Longer drive time to health services impacts COPD care for veterans
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SAN FRANCISCO — Longer drive times to health services impact COPD care access for U.S. veterans, researchers reported at the American Thoracic Society International Conference.
“Rural residents with COPD experience worse outcomes compared to patients who reside in urban areas,” Arianne K. Baldomero, MD, MS, assistant professor in pulmonary, allergy, critical care and sleep medicine at the Minneapolis VA Health Care System and University of Minnesota, Minneapolis, said during the presentation. “They have higher 30-day mortality, and those hospitalized with COPD exacerbations have increased frequency of COPD exacerbations and they have worse health status and more respiratory symptoms. Factors that lead to these poor outcomes are not well understood.”
The retrospective analysis included 281,597 veterans with newly diagnosed COPD from the national Veterans Health Administration database. Overall, 111,264 veterans were living in rural areas (mean age, 68 years; 96% men) and 170,333 were living in urban areas (mean age, 68 years; 95% men). Researchers assessed two predictor variables of rurality, based on patient’s geocoded residential address, and drive time to the closest VA facility for spirometry and pulmonary specialty care.
Fifty-six percent of veterans had pulmonary encounters.
Compared with those living in urban areas, veterans from rural areas experienced worse socioeconomic disadvantage and had longer drive times to the closest spirometry center (28 vs. 61 minutes) and pulmonary center (32 vs. 66 minutes).
Study models including drive time to the closest health care service more strongly predicted receipt of spirometry and pulmonary specialty clinic encounters compared with models of only rurality, Baldomero said.
Veterans with longer drive times had lower odds of spirometry and pulmonary encounters. Among veterans with drive times of 120 minutes or more living in urban or rural areas, the adjusted OR for spirometry was 0.67 and the adjusted OR for pulmonary specialty encounters was 0.7.
“In this national sample of veterans with COPD, drive time to health care services was independently associated with receipt of COPD care,” Baldomero said. “We need to consider drive times, in addition to rurality, when designing programs to help improve receipt of health care services among COPD patients.”