"People on Medicare with chronic conditions such as heart failure or diabetes who live in rural areas have higher death and hospitalization rates than their urban peers," said study leader Kenton Johnston. He's an assistant professor of health management and policy at Saint Louis University College for Public Health and Social Justice.
"The biggest reason for this appears to be that people in rural areas have less access to specialist physicians like cardiologists and endocrinologists," Johnston said in a university news release.
He and his team examined 2006-2013 Medicare claims data on patients in rural and urban areas with heart disease, diabetes and other chronic conditions, and compared that with hospital data.
Of the patients in the study, 10% lived in a rural area, defined as a town with less than 10,000 people.
Compared to urban patients, rural patients had a 40% higher rate of preventable hospitalizations and a 23% higher death rate.
Patients who saw a specialist at least once in addition to a primary care provider were 15.9% less likely to be hospitalized for a preventable cause and 16.6% less likely to die than patients who saw only a primary care provider.
The study appears in the December issue of the journal Health Affairs.
The findings have implications for all Medicare patients with chronic conditions, according to the researchers.
"Our research shows that all Medicare beneficiaries with chronic conditions - urban and rural - have lower death and hospitalization rates when they visit a specialist at least once annually," Johnston said. "Primary care is important, but it is not enough by itself; specialist care is needed as well."
The study authors suggested a number of ways to improve rural patient access to specialists, including: expanding telemedicine; incentives for physicians to practice in rural areas; higher pay for specialists who practice in rural areas; and bringing urban specialists into rural health systems on certain days.