Raknes Guttorm, Hansen Elisabeth Holm, Hunskaar Steinar
BMC Health Serv Res. 2013 Jun 17;13:222. doi: 10.1186/1472-6963-13-222.
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.
长途距离限制了医疗服务的利用。我们想要研究挪威非工作时间服务的利用情况与从市政人口中心到相关急诊诊所的距离之间的关系。
对阿伦达尔非工作时间区十个市政的所有首次就诊情况进行了2007年至2011年的登记。主要结果是每年每个市政的就诊率和咨询率。通过线性回归研究主要结果与参与市政的人口中心到急诊诊所的距离之间的关联。人口统计学和社会经济因素纳入多元线性回归。次要终点包括距离与采取的不同首次行动的比率以及分诊护士评估的优先级之间的关联。进行了年龄和性别特定的亚组分析。
分析纳入了141342次就诊。除医生电话咨询外，距离增加与所有就诊类型的显著较低比率相关。距离急诊诊所43公里会导致与医生面对面咨询的比率下降50%。初级保健医生的可及性和教育水平对咨询率差异的贡献有限。所有优先级的比率都随着距离增加而显著下降。距离增加50公里时，急性事件的比率降低22%。66岁以上患者的比例随着距离增加而增加，而13至19岁患者的比例下降。女性患者的比例随着距离增加而下降。
结果证实，距离增加与非工作时间服务的利用率降低相关，即使是最急性的病例也是如此。极长的距离可能会危及患者安全。在规划未来的非工作时间区时必须考虑到这一点。
