The extent to which professional pharmaceutical care access may be limited and the implications of such limitations for adequacy of health care among the rural elderly remain unanswered questions. Principal goals of this study are: (1) to provide a detailed, objective measure of rural elders' geographical access to physicians and pharmacies; (2) to determine whether restricted geographical access leads individuals to substitute home remedies and nonprescription medications for prescription medications; and (3) to generate hypotheses about the effects of individuals' attributes on symptom self-care. The design for the study is cross-sectional and population-based. A spatially stratified random sample of 270 rural Iowa residents aged 65 years and older will be selected. Health Care Financing Administration tapes that list name and address of a random sample of Iowa Medicare enrollers will be used as the sampling frame. The distance of individuals' residences from the nearest pharmacy and physician will be determined by linking addresses to geographical coordinates. The sampling frame will be stratified using three levels of distance to the nearest pharmacy and of distance to the nearest physician. These will be permuted to define nine strata. Equal sample sizes (n=30) will be selected from each stratum. Interviews will collect all symptoms, consultations, and treatments occurring in the preceding seven days as well as data on attributes of individuals.
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