Funding: This project was funded in part by cooperative agreement number U48/DP001903 from the CDC, Prevention Research Centers Program. It was also supported in part by the National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH, through Grants TL1RR024995 and UL1RR024992. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors have no disclosures to report.
Rural, Suburban, and Urban Differences in Factors That Impact Physician Adherence to Clinical Preventive Service Guidelines
Article first published online: 23 MAY 2013
© 2013 National Rural Health Association
The Journal of Rural Health
Volume 30, Issue 1, pages 7–16, Winter 2014
How to Cite
Khoong, E. C., Gibbert, W. S., Garbutt, J. M., Sumner, W. and Brownson, R. C. (2014), Rural, Suburban, and Urban Differences in Factors That Impact Physician Adherence to Clinical Preventive Service Guidelines. The Journal of Rural Health, 30: 7–16. doi: 10.1111/jrh.12025
Acknowledgments: We would like to thank Dr. Jay Piccirillo for his feedback on study design and implementation; many individuals that assisted with recruitment of participants; and the physicians who shared their time with us.
- Issue published online: 2 JAN 2014
- Article first published online: 23 MAY 2013
- CDC, Prevention Research Centers Program. Grant Number: U48/DP001903
- National Center for Research Resources
- National Center for Advancing Translational Sciences, NIH. Grant Numbers: TL1RR024995, UL1RR024992
- guideline adherence;
- health disparities;
- preventive health services;
Rural-urban disparities in provision of preventive services exist, but there is sparse research on how rural, suburban, or urban differences impact physician adherence to clinical preventive service guidelines. We aimed to identify factors that may cause differences in adherence to preventive service guidelines among rural, suburban, and urban primary care physicians.
This qualitative study involved in-depth semistructured interviews with 29 purposively sampled primary care physicians (10 rural, 10 suburban, 9 urban) in Missouri. Physicians were asked to describe barriers and facilitators to clinical preventive service guideline adherence. Using techniques from grounded theory analysis, 2 coders first independently conducted content analysis then reconciled differences in coding to ensure agreement on intended meaning of transcripts.
Patient epidemiologic differences, distance to health care services, and care coordination were reported as prominent factors that produced differences in preventive service guideline adherence among rural, suburban, and urban physicians. Epidemiologic differences impacted all physicians, but rural physicians highlighted the importance of occupational risk factors in their patients. Greater distance to health care services reduced visit frequency and was a prominent barrier for rural physicians. Care coordination among health care providers was problematic for suburban and urban physicians. Patient resistance to medical care and inadequate access to resources and specialists were identified as barriers by some rural physicians.
The rural, suburban, or urban context impacts whether a physician will adhere to clinical preventive service guidelines. Efforts to increase guideline adherence should consider the barriers and facilitators unique to rural, suburban, or urban areas.