Distance and utilisation of out-of-hours services in a Norwegian urban/rural district: an ecological study
Open Access
- 17 June 2013
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Health Services Research
- Vol. 13 (1), 222-10
- https://doi.org/10.1186/1472-6963-13-222
Abstract
Long 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. All 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. 141 342 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. The 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.Keywords
This publication has 9 references indexed in Scilit:
- Tiempo de viaje y participación en el cribado del cáncer de mama en una región de alta dispersión poblacionalGaceta Sanitaria, 2011
- Computing travel time when the exact address is unknown: a comparison of point and polygon ZIP code approximation methodsInternational Journal of Health Geographics, 2009
- Impact on mortality following first acute myocardial infarction of distance between home and hospital: cohort studyHeart, 2008
- Development, implementation, and pilot study of a sentinel network ("The Watchtowers") for monitoring emergency primary health care activity in NorwayBMC Health Services Research, 2008
- On ecological fallacy, assessment errors stemming from misguided variable selection, and the effect of aggregation on the outcome of epidemiological studyJournal of Exposure Science & Environmental Epidemiology, 2006
- General practice out-of-hours service, variations in use and equality in access to a doctor: a cross-sectional study.2001
- Effects of distances to hospital and GP surgery on hospital inpatient episodes, controlling for needs and provisionSocial Science & Medicine, 1999
- Geography and mental health: a reviewSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1998
- Physician Use of Hospitals: Effects of Physician, Patient, and Hospital CharacteristicsHealth Services Management Research, 1989