Unger Carla C, Warren Narelle, Canway Rachel, Manderson Lenore, Grigg Kaine
School of Psychology and Psychiatry, Monash University, Caulfield, Victoria, Australia.
Rural Remote Health. 2011;11(4):1795. Epub 2011 Nov 7.
There are marked inequities in access to and use of different primary care providers - including GPs, practice nurses, allied health services and complementary and alternative medicine (CAM) providers among populations residing in different geographical areas of Australia. Little research has focused on patterns of primary care health service utilisation according to locality in relation to the management of serious chronic illness, with even less on the use of CAM. In this article geographic similarities and differences in primary care service usage are examined among people with cardiovascular disease and/or type 2 diabetes mellitus residing in regional and urban Victoria, Australia.
Between April and July 2010, hard-copy questionnaires were sent to a random selection of 10 000 registrants from the National Diabetes Services Scheme, 2162 were distributed via Heart Support Australia and community organisations within the state of Victoria; an online version yielded 290 valid responses. This article draws on data from the 2914 returned survey responses in which people provided their residential postal codes. From this information, geographic location was determined on the basis of the Australian Standard Geographical Classification. Data were subject to inferential analyses using PASW Statistics 18.0 (SPSS; Chicago, IL, USA). A series of contingency table analyses were conducted to evaluate the relationship between primary care service use and respondents' geographical locality. Contingency analyses and χ(2) tests were also conducted to examine the differences between rural and metropolitan frequency of GP use.
In comparison with urban respondents, rural respondents reported greater use of allied health practitioners, district or practice nurses, and community health centres. Conversely, use of hospital outpatient services was significantly higher among metropolitan respondents. Use of GP clinics was not related significantly to respondents' locality, nor was use of inpatient hospital services or use of counselling, psychiatry or psychology services. Frequency of GP use, however, varied significantly among geographical categorisations, with urban respondents visiting their GPs more frequently.
While GPs play an important role in chronic disease management in Australia, the rate of GP attendance remains lower among patients living in regional areas. By contrast, the level of patient engagement with nurse practitioners and allied health professionals in this study was significantly higher among rural respondents. Issues related to access appear to play an important role in determining what primary care services people use when managing their chronic conditions and their frequency of consultation.
在澳大利亚不同地理区域的人群中，获取和使用不同初级保健服务提供者（包括全科医生、执业护士、专职医疗服务以及补充和替代医学（CAM）提供者）的情况存在显著不平等。很少有研究关注根据地区划分的初级保健卫生服务利用模式与严重慢性病管理的关系，而关于补充和替代医学使用情况的研究更少。在本文中，我们研究了居住在澳大利亚维多利亚州农村和城市地区的心血管疾病和/或2型糖尿病患者在初级保健服务使用方面的地理异同。
2010年4月至7月期间，向从国家糖尿病服务计划中随机抽取的10000名登记人员发送了纸质问卷，通过澳大利亚心脏支持组织和维多利亚州的社区组织分发了2162份问卷；在线版本获得了290份有效回复。本文利用了2914份返回的调查回复数据，其中人们提供了他们的居住邮政编码。根据这些信息，依据澳大利亚标准地理分类确定地理位置。数据使用PASW Statistics 18.0（SPSS；美国伊利诺伊州芝加哥）进行推断分析。进行了一系列列联表分析，以评估初级保健服务使用与受访者地理位置之间的关系。还进行了列联分析和χ²检验，以检查农村和大城市地区全科医生使用频率的差异。
与城市受访者相比，农村受访者报告更多地使用专职医疗人员、地区或执业护士以及社区卫生中心。相反，大城市受访者使用医院门诊服务的比例显著更高。全科医生诊所的使用与受访者的地理位置没有显著关系，住院医院服务的使用以及咨询、精神病学或心理学服务的使用也没有显著关系。然而，全科医生的使用频率在不同地理分类中差异显著，城市受访者看全科医生的频率更高。
虽然全科医生在澳大利亚慢性病管理中发挥着重要作用，但居住在农村地区的患者看全科医生的比例仍然较低。相比之下，在本研究中，农村受访者与执业护士和专职医疗专业人员的接触程度明显更高。在确定人们在管理慢性病时使用何种初级保健服务及其咨询频率方面，与获取相关的问题似乎起着重要作用。
