Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto ON M4N3M5, Canada.
BMC Health Serv Res. 2011 Jan 31;11:20. doi: 10.1186/1472-6963-11-20.
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.
比较农村和城市人口获得医疗保健的研究结果相互矛盾，没有定论。这些研究受到其他因素的影响而变得复杂，这些因素与获得和利用医疗保健有关。本研究评估了在考虑到获得医疗保健的其他决定因素之前和之后，加拿大农村-城市连续体中医疗保健服务获取的公平性。
这是一项使用加拿大社区健康调查（CCHS 2.1）数据对加拿大 10 个省的人口进行的横断面研究。在农村-城市连续体中比较了五种不同的获取和利用措施。根据安德森健康行为模型（HBM）考虑了已知的利用决定因素；还根据省、卫生区域和社区的居住地位置进行了控制。
本研究发现，不临近主要中心的小城市居民的流感疫苗和家庭医生服务利用率最高，最有可能有固定的医生，并且最有可能报告未满足的需求。在农村类别中，存在梯度，最农村的人最不可能接种流感疫苗、使用专科医生服务或有固定医生。居住在最城市中心的人更有可能报告使用专科医生服务。许多这些差异在考虑其他因素后会减少或消除。在调整其他因素后，居住在最城市地区的人更有可能看专科医生。居住在农村社区的人接种流感疫苗和有固定医生的可能性较低。居住在最城市和最农村社区的人更不可能有固定医生。居住在任何农村类别的人更不可能报告未满足的需求。
在农村-城市连续体中存在医疗保健获取方面的不平等，并且当使用农村-城市的粗略指标进行大规模评估时，这些不平等可能会被掩盖。了解农村-城市与其他决定因素之间的关系将有助于政策制定者有针对性地进行干预：针对特定的人口、省级、社区或农村类别。
