Travel burden, rurality, and continuity of care among adults with prediabetes: a retrospective cohort study

Purpose Travel-related barriers to care may limit access and reduce continuity of care among rural patients who are at risk for type 2 diabetes (T2D) which may contribute to diabetes-related health disparities among rural populations. This study aimed to compare travel burden between rural and non-rural patients at risk for type 2 diabetes, evaluate the association between travel burden and continuity of care, and assess whether travel burden and rurality were associated with three-year progression to type 2 diabetes. Methods We used patient-level data from a retrospective cohort of patients at risk for T2D from Geisinger's electronic health record between 1997 and 2017 and performed a secondary data analysis. Our dependent variable is continuity of care, and our primary independent variable is drive time in minutes (in 10-minute increments) from the patient's address to their primary care clinic. We used fractional logistic regression to assess associations between continuity of care with drive time and rurality. We used logistic regression to assess progression to T2D by rurality and drive time. All models adjusted for demographic and clinical covariates. Results Rural patients had longer drive times than non-rural patients (18 vs. 7 min) and a higher proportion drove ≥30 min to their primary care clinic. Drive time was not associated with continuity of care in overall or stratified analyses. Neither drive time nor rurality predicted 3-year progression to diabetes. Conclusion Drive time was not associated with continuity of care among rural patients. Further research is needed to identify other health-related social needs influencing continuity of care for rural populations at risk for T2D.