Hawkins Katherine E, Thompson Lucy, Wilson Philip
NHS Education Scotland, Centre for Health Science, Inverness, Scotland.
Centre for Rural Health, University of Aberdeen, Scotland.
Rural Remote Health. 2016 Jan-Mar;16(1):3588. Epub 2016 Mar 10.
The aim of this study was to assess access to sexual health care in remote and rural settings using testing as a focus by measuring the extent of Chlamydia testing and positivity across the Scottish Highlands in relation to the Scottish Index of Multiple Deprivation Quintile (SIMD) and Urban Rural 8-fold index (UR8).
Tests processed through Raigmore Hospital in Inverness, the main testing laboratory for microbiology tests in North and West and South and Mid Highlands, were studied. Where people are tested in relation to where they live was assessed, as well as the type of test they opt for. Also assessed was the rate of positivity in male and female patients in rural compared with urban settings using the Scottish Government UR8 and in relation to the SIMD.
9644 results were analysed. 77.2% of the results were for females and 22.4% for males. 8.1% of the results were positive and 84.4% were negative. There were proportionately more positive tests from the sexual health sources than from general practice. The proportion of men who had positive tests was almost double that for women (12.7% vs 6.6%) although men made up only 27.9% of the total number of tests. There was no significant difference in positivity when compared with UR8 index or SIMD. 37.7% of people living in the most rural areas (UR8 7-8) had their test performed in a more urban setting (UR8 1-6), and 20.4% people had their test performed in a very urban setting (UR8 1-2). Of these tests, there was a tendency for UR8 7-8 patients to be more likely to have a positive test if tested in an urban setting.
These results are similar to previous results in other countries that suggest that Chlamydia positivity is similar in rural and urban settings. A large proportion of people living in more rurally classified areas, and perhaps those with a higher risk, have their test in a central setting, suggesting that they may be bypassing local resources to get a test. The reason for this is not clear. The results also show that men are more likely to have their test in a genitourinary setting as well as have proportionately more positive results. These results support the case for customising sexual health services to the most rural areas and suggest that providing an anonymous testing service in these areas might be beneficial, especially for men.
本研究的目的是通过将衣原体检测的范围和阳性率与苏格兰多重贫困指数五分位数（SIMD）及城乡八类指数（UR8）相关联，以检测为重点评估偏远和农村地区获得性健康护理的情况。
对通过因弗内斯的雷格莫尔医院处理的检测进行研究，该医院是苏格兰北部、西部、南部和中部高地微生物检测的主要实验室。评估了人们接受检测的地点与其居住地的关系，以及他们选择的检测类型。还使用苏格兰政府的UR8并结合SIMD评估了农村与城市环境中男性和女性患者的阳性率。
分析了9644份检测结果。77.2%的结果是女性的，22.4%是男性的。8.1%的结果为阳性，84.4%为阴性。性健康来源的阳性检测比例比全科医疗的更高。男性阳性检测的比例几乎是女性的两倍（12.7%对6.6%），尽管男性仅占检测总数的27.9%。与UR8指数或SIMD相比，阳性率没有显著差异。生活在最农村地区（UR8为7 - 8）的人群中，37.7%的人在更城市化的环境（UR8为1 - 6）中进行检测；20.4% 的人在非常城市化的环境（UR8为1 - 2）中进行检测。在这些检测中，如果在城市环境中进行检测，UR8为7 - 8 的患者有更可能获得阳性检测结果 的趋势。
这些结果与其他国家之前的结果相似，表明农村和城市环境中的衣原体阳性率相似。很大一部分生活在农村分类地区的人，可能包括那些风险较高者，在中心地点进行检测，这表明他们可能绕过当地资源去进行检测。原因尚不清楚。结果还表明，男性更有可能在泌尿生殖科环境中进行检测，且阳性结果的比例相对更高。这些结果支持针对最农村地区定制性健康服务的观点，并表明在这些地区提供匿名检测服务可能是有益的，特别是对男性而言。
