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By Emma Patten-Hitt, PhD
NEW YORK, Mar 21 (Reuters Health) - Even simple treatments like giving aspirin to heart attack patients are sometimes neglected in rural hospitals, according to a new study, suggesting that standards of care may be lower in rural hospitals compared with their big-city counterparts.
"There is really an urgent need for quality of care provided in a rural setting," Dr. Kazim Sheikh told Reuters Health. "It's not just for treatment of (heart attack) either," he said. "Studies have also found similar differences in patient care for other heart conditions, as well as care for diabetes in the outpatient setting," he said.
Sheikh and colleague Claudia Bullock, from the Health Care Financing Administration in Kansas City, Missouri, looked at the medical records of over 2,500 Medicare patients who had been treated for heart attack in 12 urban, 31 semirural and 76 rural hospitals in Kansas.
The investigators found that heart attack patients were more likely to get standard treatments such as aspirin, heparin (a clot-preventing drug), and intravenous nitroglycerin (a drug for chest pain) in the urban hospitals, compared with patients in semirural hospitals.
Patients were even less likely to get the treatments in rural hospitals compared with semirural hospitals, the researchers report in the March 12th issue of the Archives of Internal Medicine.
Sheikh pointed out that patients from small community hospitals are often transferred to better-equipped and better-staffed urban hospitals. "In some cases it make sense when specialized procedures are required, but in many cases, standards in rural hospitals could be improved," he added.
Overall, one third of elderly Medicare patients with heart attack did not receive aspirin within the first 2 days of being in the hospital, half did not receive beta-blockers (blood pressure-lowering drugs) at discharge, and 24% did not receive blood-thinning drugs.
But "failure to adhere to the clinical guidelines was much more severe in small rural hospitals," Sheikh and Bullock write.
The length of stay in rural hospitals was also much shorter than that in urban hospitals and there were fewer cardiologists in rural counties than in urban areas of Kansas, according to the authors.
Relatively poor quality of healthcare in rural areas might be due to "poor access to health care, poor access to medical education, delays in initiating critical therapy, and to rural hospitals being accustomed to providing 'charity' care," the researchers note.
"I think one solution would be for small community hospitals in the same area to partner with each other and come to an agreement about sharing the patients and services," Sheikh said.
SOURCE: Archives of Internal Medicine 2001;161:737-743.
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