March/April 2008 Annals of Family Medicine tip sheet

Approximately one third of patients living in rural areas bypass their local health care professionals and facilities and obtain medical care elsewhere, in part because of perceptions of limited local services and specialty care. According to a telephone survey of 1,264 adults living in rural areas, 32 percent bypassed local primary care. Notably, the researchers observed a wide variation in bypass rates in the 25 rural areas sampled, ranging from 9.4 percent to 66 percent. Compared with those who use services in their local community, bypassers were younger, had higher incomes, were more likely to have had inpatient care in the past year and were less satisfied with their local hospital. When asked why people might bypass local care, respondents cited lack of services or specialty care (50 percent), referral out of the community by their physician (19 percent), poor quality of care (15 percent) and poor reputation of local facilities (14 percent). Bypassers suggested measures their local hospitals could take to keep patients locally: add more specialty services (24 percent), add more physicians and services (17 percent), get better physicians (17 percent) and provide better customer service (11 percent).

The authors assert the wide variation in bypass rates suggest the need for local communities and facilities to develop tailored strategies that fit their unique circumstances and needs. They conclude that changing rural residents’ perception of their local care, helping them gain a better understanding of the function of primary care, and increasing the number of primary care physicians might help retain patients and keep rural communities healthy.

Bypass of Local Primary Care in Rural Counties: Effect of Patient and Community Characteristics
By Jiexin (Jason) Liu, Ph.D., M.B.A., M.S., et al

Adopting an American Diet Undesirable for Diabetic Latinos

Contrary to the common assumption that ethnic minority populations always benefit from acculturation to mainstream U.S. society, this study finds that acculturation among diabetic Latinos to the general U.S. culture is associated with adoption of some less desirable dietary habits. Analyzing nationally representative data on 467 Latino adults from the 1999-2004 National Health and Nutrition Examination Survey, researchers found more-acculturated Latinos were less likely to have diets high in fiber (9.4 vs. 35.4 percent) and lower in saturated fat (17.2 vs. 46.5 percent) than their less-acculturated counterparts. Acculturation, however, appeared to positively influence leisure time exercise habits, with more-acculturated individuals more likely to report leisure time exercise (59.2 vs. 19.3 percent). The proportion of those who smoked did not differ. The researchers conclude that when developing culturally sensitive health care programs, it is important to understand the complex process of acculturation and encourage patients to maintain healthy traditional behaviors while simultaneously adopting beneficial aspects of the mainstream culture.