Steinhaeuser Jost, Otto Petra, Goetz Katja, Szecsenyi Joachim, Joos Stefanie
Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstrasse 2, Heidelberg 69115, Germany.
BMC Health Serv Res. 2014 Apr 2;14:147. doi: 10.1186/1472-6963-14-147.
In many countries, rural areas are facing a shortage of general practitioners (GPs). Appropriate strategies to address this challenge are needed. From a health care delivery point of view, the term rural area is often poorly defined. However rural areas have to be adequately defined to ensure specific strategies are tailored to these environments. The aims of this study were to translate the New Zealand 6-item Rural Ranking Scale (RRS), to culturally adapt it and to implement it to identify rural areas from a health care delivery perspective. Therefore we aimed to validate the RRS by defining cut-off scores for urban, semi-rural and rural areas in Germany.
After receiving permission, two researchers independently translated the RRS. In a consensus meeting, four items were identified that had to be culturally adapted. The modified RRS-Germany (mRRS-G) was sent to 724 GPs located in urban, semi-rural and rural areas to validate the "rurality" scoring system for conditions in Germany.
Four items, "travelling time to next major hospital", "on-call duty", "regular peripheral clinic" and "on-call for major traumas" had to be adapted due to differences in the health care system. The survey had a response rate of 33.7%. A factor analysis showed a three dimensional structure of the mRRS-G scale with a poor internal consistency. Nevertheless, the three items regarding "on-call duty", "next major hospital" and "most distant boundary covered by your practice" were identified as significant predictors for rurality. The adapted cut-off point for rurality in Germany was 16. From this study's participants, 9 met the RRS cut-off point for rurality (a score of 35 or more).
Compared with New Zealand rurality scores based on this tool, German scores are far less rural from a health care delivery point of view. We consider that the construct of rurality has more aspects than those assessed by the mRRS-G. Nevertheless, rural areas from a health care delivery viewpoint can be effectively defined using mRRS-G and therefore it can support tailored strategies against GPs shortage.
在许多国家，农村地区面临全科医生短缺的问题。需要采取适当策略应对这一挑战。从医疗服务提供的角度来看，农村地区的定义往往不够明确。然而，必须对农村地区进行充分界定，以确保针对这些环境制定具体策略。本研究的目的是翻译新西兰6项农村排名量表（RRS），对其进行文化调适，并从医疗服务提供的角度运用该量表识别农村地区。因此，我们旨在通过确定德国城市、半农村和农村地区的临界值来验证RRS。
获得许可后，两名研究人员独立翻译RRS。在一次共识会议上，确定了4个需要进行文化调适的项目。修改后的德国版RRS（mRRS-G）被发送给位于城市、半农村和农村地区的724名全科医生，以验证该“农村性”评分系统在德国的适用性。
由于医疗系统的差异，“到下一家主要医院的出行时间”“值班”“定期周边诊所”和“重大创伤值班”这4个项目需要进行调适。该调查的回复率为33.7%。因子分析显示mRRS-G量表具有三维结构，内部一致性较差。尽管如此，“值班”“下一家主要医院”和“您的诊所覆盖的最远距离边界”这三个项目被确定为农村性的重要预测指标。德国农村性的调适临界值为16。在本研究的参与者中，有9人达到了农村性的RRS临界值（得分35分及以上）。
与基于该工具的新西兰农村性得分相比，从医疗服务提供的角度来看，德国的得分农村性要低得多。我们认为，农村性的构成要素比mRRS-G评估的要多。尽管如此，从医疗服务提供的角度来看，使用mRRS-G可以有效地界定农村地区，因此它可以支持针对全科医生短缺的量身定制策略。
