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An evaluation of access to health care services along the rural-urban continuum in Canada.

https://arctichealth.org/en/permalink/ahliterature137456
Source
BMC Health Serv Res. 2011;11:20
Publication Type
Article
Date
2011
Author
Lyn M Sibley
Jonathan P Weiner
Author Affiliation
Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto ON M4N3M5, Canada. lyn.sibley@utoronto.ca
Source
BMC Health Serv Res. 2011;11:20
Date
2011
Language
English
Publication Type
Article
Keywords
Canada
Cross-Sectional Studies
Female
Health Services Accessibility - statistics & numerical data
Humans
Male
Odds Ratio
Questionnaires
Rural Health Services - utilization
Rural Population
Urban Health Services - utilization
Urban Population
User-Computer Interface
Young Adult
Abstract
Studies comparing the access to health care of rural and urban populations have been contradictory and inconclusive. These studies are complicated by the influence of other factor which have been shown to be related to access and utilization. This study assesses the equity of access to health care services across the rural-urban continuum in Canada before and after taking other determinants of access into account.
This is a cross-sectional study of the population of the 10 provinces of Canada using data from the Canadian Community Health Survey (CCHS 2.1). Five different measures of access and utilization are compared across the continuum of rural-urban. Known determinants of utilization are taken into account according to Andersen's Health Behaviour Model (HBM); location of residence at the levels of province, health region, and community is also controlled for.
This study found that residents of small cities not adjacent to major centres, had the highest reported utilisation rates of influenza vaccines and family physician services, were most likely to have a regular medical doctor, and were most likely to report unmet need. Among the rural categories there was a gradient with the most rural being least likely to have had a flu shot, use specialist physicians services, or have a regular medical doctor. Residents of the most urban centres were more likely to report using specialist physician services. Many of these differences are diminished or eliminated once other factors are accounted for. After adjusting for other factors those living in the most urban areas were more likely to have seen a specialist physician. Those in rural communities had a lower odds of receiving a flu shot and having a regular medical doctor. People residing in the most urban and most rural communities were less likely to have a regular medical doctor. Those in any of the rural categories were less likely to report unmet need.
Inequities in access to care along the rural-urban continuum exist and can be masked when evaluation is done at a very large scale with gross indicators of rural-urban. Understanding the relationship between rural-urban and other determinants will help policy makers to target interventions appropriately: to specific demographic, provincial, community, or rural categories.
Notes
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PubMed ID
21281470 View in PubMed
Less detail

Barriers to healthcare as reported by rural and urban interprofessional providers.

https://arctichealth.org/en/permalink/ahliterature82500
Source
J Interprof Care. 2006 Mar;20(2):105-18
Publication Type
Article
Date
Mar-2006
Author
Brems Christiane
Johnson Mark E
Warner Teddy D
Roberts Laura Weiss
Author Affiliation
University of Alaska, Anchorage, AK 99508, USA. cbrems@uaa.alaska.edu
Source
J Interprof Care. 2006 Mar;20(2):105-18
Date
Mar-2006
Language
English
Publication Type
Article
Keywords
Alaska
Female
Health Care Surveys
Health Personnel
Health Services Accessibility - statistics & numerical data
Humans
Male
Middle Aged
New Mexico
Rural Health Services - utilization
Urban Health Services - utilization
Abstract
The research literature is replete with reports of barriers to care perceived by rural patients seeking healthcare. Less often reported are barriers perceived by the rural healthcare providers themselves. The current study is an extensive survey of over 1,500 healthcare providers randomly selected from two US states with large rural populations, Alaska and New Mexico. Barriers consistently identified across rural and urban regions by all healthcare professionals were Patient Complexity, Resource Limitations, Service Access, Training Constraints, and Patient Avoidance of Care. Findings confirmed that rural areas, however, struggle more with healthcare barriers than urban and small urban areas, especially as related to Resource Limitations, Confidentiality Limitations, Overlapping Roles, Provider Travel, Service Access, and Training Constraints. Almost consistently, the smaller a provider's practice community, the greater the reports of barriers, with the most severe barriers reported in small rural communities.
PubMed ID
16608714 View in PubMed
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Care access in rural areas: what leverage mechanisms do regulatory agencies have in a public system?

https://arctichealth.org/en/permalink/ahliterature178491
Source
Health Care Manage Rev. 2004 Jul-Sep;29(3):249-57
Publication Type
Article
Author
Nassera Touati
André-Pierre Contandriopoulos
Jean-Louis Denis
Charo Rodriguez
Claude Sicotte
Author Affiliation
Centre de recherche, Hôpital Charles-Lemoyne, Quebec, Canada.
Source
Health Care Manage Rev. 2004 Jul-Sep;29(3):249-57
Language
English
Publication Type
Article
Keywords
Government Regulation
Health Services Accessibility - legislation & jurisprudence
Humans
National Health Programs
Public Sector
Quebec
Rural Health Services - utilization
Abstract
Based on observations of the government's vital role in enhancing rural health care accessibility, in this article, we analyze solutions implemented by Quebec's public health system by highlighting the limitations in incentives used to remedy the dearth of rural medical resources and the consequent interest in ameliorating health care accessibility through service integration. The current challenge lies in fostering cooperation between health care institutions not subject to market incentives and integrating private practice physicians into the public system. To this end, regulatory agencies in public systems use four main leverage mechanisms: formal power, economic power, influence, and commitment, as illustrated in an experiment conducted in rural Quebec.
PubMed ID
15357235 View in PubMed
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Comparing the experiences of rural and urban family caregivers of the terminally ill.

https://arctichealth.org/en/permalink/ahliterature117484
Source
Rural Remote Health. 2013 Jan-Mar;13(1):2250
Publication Type
Article
Author
Kevin Brazil
Sharon Kaasalainen
Allison Williams
Christine Rodriguez
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. brazilk@mcmaster.ca
Source
Rural Remote Health. 2013 Jan-Mar;13(1):2250
Language
English
Publication Type
Article
Keywords
Adult
Aged
Caregivers - psychology - statistics & numerical data
Cost of Illness
Cross-Sectional Studies
Family Health - statistics & numerical data
Family Relations
Female
Health Services Accessibility - statistics & numerical data
Health status
Humans
Male
Middle Aged
Neoplasms - epidemiology
Ontario
Rural Health Services - utilization
Social Class
Social Support
Terminally ill
Urban Health Services - utilization
Abstract
There are many challenges in delivering rural health services; this is particularly true for the delivery of palliative care. Previous work has identified consistent themes around end-of-life care, including caregiver burden in providing care, the importance of informal care networks and barriers imposed by geography. Despite these well-known barriers, few studies have explored the experience of palliative care in rural settings. The purpose of the present study was to compare the experiences of rural family caregivers actively providing end-of-life care to the experiences of their urban counterparts.
Caregivers' perceived health status, the experience of burden in caregiving, assessment of social supports and the pattern of formal care used by the terminally ill were explored using a consistent and standardized measurement approach. A cross-sectional survey study was conducted with 100 informal caregivers (44 rural, 56 urban) actively providing care to a terminally ill patient recruited from a publicly funded community agency located in northeastern Ontario, Canada. The telephone-based survey included questions assessing: (i) caregiver perceived burden (14-item instrument based on the Caregiver's Burden Scale in End-of-Life Care [CBS-EOLC]); (ii) perceived social support (modified version of the Multidimensional Scale of Perceived Social Support [MSPSS] consisting of 12 items); and (iii) functional status of the care recipient (assessed using the Eastern Collaborative Oncology Group performance scale).
Rural and urban caregivers were providing care to recipients with similar functional status; the majority of care recipients were either capable of all self-care or experiencing some limitation in self-care. No group differences were observed for caregiver perceived burden: both rural and urban caregivers reported low levels of burden (CBS-EOLC score of 26.5 [SD=8.1] and 25.0 [SD=9.2], respectively; p=0.41). Urban and rural caregivers also reported similarly high levels of social support (mean MSPSS total score of 4.3 [SD=0.7] and 4.1 [SD=0.8], respectively; p=0.40). Although caregivers across both settings reported using a comparable number of services (rural 4.8 [SD=1.9] vs urban 4.5 [SD=1.8]; p=0.39), the types of services used differed. Rural caregivers reported greater use of family physicians (65.1% vs 40.7%; p=0.02), emergency room visits (31.8% vs 13.0%; p=0.02) and pharmacy services (95.3% vs 70.4%; p=0.002), while urban caregivers reported greater use of caregiver respite services (29.6% vs 11.6%; p=0.03).
Through the use of standardized tools, this study explored the experiences of rural informal family caregivers providing palliative care in contrast to the experiences of their urban counterparts. The results of the present study suggest that while there are commonalities to the caregiving experience regardless of setting, key differences also exist. Thus, location is a factor to be considered when implementing palliative care programs and services.
PubMed ID
23294373 View in PubMed
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Differences in the use of health care facilities and patterns of general risk factors in farmers with and without occupational health care programs.

https://arctichealth.org/en/permalink/ahliterature75014
Source
Int J Occup Environ Health. 1999 Jul-Sep;5(3):170-6
Publication Type
Article
Author
A. Thelin
E L Stiernström
S. Holmberg
Author Affiliation
Gatugård, S-355 94 Wederslöf, Sweden. athelin@wgab.se
Source
Int J Occup Environ Health. 1999 Jul-Sep;5(3):170-6
Language
English
Publication Type
Article
Keywords
Aged
Agriculture
Health Care Surveys
Health Services Accessibility - statistics & numerical data
Health status
Health Surveys
Humans
Male
Middle Aged
Occupational Health Services - utilization
Questionnaires
Research Support, Non-U.S. Gov't
Risk factors
Rural Health Services - utilization
Sweden
Abstract
To investigate whether differences in the use of health care facilities and the distribution of risk factors were related to the accessibility of occupational health services, 912 farmers in a large research project were studied. Information was collected from nine different localities in rural areas, using questionnaires, standardized interviews, physical examinations, and blood tests. The results showed that there was hardly any difference in the use of general health care facilities between the groups. Those with occupational health services generally had more medical visits, but also had fewer diagnoses of cardiac disease. Known risk factors were present more often in the group without occupational health services. The work of the occupational health care service and the individual's interest in health questions appeared to be of significance in the way the risk factors were distributed.
PubMed ID
10441255 View in PubMed
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Effect of community population size on breast cancer screening, stage distribution, treatment use and outcomes.

https://arctichealth.org/en/permalink/ahliterature126944
Source
Can J Public Health. 2012 Jan-Feb;103(1):46-52
Publication Type
Article
Author
Robert A Olson
Alan Nichol
Nadine R Caron
Ivo A Olivotto
Caroline Speers
Stephen Chia
Ashley Davidson
Andy Coldman
Chris Bajdik
Scott Tyldesley
Author Affiliation
BC Cancer Agency, Centre for the North, Prince George, BC. rolson2@bccancer.bc.ca
Source
Can J Public Health. 2012 Jan-Feb;103(1):46-52
Language
English
Publication Type
Article
Keywords
Antineoplastic Agents
Breast Neoplasms - epidemiology - mortality - pathology - therapy
British Columbia - epidemiology
Combined Modality Therapy - utilization
Drug Utilization
Female
Health Services Accessibility
Humans
Mass Screening - utilization
Mastectomy - methods - utilization
Middle Aged
Multivariate Analysis
Outcome Assessment (Health Care)
Radiotherapy, Adjuvant - utilization
Rural Health Services - utilization
Survival Rate
Abstract
Residents of rural communities have decreased access to cancer screening and treatments compared to urban residents, though use of resources and patient outcomes have not been assessed with a comprehensive population-based analysis. The objectives of this study were to investigate whether breast cancer screening and treatments were utilized less frequently in rural BC and whether this translated into differences in outcomes.
All patients diagnosed with breast cancer in British Columbia (BC) during 2002 were identified from the Cancer Registry and linked to the Screening Mammography database. Patient demographics, pathology, stage, treatments, mammography use and death data were abstracted. Patients were categorized as residing in large, small and rural local health authorities (LHAs) using Canadian census information. Use of resources and outcomes were compared across these LHA size categories. We hypothesized that mastectomy rates (instead of breast-conserving surgery) would be higher in rural areas, since breast conservation is standardly accompanied by adjuvant radiotherapy, which has limited availability in rural BC. In contrast we hypothesized that cancer screening and systemic therapy use would be similar, as they are more widely dispersed across BC. Exploratory analyses were performed to assess whether disparities in screening and treatment utilization translated into differences in survival.
2,869 breast cancer patients were included in our study. Patients from rural communities presented with more advanced disease (p=0.01). On multivariable analysis, patients from rural, compared to urban, LHAs were less likely to be screening mammography attendees (OR=0.62; p
PubMed ID
22338328 View in PubMed
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Emergency medicine ultrasonography in rural communities.

https://arctichealth.org/en/permalink/ahliterature123079
Source
Can J Rural Med. 2012;17(3):99-104
Publication Type
Article
Date
2012
Author
Candi J Flynn
Alison Weppler
Daniel Theodoro
Elizabeth Haney
W Ken Milne
Author Affiliation
Faculty of Medicine, University of Toronto, Toronto, Ont., Canada.
Source
Can J Rural Med. 2012;17(3):99-104
Date
2012
Language
English
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - ultrasonography
Canada
Data Collection
Emergency Medical Services - utilization
Female
Health Services Accessibility - statistics & numerical data
Humans
Interviews as Topic
Male
Middle Aged
Rural Health Services - utilization
Ultrasonography - utilization
Abstract
The Canadian Association of Emergency Physicians (CAEP) published a position statement in 2006 encouraging immediate access to emergency medicine ultrasonography (EMUS) 24 hours a day, 7 days a week. However, barriers to advanced imaging care still exist in many rural hospitals. Our study investigated the current availability of EMUS in rural communities and physicians' ability to use this technology.
A literature review and interviews with rural physicians were conducted in the summer of 2010 to design a questionnaire focusing on EMUS. The survey was then sent electronically or via regular mail in November 2010 to all Ontario physicians self-identified as "rural." Descriptive statistics and the Fisher exact test were used to analyze the data.
A total of 207 rural physicians responded to the survey (response rate 28.6%). Of the respondents, 70.9% were male, median age was 49 years and median year of graduation was 1988. The respondents had been in practice for a median of 20 years and had been in their present community for a median of 15 years. More than two-thirds of physicians (69.5%) practised in communities with populations of less than 10 000. Nearly three-quarters (72.6%) worked in a rural emergency department (ED). Almost all (96.9%) reported having access to ultrasonography in the hospital. However, only 60.6% had access to ultrasonography in the ED. Less than half (44.4%) knew how to perform ultrasonography, with 77.3% citing lack of training. Of those using EMUS, 32.5% were using it at least once per shift. The most common reason to use EMUS was to rule out abdominal aortic aneurysm (58.3%). Most respondents (71.5%) agreed or strongly agreed that EMUS is a skill that all rural ED physicians should have.
Patients in many rural EDs do not have immediate access to EMUS, as advocated by CAEP. This gap in care needs to be addressed to ensure that all patients, no matter where they live, have access to this proven imaging modality.
PubMed ID
22735086 View in PubMed
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Frequent attenders in a Finnish health centre: morbidity and reasons for encounter.

https://arctichealth.org/en/permalink/ahliterature72475
Source
Scand J Prim Health Care. 1998 Sep;16(3):141-8
Publication Type
Article
Date
Sep-1998
Author
S. Jyväsjärvi
S. Keinänen-Kiukaanniemi
E. Väisänen
P. Larivaara
S L Kivelä
Author Affiliation
Department of Public Health Science and General Practice, University of Oulu, Finland.
Source
Scand J Prim Health Care. 1998 Sep;16(3):141-8
Date
Sep-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Case-Control Studies
Catchment Area (Health)
Chronic Disease - psychology
Community Health Centers - utilization
Cross-Sectional Studies
Educational Status
Female
Finland - epidemiology
Humans
Male
Middle Aged
Morbidity
Patient Acceptance of Health Care - psychology - statistics & numerical data
Primary Health Care - utilization
Questionnaires
Rural Health Services - utilization
Socioeconomic Factors
Abstract
OBJECTIVE: To describe the proportion of frequent attenders among primary health care patients and their sociodemographic characteristics, morbidity and reasons for encounter. DESIGN: A cross-sectional case-control study. SETTING: A municipal health centre in Oulainen, a small rural town in northern Finland. PARTICIPANTS: Three hundred and four frequent attenders (eight or more visits to health centre physicians (GPs) during the year 1994) and 304 age- and sex-matched controls. MAIN OUTCOME MEASURES: Sociodemographic characteristics, numbers of encounters, chronic diseases classified by ICD-9 and reasons for encounter coded by the International Classification of Primary Care chapter codes (ICPC). RESULTS: 4.7% of the population aged 15 years or older and 6.8% of the annual patients were frequent attenders and they made 23.5% of all encounters with GPs. The frequent attenders had lower basic education and there were more people on disability pension among them. They had significantly more mental disorders and diseases of the musculoskeletal and digestive systems than the controls. The frequent attenders' most common reasons for encounter were musculoskeletal problems, and they had significantly more musculoskeletal, digestive system and psychiatric reasons for encounters than the controls. CONCLUSIONS: Frequent attenders express more somatic and less psychiatric reasons for encounter than can be assumed according to their morbidity. The role of somatization is discussed.
PubMed ID
9800226 View in PubMed
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Health service utilization among older adults in British Columbia: making sense of geography.

https://arctichealth.org/en/permalink/ahliterature168467
Source
Can J Aging. 2006;25(2):219-32
Publication Type
Article
Date
2006
Author
Diane Allan
Denise Cloutier-Fisher
Author Affiliation
Centre on Aging, Sedgewick Building, Rm A104, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada. dallan@uvic.ca
Source
Can J Aging. 2006;25(2):219-32
Date
2006
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
British Columbia
Home Care Services - utilization
Home Nursing - utilization
Humans
Length of Stay - statistics & numerical data
Medicine - statistics & numerical data
Multivariate Analysis
Office visits - statistics & numerical data
Physicians, Family
Residence Characteristics
Rural Health Services - utilization
Specialization
Urban Health Services - utilization
Abstract
The utilization of health services by older adults has received increased attention over the past decade, but little is known about how service utilization varies between rural and urban areas. In an era of restructuring and downsizing within the Canadian health care system, there are concerns that rural older adults may be increasingly disadvantaged when it comes to accessing health care. This article examines the utilization of a range of health services by older adults living in urban and rural communities in British Columbia. A major strength of this article is its concurrent focus on a continuum of geographic communities and a broad range of services needed and used by older populations. The research utilizes provincial administrative health data from 48,407 older residents of British Columbia who used services in 1998-1999. Multivariate analyses of co-variance reveal some unique service utilization patterns by geographical area and population.
PubMed ID
16821195 View in PubMed
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Impact of the H1N1 influenza pandemic in two rural emergency departments.

https://arctichealth.org/en/permalink/ahliterature120732
Source
Rural Remote Health. 2012;12:2063
Publication Type
Article
Date
2012
Author
Erin Falconer
Maeghan Keddy
William K Milne
Author Affiliation
Schulich School of Medicine and Dentistry, London, Ontario, Canada. efalconer2012@meds.uwo.ca
Source
Rural Remote Health. 2012;12:2063
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Catchment Area (Health) - statistics & numerical data
Child
Child, Preschool
Emergency Service, Hospital - utilization
Hospital Mortality - trends
Humans
Incidence
Infant
Influenza A Virus, H1N1 Subtype - isolation & purification
Influenza, Human - complications - diagnosis - epidemiology - virology
International Classification of Diseases
Length of Stay - statistics & numerical data - trends
Middle Aged
Ontario - epidemiology
Outcome and Process Assessment (Health Care) - statistics & numerical data - trends
Pandemics - statistics & numerical data
Patient Admission - statistics & numerical data - trends
Rural Health Services - utilization
Severity of Illness Index
Time Factors
Abstract
The World Health Organization declared an influenza H1N1 global pandemic in June 2009, which resulted in a great deal of research. However, no studies have been published on incidence, characteristics and impact in rural emergency departments (EDs).
Data were gathered from two rural EDs located in Southwestern Ontario. A retrospective chart review was performed on all visits to the hospitals' EDs with ICD-10 codes relating to influenza-like illnesses (ILI). The chart review periods were 1 September 2009 to 1 January 2010 for the H1N1 study group and 1 September 2008 to 1 January 2009 for the control group.
There were 546 cases of ILI during the H1N1 pandemic period out of 8339 total ED visits (6.5%). This was a 4.1 fold increase from the previous year when 132 cases of ILI were identified out of 8125 ED visits (1.6%). Half the cases of ILI that presented during the H1N1 pandemic occurred in patients aged 1 to 20 years, a proportion significantly larger during the pandemic compared with the control period. Time-to-physician assessment did increase significantly during the pandemic (41 min vs 52 min) without resulting in an increased mean length of stay in the ED (122 min vs 120 min). Using the Canadian Triage and Acuity Scale, a patient severity rating that dictates time to medical care, no differences in severity of ILI cases were observed. Nor were there no differences observed in discharge rates, admission rates, transfers to other facilities, unscheduled ED visits with 72 hours, or mortality during the two periods.
There was a significant increase in the incidence of ILI at the two rural EDs during the H1N1 pandemic compared with the previous year without a corresponding increase in severity of illness.
PubMed ID
22974571 View in PubMed
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33 records – page 1 of 4.