Kashima Saori, Inoue Kazuo, Matsumoto Masatoshi, Eboshida Akira, Takeuchi Keisuke
Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan.
Health Serv Res Manag Epidemiol. 2015 Aug 3;2:2333392815598294. doi: 10.1177/2333392815598294. eCollection 2015 Jan-Dec.
Whether traffic remoteness from health care service in rural areas influences usage of ambulance service has not been well investigated. This study aimed to evaluate the relation between remoteness to health care facilities and incidence of ambulance calls in rural areas of Japan.
We analyzed 155 rural communities of Hiroshima. Data were obtained on all ambulance dispatches from 2010 to 2012. Driving time was calculated from each community to the closest primary/secondary and tertiary health care facility (equivalent to tertiary emergency care centers). We estimated the incidence rate and the incidence rate ratio (IRR) of ambulance calls for each 10-minute increase in the driving time, using generalized log-linear regression models, and evaluated the effect among each specific subgroup of emergency level and season.
During the study period, the median incidence rate was 436 per 10 000 people in targeted communities. When driving time to the closest primary/secondary facility increased by an increment of 10 minutes, there was a significant increase in the IRR of ambulance calls, especially during colder seasons (IRR: 1.29 [95% confidence interval: 1.11-1.49]), and this relation was also obtained for most emergency levels. In comparison, there was no such increase in IRRs observed for driving time to a tertiary facility.
This study indicated a positive association between remoteness to primary/secondary medical facilities and the frequency of ambulance calls. The remoteness to a primary/secondary health care may induce an increase in ambulance calls, particularly during cold seasons.
农村地区距离医疗服务机构的远近是否会影响救护车服务的使用情况，目前尚未得到充分研究。本研究旨在评估日本农村地区距离医疗设施的远近与救护车呼叫发生率之间的关系。
我们分析了广岛的155个农村社区。获取了2010年至2012年所有救护车调度的数据。计算了从每个社区到最近的一级/二级和三级医疗设施（相当于三级急救中心）的驾车时间。我们使用广义对数线性回归模型，估计了驾车时间每增加10分钟时救护车呼叫的发生率和发生率比（IRR），并评估了在每个特定的紧急程度和季节亚组中的影响。
在研究期间，目标社区的中位发生率为每万人436次。当到最近的一级/二级设施的驾车时间每增加10分钟时，救护车呼叫的IRR显著增加，尤其是在较冷的季节（IRR：1.29[95%置信区间：1.11 - 1.49]），并且在大多数紧急程度中也观察到了这种关系。相比之下，到三级设施的驾车时间增加时，未观察到IRR有此类增加。
本研究表明距离一级/二级医疗设施的远近与救护车呼叫频率之间存在正相关。距离一级/二级医疗保健机构较远可能会导致救护车呼叫增加，尤其是在寒冷季节。
