University of British Columbia, Faculty of Medicine, Kelowna Rural Program, Kelowna, British Columbia, Canada
School of Medicine, University of Limerick, Limerick, Ireland
Rural Remote Health. 2023 Jan;23(1):8127. doi: 10.22605/RRH8127. Epub 2023 Jan 10.
The 'Inverse Care Law' suggests the availability of good medical care tends to vary inversely with the needs of the local population. Dr Julian Tudor Hart's observations related to lack of access to care for those in both socially deprived and geographically remote areas. In this study, we aim to examine if the 'Inverse Care Law' is still relevant to GP service provision in the Mid-West of Ireland.
GP clinic locations in Limerick and Clare were identified using the Health Service Executive (HSE) Service Finder and geocoded. GeoHive.ie was used to determine Electoral District (ED) centroids across the Mid-West. The shortest linear distance to a GP clinic was calculated for each ED. PobalMaps.ie was used to determine population and social deprivation scores of each ED.
In total, 122 GP practices were identified across 324 EDs. The average travel distance to a GP clinic in the Mid-West is 4.7 km. Limerick City EDs had the smallest patient population per GP clinic and were all found to be within 1.5 km of a GP clinic. Proximity to GP clinics did not correlate with deprivation. However, by removing GP clinics from the analyses, it was possible to determine how vulnerable different areas (rural vs urban, deprived vs affluent) are to potential changes in GP clinic availability in the future.
People living in urban areas such a Limerick City have improved geographic accessibility to GP clinics compared with their rural counterparts. However, within urban areas assessed, GP clinics were rarely found in deprived areas. Therefore, remote and urban-deprived areas are far more vulnerable to negative proximity effects secondary to practice closures, suggesting the principles of the 'Inverse Care Law' may still be active in the Mid-West of Ireland.
“逆向医疗保健法则”表明，优质医疗服务的可及性往往与当地人群的需求呈反比。朱利安·图多尔·哈特博士（Julian Tudor Hart）的观察结果涉及到社会贫困和地理偏远地区的人们无法获得医疗保健的问题。在这项研究中，我们旨在检验“逆向医疗保健法则”在爱尔兰中西部的全科医生服务提供中是否仍然相关。
使用卫生服务行政署（HSE）服务查找器识别利默里克和克莱尔的 GP 诊所位置，并对其进行地理编码。使用 GeoHive.ie 确定中西部的选区（ED）质心。计算每个 ED 到 GP 诊所的最短直线距离。使用 PobalMaps.ie 确定每个 ED 的人口和社会贫困评分。
共在 324 个 ED 中确定了 122 家 GP 诊所。爱尔兰中西部地区到 GP 诊所的平均出行距离为 4.7 公里。利默里克市 ED 的每个 GP 诊所的患者人数最少，并且都在距离 GP 诊所 1.5 公里以内。与贫困程度相比，接近 GP 诊所与贫困程度无关。但是，通过从分析中去除 GP 诊所，可以确定在未来 GP 诊所可用性发生潜在变化时，不同地区（农村与城市、贫困与富裕）的脆弱程度。
与农村地区相比，居住在城市地区（如利默里克市）的人在地理上更容易获得 GP 诊所。然而，在评估的城市地区内，贫困地区很少有 GP 诊所。因此，偏远和城市贫困地区更容易受到实践关闭带来的负面接近效应的影响，这表明“逆向医疗保健法则”的原则在爱尔兰中西部可能仍然有效。
