Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Accessing doctors at times of need–measuring the distance tolerance of rural residents for health-related travel

Authors: Matthew Richard McGrail, John Stirling Humphreys, Bernadette Ward

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

Background

Poor access to doctors at times of need remains a significant impediment to achieving good health for many rural residents. The two-step floating catchment area (2SFCA) method has emerged as a key tool for measuring healthcare access in rural areas. However, the choice of catchment size, a key component of the 2SFCA method, is problematic because little is known about the distance tolerance of rural residents for health-related travel. Our study sought new evidence to test the hypothesis that residents of sparsely settled rural areas are prepared to travel further than residents of closely settled rural areas when accessing primary health care at times of need.

Methods

A questionnaire survey of residents in five small rural communities of Victoria and New South Wales in Australia was used. The two outcome measures were current travel time to visit their usual doctor and maximum time prepared to travel to visit a doctor, both for non-emergency care. Kaplan-Meier charts were used to compare the association between increased distance and decreased travel propensity for closely-settled and sparsely-settled areas, and ordinal multivariate regression models tested significance after controlling for health-related travel moderating factors and town clustering.

Results

A total of 1079 questionnaires were completed with 363 from residents in closely-settled locations and 716 from residents in sparsely-settled areas. Residents of sparsely-settled communities travel, on average, 10 min further than residents of closely-settled communities (26.3 vs 16.9 min, p < 0.001), though this difference was not significant after controlling for town clustering. Differences were more apparent in terms of maximum time prepared to travel (54.1 vs 31.9 min, p < 0.001). Differences of maximum time remained significant after controlling for demographic and other constraints to access, such as transport availability or difficulties getting doctor appointments, as well as after controlling for town clustering and current travel times.

Conclusions

Improved geographical access remains a key issue underpinning health policies designed to improve the provision of rural primary health care services. This study provides empirical evidence that travel behaviour should not be implicitly assumed constant amongst rural populations when modelling access through methods like the 2SFCA.
Literature
1.
World Health Organization. Declaration of Alma-Ata. In: International conference on primary health care: 1978; Alma-Ata, USSR. Geneva: WHO; 1978.
2.
Schuurman N, Berube M, Crooks VA. Measuring potential spatial access to primary health care physicians using a modified gravity model. Can Geogr. 2010;54(1):29–45.CrossRef
3.
LaVela SL, Smith AC, Weaver FM, Miskevics SA. Geographical proximity and health care utilization in veterans with SCI&D in the USA. Soc Sci Med. 2004;59(11):2387–99.CrossRefPubMed
4.
Leonard C, Stordeur S, Roberfroid D. Association between physician density and health care consumption: A systematic review of the evidence. Health Policy. 2009;91(2):121–34.CrossRefPubMed
5.
Manning W, Newhouse J, Duan N, Keeler E, Leibowitz A, Marquis M. Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment. Am Econ Rev. 1987;77(3):251–77.PubMed
6.
Gorey KM, Luginaah IN, Holowaty EJ, Fung KY, Hamm C. Associations of physician supplies with breast cancer stage at diagnosis and survival in Ontario, 1988 to 2006. Cancer. 2009;115(15):3563–70.CrossRefPubMedPubMedCentral
7.
Grzybowski S, Stoll K, Kornelsen J. Distance matters: a population based study examining access to maternity services for rural women. BMC Health Serv Res. 2011;11:147.CrossRefPubMedPubMedCentral
8.
Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv. 2007;37(1):111–26.CrossRefPubMed
9.
Laditka J, Laditka S, Probst J. Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality. Health Place. 2009;15(3):731–40.CrossRefPubMed
10.
Russell D, Humphreys JS, Ward B, Chisholm M, Buykx P, McGrail M, et al. Helping policymakers address rural health access problems. Aust J Rural Health. 2013;12(1):61–71.CrossRef
11.
Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127–40.CrossRefPubMed
12.
Wakerman J, Humphreys JS. Sustainable workforce and sustainable health systems for rural and remote Australia. MJA Open. 2012;1(Supp 3):14–7.
13.
Buykx P, Humphreys JS, Wakerman J, Pashen D. A systematic review of effective retention incentives for health workers in rural and remote areas: Towards evidence-based policy. Aust J Rural Health. 2010;18(3):102–9.CrossRefPubMed
14.
World Health Organization. Increasing access to health workers in remote and rural locations through improved retention: Global policy recommendations. Geneva: WHO Press; 2010.
15.
Scott A, Witt J, Humphreys JS, Joyce C, Kalb G, Jeon S-H, et al. Getting doctors into the bush: General Practitioners’ preferences for rural location. Soc Sci Med. 2013;96(1):33–44.CrossRefPubMed
16.
Dolea C, Stormont L, Braichet J-M. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bulletin of the World Health Organisation. 2010;88(5):379–85.CrossRef
17.
Goertzen J. The four-legged kitchen stool: recruitment and retention of rural family physicians. Can Fam Physician. 2005;51:1181–3.PubMedPubMedCentral
18.
Humphreys JS, Jones JA, Jones MP, Hugo G, Bamford E, Taylor D. A critical review of rural medical workforce retention in Australia. Aust Health Rev. 2001;24(4):91–102.CrossRefPubMed
19.
Li J, Scott A, McGrail MR, Humphreys JS, Witt J. Retaining rural doctors: doctors’ preferences for rural medical workforce incentives. Soc Sci Med. 2014;121(1):56–64.CrossRefPubMed
20.
Arcury T, Gesler W, Preisser J, Sherman J. The effects of geography and spatial behavior on health care utilization among the residents of a rural region. Health Serv Res. 2005;40(1):135–55.CrossRefPubMedPubMedCentral
21.
Pagano E, Di Cuonzo D, Bona C, Baldi I, Gabriele P, Ricardi U, et al. Accessibility as a major determinant of radiotherapy underutilization: a population based study. Health Policy. 2007;80(3):483–91.CrossRefPubMed
22.
Littenberg B, Strauss K, MacLean CD, Troy AR. The use of insulin declines as patients live farther from their source of care: results of a survey of adults with type 2 diabetes. BMC Public Health. 2006;6:198.CrossRefPubMedPubMedCentral
23.
24.
Chan L, Hart G, Goodman DC. Geographic access to health care for rural medicare beneficiaries. J Rural Health. 2006;22(2):140–6.CrossRefPubMed
25.
Sherman J, Spencer J, Preisser J, Gesler WM, Arcury T. A suite of methods for representing activity space in a healthcare accessibility study. Int J Health Geogr. 2005;4:24.CrossRefPubMedPubMedCentral
26.
Kwan M, Weber J. Individual Accessibility Revisited: Implications for Geographical Analysis in the Twenty-first Century. Geogr Anal. 2003;35(4):341–53.CrossRef
27.
Shannon G, Lovett J, Bashshur R. Travel for primary care: expectation and performance in a rural setting. J Commun Health. 1979;5(2):113–25.CrossRef
28.
Buzza C, Ono SS, Turvey C, Wittrock S, Noble M, Reddy G, et al. Distance is relative: Unpacking a principal barrier in rural healthcare. J Gen Intern Med. 2011;26 Suppl 2:648–54.CrossRefPubMedPubMedCentral
29.
Tanser F, Gijsbertsen B, Herbst K. Modelling and understanding primary health care accessibility and utilization in rural South Africa: An exploration using a geographical information system. Soc Sci Med. 2006;63(3):691–705.CrossRefPubMed
30.
Slifkin R. Developing policies responsive to barriers to health care among rural residents: what do we need to know? J Rural Health. 2002;18(Suppl):233–41.CrossRefPubMed
31.
McGrail MR, Humphreys JS. The index of rural access: an innovative integrated approach for measuring primary care access. BMC Health Serv Res. 2009;9:124.CrossRefPubMedPubMedCentral
32.
Wang F, Luo W. Assessing spatial and nonspatial factors for healthcare access: towards an integrated approach to defining health professional shortage areas. Health Place. 2005;11:131–46.CrossRefPubMed
33.
Luo W, Wang F. Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region. Environ Plann B. 2003;30(6):865–84.CrossRef
34.
Wan N, Zou B, Sternberg T. A 3-step floating catchment area method for analyzing spatial access to health services. Int J Geogr Inf Sci. 2012;26(6):1073–89.CrossRef
35.
McGrail MR. Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements. Int J Health Geogr. 2012;11:50.CrossRefPubMedPubMedCentral
36.
Wang F. Measurement, optimization and impact of health care accessibility: a methodological review. Ann Assoc Am Geog. 2012;102(5):1104–12.CrossRef
37.
38.
Australian Bureau of Statistics. ASGC remoteness classification: purpose and use. Canberra: ABS; 2003.
39.
40.
Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, et al. Methods to increase response rates to postal and electronic questionnaires. Cochrane Database Syst Rev. 2009;3:MR000008.PubMed
41.
Luo W, Whippo TL. Variable catchment sizes for the two-step floating catchment area (2SFCA) method. Health Place. 2012;18(4):789–95.CrossRefPubMed
42.
Luo W, Qi Y. An enhanced two-step floating catchment area (E2SFCA) method for measuring spatial accessibility to primary care physicians. Health Place. 2009;15(4):1100–7.CrossRefPubMed
43.
Britt H, Miller G, Charles J, Henderson J, Valenti L, Harrison C, et al. A decade of Australian general practice activity 2002–03 to 2011–12. In: vol. General Practice Series 32. Sydney: Sydney University Press; 2012.
Metadata
Title
Accessing doctors at times of need–measuring the distance tolerance of rural residents for health-related travel
Authors
Matthew Richard McGrail
John Stirling Humphreys
Bernadette Ward
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0880-6

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue

Research article

Improving access to medicines through centralised dispensing in the public sector: a case study of the Chronic Dispensing Unit in the Western Cape Province, South Africa

Research article

The integrated disease surveillance and response system in northern Ghana: challenges to the core and support functions

Research article

The cost of illness attributable to diabetic foot and cost-effectiveness of secondary prevention in Peru

Research article

Costs and utilization of treatment in patients with hemophilia

Study protocol

An institutional ethnography of chronic pain management in family medicine (COPE) study protocol

Debate

Admissions for chronic ambulatory care sensitive conditions - a useful measure of potentially preventable admission?