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Publication Briefs

Study Shows Distance Most Important Barrier for Rural-Residing Veterans Seeking Healthcare

VA provides healthcare for approximately 7.8 million of the 25 million Veterans, with 36% of these enrollees residing in rural areas; therefore, VA has made rural outreach and support a top priority, e.g., establishing the Office of Rural Health to address rural Veteran needs. Compared to urban Veterans, rural Veterans have lower health-related quality of life, in particular for physical as compared to mental symptoms. Though the causes for this are likely multi-factorial, access to health services may be hindered by travel distance. To improve access to primary care and help address the distance issue, VA developed 788 Community Based Outpatient Clinics (CBOCs). This mixed-methods study of rural Veterans, providers, and staff examined the impact of travel distance on the use of VA healthcare services, satisfaction, and impact on care delivery. Investigators identified study participants from 15 VA primary care clinics, including CBOCs, in 8 Midwestern states. Study surveys were completed by 96 Veterans and 88 providers/staff, and in-depth interviews were completed by 42 Veterans and 64 providers/staff. In addition, 7 focus groups were convened consisting of 60 total providers and staff.


  • Distance was identified by Veterans, providers, and staff as the most important barrier for rural Veterans seeking healthcare. The average one-way distance that Veterans traveled to a VA primary care clinic was 44.5 miles.
  • The most common types of distance barriers discussed pertained to patient health, functioning, and financial or time resources. Other barriers frequently cited included challenges associated with travel, such as limited transportation and cost/expense.
  • Veterans perceived the same travel distance as more burdensome when seeking care for regular services available locally (e.g. laboratory, podiatry), when compared with specialty care (e.g., cardiology, neurology).
  • Many older Veterans who were able to drive viewed distance more as a ‘way of life’ than a ‘barrier.’ However, given that 44% of Veterans are >65 years old, travel distance is likely to become increasingly salient as a barrier in this aging population.


  • While investigators used a stratified sampling across eight states, aspects influencing rural health may differ in other regions.
  • Participants were not selected randomly from the entire clinic population, but were a convenience sample of Veterans and providers/staff available on the days the study team was present.

This study was partly funded through HSR&D and VA’s Office of Rural Health. Dr. Reisinger was supported by an HSR&D Career Development Award. Drs. Ono, Turvey, Kaboli, and Reisinger, and Ms. Wittrock are part of HSR&D’s Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) in Iowa City, IA.

PubMed Logo Buzza C, Ono S, Turvey C, Wittrock S, Noble M, Reddy G, Kaboli P, and Reisinger H. Distance is Relative: Unpacking a Principal Barrier in Rural Healthcare. Journal of General Internal Medicine 2011 Nov;26 Suppl 2:648-54.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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