematic Review. VA-ESP Project #09-009;2011.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Minneapolis VA Medical Center, Minneapolis, MN funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.