Rurality and prescription drug utilization among the elderly: an archival study

Despite documentation that rural elderly have reduced access to both primary care and specialist physician services, there have been very few studies comparing rural and urban patterns of prescription drug use. This is unfortunate, because prescription drugs are the most commonly used type of health care by the elderly. This research merged claims data for a random sample of 18,641 enrolled elderly in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) for the years 1984 through 1988 with Medicare inpatient and outpatient health services records and with county-level demographic and health services resources data bases to test several models of factors associated with prescription drug use. The Human Resources Profile County Code from 1980 census data (HRPCC80) in the Area Resource File provided a very detailed (10 levels) definition of rurality. Consistent with our hypotheses based on preliminary studies, neither rurality designations nor county-level health care resource indices, nor interaction terms of health services resources with rurality were powerful predictors of prescription drug use. Use of health services (from Medicare data) and variables of longevity and continuity in the PACE program were consistently robust predictors of prescription drug use. Personal demographic characteristics were also strong predictors: white widowed women under age 85 with relatively higher incomes used more prescription drugs.