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APHA Scientific Session and Event Listing

Recorded presentation

Brenda R. Wamsley, PhD, Department of Social Work, West Virginia State University, 928 Wallace Hall, P.O. Box 1000, Institute, WV 25112, 304-766-5240, wamsleyb@wvstateu.edu, Hongdao Meng, PhD, Department of Preventive Medicine, Stony Brook University, HSC, Level 3, Rm 071, Stony Brook, NY 11794-8338, Bruce Friedman, PhD, MPH, Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue Box 644, Rochester, NY 14642, and Gerald Eggert, PhD, Rural Health Consultant, 28 Lawton Street, Rochester, NY 14607.

Although primary prevention of debilitating disease is an overarching goal of public health, priority must also be given to improving the lives of those already suffering from chronic health conditions. Self-management approaches offer the potential to slow functional decline among older adults with progressive chronic diseases and thereby reduce a growing burden on the Medicare system, the major health insurer in rural communities.

A previous analysis used data from the Medicare Primary and Consumer-Directed Care Demonstration to examine the impact of 1) a primary care affiliated Health Promotion Nurse, 2) a consumer-directed Voucher for in-home care, and 3) their Combination on functional change among rural Medicare beneficiaries at 22 months. Results indicated that the Nurse group reported fewer limitations (p<.01) controlling for baseline function and other factors. The current analysis provides a rural (n=288) vs. urban (N=718) comparison. We found that rural participants in the Nurse group reported significantly less decline in activities of daily living (ADLs) (p=.02) compared to controls; whereas, the Nurse intervention showed no significant effect (p=.36) on function in the urban sample. Neither the Voucher nor the Combination interventions had significant effects on function, regardless of rural or urban status. We conclude that the Nurse intervention minimized decline in ADLs better in rural participants than it did in their urban counterparts. Possible explanations for this difference and implications for rural public health policy are discussed.

Learning Objectives: Participants will be able to

• Describe the effects of a Heaalth Promotion Nurse intervention on functional outcomes in a Medicare population;
• Identify possible explanation for different ADL outcomes in a rural population versus an urban population; and
• Discuss rural public health strategies to maximize the impact of the strong findings on a wider scale.

Keywords: Chronic Illness, Health Promotion

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation