ArticleJournal of general internal medicine2011
Distance is relative: unpacking a principal barrier in rural healthcare.
Article in Journal of general internal medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 108 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
108 citing papers in PubMed, 4 syntheses or guidelines pooled it, 248 citations in OpenAlex.
- A systematic review of the scope and impact of rural primary healthcare innovations using digital health technology.BMJ open · 2026Pooled it
- Rural healthcare workers' well-being: A systematic review of support interventions.Families, systems & health : the journal of collaborative family healthcare · 2024Pooled it
- The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control.BMC public health · 2020Pooled it
- Pooled it
- Brief Peer-Supported Web-Based Skills Training in Affective and Interpersonal Regulation (BPS webSTAIR) for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial.Journal of medical Internet research · 2024Trial
- Older Adults and Diabetes Prevention Programs in the Veterans Health Administration.Diabetes care · 2018Trial
- Correlates of quality of life in rural patients with heart failure.Circulation. Heart failure · 2014Trial
- Blood pressure control in a hypertension telemedicine intervention: does distance to primary care matter?Journal of clinical hypertension (Greenwich, Conn.) · 2013Trial
- Patient travel burden and postoperative outcomes after lumbar fusion.North American Spine Society journal · 2026Article
- Perspectives of Rural and Urban Veterans with Military Sexual Trauma Seeking Psychotherapy Through Community Care: A Qualitative Study.The journal of behavioral health services & research · 2026Article
- Burden of Travel is not Associated with Adherence to Follow-up Appointments - A Call for Centralization of Cleft Care in Germany.The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2026Article
- Article
- Beyond Geography: Using a Cluster-Based Analysis to Conceptualize the Rurality of Veterans Health Administration Hospitals.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Bridging Gaps in Acute Care Access for Rural Veterans: The Reach and Impact of VA's Virtual Emergency and Urgent Care Programs.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Spatial and telehealth accessibility to eating disorder treatment in the United States: evidence from registry and LLM-augmented data.International journal of health geographics · 2026Article
- Development and Validation of a Family Caregiver Constraint Index.JAMA network open · 2026Article
- Cost and Utilization of Ambulance Services Across the United States.Healthcare (Basel, Switzerland) · 2026Article
- Article
- Post-Intensive Care Fragmentation Among Rural Veterans: Transitions Between VA and Community Health Systems.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Cultivating the Field of Rural Health Research: The Case for Rural Health Research Competencies.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
48 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDistance to healthcare services is a known barrier to access. However, the degree to which distance is a barrier is not well described. Distance may impact different patients in different ways and be mediated by the context of medical need.
objectiveIdentify factors related to distance that impede access to care for rural veterans. APPROACH: Mixed-methods approach including surveys, in-depth interviews, and focus groups at 15 Veterans Health Administration (VHA) primary care clinics in 8 Midwestern states. Survey data were compiled and interviews transcribed and coded for thematic content.
participantsSurveys were completed by 96 patients and 88 providers/staff. In-depth interviews were completed by 42 patients and 64 providers/staff. A total of 7 focus groups were convened consisting of providers and staff. KEY
resultsDistance was identified by patients, providers, and staff as the most important barrier for rural veterans seeking healthcare. In-depth interviews revealed specific examples of barriers to care such as long travel for common diagnostic services, routine specialty care, and emergency services. Patient factors compounding the impact of these barriers were health status, functional impairment, travel cost, and work or family obligations. Providers and staff reported challenges to healthcare delivery due to distance.
conclusionsDistance as a barrier to healthcare was not uniformly defined. Rather, its importance was relative to the health status and resources of patients, complexity of service provided, and urgency of service needed. Improved transportation, flexible fee-based services, more structured communication mechanisms, and integration with community resources will improve access to care and overall health status for rural veterans.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.