PREVENTIVE CARE IN RURAL PRIMARY-CARE PRACTICE

Delivering preventive care in a primary care practice is often more di fficult for rural than for urban practices. First, rural compared with urban patients tend to be older, poorer, and less well insured, all c haracteristics associated with lower levels of preventive care. Second , there are many more patients per physician in rural than urban setti ngs. Third, the distance from sources of preventive care is much great er for rural than for urban people. Fourth, rural practices tend to be smaller, with fewer resources to perform high-quality preventive care . Long-term programs to increase recruitment and retention of primary care physicians and improve insurance coverage for rural people may ev entually improve preventive care utilization. A more immediate approac h is to change the organization of medical practice, including develop ing satellite clinics, redefining the roles of nurses and nurse practi tioners, and using organized systems within practices to reach and fol low-up underserved groups. Initial impressions from the North Carolina Prescribe for Health project indicate that an organized approach to p reventive care within physicians' offices may improve utilization of c arefully designed packages of preventive care. More information is nee ded to understand the differences among rural, urban, and suburban are as in delivering preventive care to primary care patients.