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The Influence of Rural Versus Urban Residence on Utilization and Receipt of Care for Chronic Low Back Pain

Authors

  • Adam P. Goode PT, DPT, PhD,

    1.  Department of Community and Family Medicine, Duke University, Durham, North Carolina
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  • Janet K. Freburger PT, PhD,

    1.  Cecil G. Sheps Center for Health Services Research and Scientist, Institute on Aging, University of North Carolina, Chapel Hill, North Carolina
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  • Timothy S. Carey MD, MPH

    1.  Department of Medicine and Director, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
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  • Funding: Dr. Goode's work was supported by the Foundation for Physical Therapy for educational tuition during his PhD in epidemiology training at the University of North Carolina Gillings School of Global Public Health, by the NIH Loan Repayment Award (National Institute of Arthritis and Musculoskeletal and Skin Diseases Grant (1-L30-AR057661–01), and by the Agency for Health Care Research and Quality (AHRQ) K-12 Comparative Effectiveness Career Development Award grant number (HS19479–01). Drs. Freburger and Carey's work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant R01-AR051970). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the AHRQ or NIAMS.

  • Acknowledgments: We would like to thank Brooke S. Oravec, PT, DPT, for her assistance in editing the manuscript.

Adam P. Goode, PT, DPT, PhD, Department of Community and Family Medicine, Duke University, 2200 West Main Street, Durham, NC 27707; e-mail: adam.goode@duke.edu.

Abstract

Purpose: (1) To describe demographic and health-related characteristics among rural/urban residents with chronic low back pain (LBP); (2) To determine if the utilization of diagnostics and treatments differs between rural and urban residents with chronic LBP; and (3) To determine the association between rural/urban residence and health care provider usage and if associations differ by race or gender.

Methods: A 2006 cross-sectional telephone survey of a representative sample of North Carolina residents. Subjects with chronic LBP were questioned regarding their health and health care use. Wald and chi-square tests were used to determine differences between demographic and health-related characteristics of rural/urban residents. Logistic regression was used to determine the association between rural/urban residence and health care provider use. Differences in race or gender were explored with stratified analysis with a P < .10.

Findings: 588 residents of North Carolina with self-reported chronic LBP sought care from a provider in the previous year. In bivariate analyses, when compared to urban residents, rural residents were younger, more likely to be uninsured, reported significantly higher levels of disability, and reported more depression/sadness. Rural residents were less likely to receive care from a rheumatologist (adjusted odds ratio [aOR] 0.47 [95% CI, 0.22-0.99]). Rural blacks were less likely to receive care from a physical therapist when compared to urban blacks (aOR 0.26 [95% CI, 0.07-0.87]).

Conclusion: Despite similarities of high provider use, imaging and therapeutics, when compared to urban residents, rural residents reported higher levels of functional limitation and depression.

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