Distance and utilisation of out-of-hours services in a Norwegian urban/rural district: an ecological study

Abstract

BackgroundLong travel distances limit the utilisation of health services. We wanted to examine the relationship between the utilisation of a Norwegian out-of-hours service and the distance from the municipality population centroid to the associated casualty clinic.MethodsAll first contacts from ten municipalities in Arendal out-of-hours district were registered from 2007 through 2011. The main outcomes were contact and consultation rates for each municipality for each year. The associations between main outcomes and distance from the population centroid of the participating municipalities to the casualty clinic and were examined by linear regression. Demographic and socioeconomic factors were included in multivariate linear regression. Secondary endpoints include association between distance and rates of different first actions taken and priority grades assessed by triage nurses. Age and gender specific subgroup analyses were performed.Results141 342 contacts were included in the analyses. Increasing distance was associated with marked lower rates of all contact types except telephone consultations by doctor. Moving 43 kilometres away from the casualty clinic led to a 50 per cent drop in the rate of face-to-face consultations with a doctor. Availability of primary care doctors and education level contributed to a limited extent to the variance in consultation rate. The rates of all priority grades decreased significantly with increasing distance. The rate of acute events was reduced by 22 per cent when moving 50 kilometres away. The proportion of patients above 66 years increased with increasing distance, while the proportion of 13- to 19 year olds decreased. The proportion of female patients decreased with increasing distance.ConclusionsThe results confirm that increasing distance is associated with lower utilisation of out-of-hours services, even for the most acute cases. Extremely long distances might compromise patient safety. This must be taken into consideration when organising future out-of-hours districts.

A high proportion of prehospital emergency patients are not transported by ambulance: a retrospective cohort study in Northern Finland

“…Especially outside office hours, when municipal health care centers are closed, people may prefer to call for an EMS unit rather than make their way to a distant emergency department. Similar findings were found in a Norwegian study in which increased distance was associated with lower rates of all contact types to casualty clinics except telephone consultations by a doctor . This correlation between NTR outside office hours and the distance to the emergency department was an interesting finding which may be difficult to interpret.…”

Reasons for attending a general emergency outpatient clinic versus a regular general practitioner – a survey among immigrant and native walk-in patients in Oslo, Norway

“…In addition, people who live a short distance from an emergency clinic and those with low socio-economic status tend to use emergency health care services more often [19–22]. A study conducted in Bergen, Norway, found that three of four patients had not tried to contact their RGP before attending an emergency primary health care clinic.…”

The organisation of out-of-hours primary care in OECD countries

“…Rural patients often delay seeking help until their PCP is available in-hours, when they are not on call (Campbell et al, 2006). In a similar vein, increasing travel distance is associated with lower use of OOH services, even for the most acute cases (Raknes et al, 2013). Together the body of evidence suggests that in rural and remote areas, access to OOH primary care is more challenging because of more limited medical infrastructure and workforce shortages, which overall increases travelling distance for sparsely distributed populations.…”