Choice of telemedicine and nurse practitioner in rural areas: The role of health status.

Increased access to rural primary care is associated with decreased mortality and morbidity and increased consumer involvement in local health system development. Efforts to increase access to primary care in rural underserved areas may be more successful if policymakers, were more aware of public preferences for type of provider and the relationship between health status and provider preference. Preference for four provider types suitable for rural primary care were examined in this study, including an out-of-town physician, an itinerant physician, a nurse practitioner, and telemedicine. Data for this dissertation were derived from a parent study funded by the Health Care Financing Administration. A two-stage probability sample was used to select 334 residents from two rural counties in Georgia who participated in two waves of in-home interviews before and after telemedicine was established. Respondents were rank-ordered their preferences among four provider types for each of ten presenting health problems. Declines in physical or mental health were hypothesized to be associated with preference for telemedicine when health problems are of low or moderate levels of complexity, and for an out-of-town physician for problems of high complexity. Conversely, respondents in stable or improved physical or mental health were expected to prefer either the nurse practitioner or itinerant physician for low and moderately complex problems, and either telemedicine or the out-of-town physician for high complexity problems. Multiple logistic regression was used to test hypotheses. In all cases, the null hypothesis could not be rejected. Although changes in health status were not associated with changes in preference as hypothesized, some relationships between health status and provider preference were observed, but the results were not conclusive. Respondents in declining physical health preferred nurse practitioner-based care for low and high complexity problems. Between Times 1 and 2, preference for telemedicine for low and medium complexity problems increased significantly. The data demonstrated that rural residents of Georgia were open to a variety of options for providing primary care services and, in particular, favored nurse practitioners and telemedicine-based care.PhDHealth and Environmental SciencesHealth care managementNursingPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131629/2/9929807.pd