Rural/urban differences in accounts of patients’ initial decisions to consult primary care

Farmer, Jane; Iversen, Lisa; Campbell, Neil; Guest, Clare Lapraik; Chesson, Rosemary; Deans, George; Macdonald, John

doi:10.1016/j.healthplace.2004.11.007

Cited by 89 publications

(79 citation statements)

References 33 publications

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“…Patients' decisions to seek medical care are influenced by a range of factors, including symptoms, service organisation, and access. 33 Evidence suggests that, other things being equal, patients' willingness to seek care declines with distance. 34 Patients' decisions to consult out of hours require further research, which needs to include a range of complex, interlinked determinants, of which geography is one.…”

Section: Implications For Future Researchmentioning

confidence: 99%

Does distance matter? Geographical variation in GP out-of-hours service use: an observational study

Turnbull¹,

Martin²,

Lattimer³

et al. 2008

Br J Gen Pract

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BackgroundGP cooperatives are typically based in emergency primary care centres, and patients are frequently required to travel to be seen. Geography is a key determinant of access, but little is known about the extent of geographical variation in the use of out-ofhours services. AimTo examine the effects of distance and rurality on rates of out-of-hours service use. Design of studyGeographical analysis based on routinely collected data on telephone calls in June (n = 14 482) and December (n = 19 747), and area-level data. SettingOut-of-hours provider in Devon, England serving nearly 1 million patients. MethodStraight-line distance measured patients' proximity to the primary care centre. At area level, rurality was measured by Office for National Statistics Rural and Urban Classification (2004) ResultsCall rates decreased with increasing distance: 172 (95% confidence interval [CI] = 170 to 175) for the first (nearest) distance quintile, 162 (95% CI = 159 to 165) for the second, and 159 (95% CI = 156 to 162) per thousand patients/year for the third quintile. Distance and deprivation predicted call rate. Rates were highest for urban areas and lowest for sparse villages and hamlets. The greatest urban/rural variation was in patients aged 0-4 years. Rates were higher in deprived areas, but the effect of deprivation was more evident in urban than rural areas. ConclusionThere is geographical variation in out-of-hours service use. Patients from rural areas have lower call rates, but deprivation appears to be a greater determinant in urban areas. Geographical barriers must be taken into account when planning and delivering services.

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Section: Implications For Future Researchmentioning

confidence: 99%

Does distance matter? Geographical variation in GP out-of-hours service use: an observational study

Turnbull¹,

Martin²,

Lattimer³

et al. 2008

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…Such ruralurban differences may be driven by social cultural differences in health-seeking behaviour, where the most remote rural patients may be displaying stoicism when seeking help. 3,4,8,26 This may be supported by studies from northern Scotland that found rural patients were more likely to present later, had lower expectations of health care, and may pursue their care less tenaciously.…”

mentioning

confidence: 91%

“…2 Second, sociocultural factors could manifest as different attitudes or stoicism in rural dwellers, with correspondingly lower rates of primary care consultation and, as a consequence, lower likelihood of GPs being enabled to detect early cancer symptoms. 3,8 Geographical location and considerations of access could also influence GP decision making if they take into account patients' journey to hospital when making referral decisions. 5,9 Acting together, these mechanisms could conspire against rural patients and their GPs, and lead to disproportionately longer diagnostic delays, later-stage presentation, and poorer survival.…”

Section: Introductionmentioning

confidence: 99%

Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care

et al. 2017

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Background: Several studies have reported a survival disadvantage for rural dwellers who develop colorectal cancer, but the underlying mechanisms remain obscure. Delayed presentation to GPs may be a contributory factor, but evidence is lacking. Aim: To examine the association between rurality and travel time on diagnosis and survival of colorectal cancer in a cohort from northeast Scotland. Design and setting: The authors used a database linking GP records to routine data for patients diagnosed between 1997 and 1998, and followed up to 2011. Method: Primary outcomes were alarm symptoms, emergency admissions, stage, and survival. Travel time in minutes from patients to GP was estimated. Logistic and Cox regression were used to model outcomes. Interaction terms were used to determine if travelling time impacted differently on urban versus rural patients. Results: Rural patients and patients travelling farther to the GP had better 3-year survival. When the travel outcome associations were explored using interaction terms, the associations differed between rural and urban areas. Longer travel in urban areas significantly reduced the odds of emergency admissions (odds ratio [OR] 0.62, P<0.05), and increased survival (hazard ratio 0.75, P<0.05). Longer travel also increased the odds of presenting with alarm symptoms in urban areas; this was nearly significant (OR 1.34, P = 0.06). Presence of alarm symptoms reduced the likelihood of emergency admissions (OR 0.36, P<0.01). Conclusion: Living in a rural area, and travelling farther to a GP in urban areas, may reduce the likelihood of emergency admissions and poor survival. This may be related to how patients present with alarm symptoms

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“…A large number of studies have shown that individuals utilize medical services differently depending on whether they reside in rural or urban areas [1][2][3][4][5][6][7][8][9][10][11][12]. Compared to those that form part of urban populations, individuals living in rural areas are generally less likely to obtain timely medical care services [1][2][3]10,[12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…Compared to those that form part of urban populations, individuals living in rural areas are generally less likely to obtain timely medical care services [1][2][3]10,[12][13][14][15][16]. Studies have pointed out that the lower utilization of physician services in these rural areas could be due to either the inferior socioeconomic status of the residents (e.g., lower education or income) [5,[9][10][11]17], or alternatively critical per capita shortages of hospital beds, physicians, nurses, and specialists [3,5,10,12,13].…”

Section: Introductionmentioning

confidence: 99%

Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan

2011

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Rural/urban differences in accounts of patients’ initial decisions to consult primary care

Cited by 89 publications

References 33 publications

Does distance matter? Geographical variation in GP out-of-hours service use: an observational study

Does distance matter? Geographical variation in GP out-of-hours service use: an observational study

Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care

Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan

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