Rolfe Margaret I, Donoghue Deborah Anne, Longman Jo M, Pilcher Jennifer, Kildea Sue, Kruske Sue, Kornelsen Jude, Grzybowski Stefan, Barclay Lesley, Morgan Geoffrey Gerard
University Centre of Rural Health, University of Sydney, PO Box 3074, Lismore, NSW, 2480, Australia.
Mater Research Institute, Women's Health and Newborn Services, Mater Health Service, The University of Queensland (UQ), School of Nursing, Midwifery and Social Work, UQ, Brisbane, QLD, 4101, Australia.
BMC Health Serv Res. 2017 Feb 23;17(1):163. doi: 10.1186/s12913-017-2084-8.
Australia has a universal health care system and a comprehensive safety net. Despite this, outcomes for Australians living in rural and remote areas are worse than those living in cities. This study will examine the current state of equity of access to birthing services for women living in small communities in rural and remote Australia from a population perspective and investigates whether services are distributed according to need.
Health facilities in Australia were identified and a service catchment was determined around each using a one-hour road travel time from that facility. Catchment exclusions: metropolitan areas, populations above 25,000 or below 1,000, and a non-birthing facility within the catchment of one with birthing. Catchments were attributed with population-based characteristics representing need: population size, births, demographic factors, socio-economic status, and a proxy for isolation - the time to the nearest facility providing a caesarean section (C-section). Facilities were dichotomised by service level - those providing birthing services (birthing) or not (no birthing). Birthing services were then divided by C-section provision (C-section vs no C-section birthing). Analysis used two-stage univariable and multivariable logistic regression.
There were 259 health facilities identified after exclusions. Comparing services with birthing to no birthing, a population is more likely to have a birthing service if they have more births, (adjusted Odds Ratio (aOR): 1.50 for every 10 births, 95% Confidence Interval (CI) [1.33-1.69]), and a service offering C-sections 1 to 2 h drive away (aOR: 28.7, 95% CI [5.59-148]). Comparing the birthing services categorised by C-section vs no C-section, the likelihood of a facility having a C-section was again positively associated with increasing catchment births and with travel time to another service offering C-sections. Both models demonstrated significant associations with jurisdiction but not socio-economic status.
Our investigation of current birthing services in rural and remote Australia identified disparities in their distribution. Population factors relating to vulnerability and isolation did not increase the likelihood of a local birthing facility, and very remote communities were less likely to have any service. In addition, services are influenced by jurisdictions.
澳大利亚拥有全民医疗保健系统和全面的安全网。尽管如此，生活在农村和偏远地区的澳大利亚人的健康状况仍比城市居民差。本研究将从人口角度审视澳大利亚农村和偏远地区小社区女性获得分娩服务的公平现状，并调查服务是否按需分配。
确定澳大利亚的医疗机构，并以距该机构一小时车程确定每个机构的服务覆盖范围。覆盖范围排除标准：大都市地区、人口超过25000或低于1000的地区，以及分娩机构覆盖范围内的非分娩机构。为覆盖范围赋予基于人口的需求特征：人口规模、出生人数、人口统计学因素、社会经济地位，以及隔离程度的替代指标——到最近提供剖宫产（C 型剖宫产）的机构的时间。机构按服务水平分为两类——提供分娩服务的（分娩机构）和不提供的（非分娩机构）。然后将分娩服务按是否提供 C 型剖宫产分为两类（C 型剖宫产分娩与非 C 型剖宫产分娩）。分析采用两阶段单变量和多变量逻辑回归。
排除后确定了259个医疗机构。将提供分娩服务的机构与不提供的机构进行比较，出生人数越多的人群越有可能获得分娩服务（调整后的优势比（aOR）：每增加10例出生为1.50，95%置信区间（CI）[1.33 - 1.69]），以及到提供 C 型剖宫产服务且车程为1至2小时的机构的距离（aOR：28.7，95%CI[5.59 - 148]）。将分娩服务按是否提供 C 型剖宫产分类进行比较，机构提供 C 型剖宫产的可能性再次与覆盖范围内出生人数的增加以及到另一个提供 C 型剖宫产服务的机构的车程时间呈正相关。两个模型均显示与司法管辖区存在显著关联，但与社会经济地位无关。
我们对澳大利亚农村和偏远地区当前分娩服务的调查发现了其分布上的差异。与脆弱性和隔离相关的人口因素并未增加当地分娩机构的可能性，而且非常偏远的社区获得任何服务的可能性更小。此外，服务受到司法管辖区的影响。
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