Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Can J Cardiol. 2024 Jun;40(6):1007-1015. doi: 10.1016/j.cjca.2024.01.015. Epub 2024 Jan 19.
Remoteness from care remains a major challenge to equitable provision of health services worldwide. Beyond the difficulties associated with geographically and climatically rugged terrain, there are also socioeconomic, cultural, and technological challenges associated with remote residence. The objective of this review is to examine the factors whereby remoteness can be associated with sociodemographic disadvantage in health care and describe some of the methodologies for measurement and analysis of remoteness, with examples from the literature, particularly focusing on Canada. As surrogates for remoteness, simple measurements of direct distance or travel time may correlate well with more complex measures and can be performed relative to specific health care services of interest (for example, tertiary obstetric service). These metrics may also be measured, as general proxies for service availability, to various sizes of population centres. More complex measures of remoteness may also incorporate modes of available transport and availability of specific services into an index such as the Canadian Index of Remoteness. As an important independent predictor of health, remoteness requires careful predictive modelling because of potential complex nonlinear relationships, edge effects created by health system zone boundaries, and covariance with other sociodemographic factors and Indigenous population proportions. To combat disadvantage caused by remoteness, innovation in health service delivery, policy, and technology is required. Health-resource allocation must be adequate, and innovative technological advances-such as remote monitoring, expert clinical support, and artificial intelligence algorithms-must be supported by development of appropriate technological infrastructure, targeting remote regions. With these, the barriers to equitable health imposed by remoteness can be overcome.
偏远地区仍然是全球公平提供卫生服务的主要挑战。除了与地理和地形崎岖相关的困难外，偏远地区还存在与社会经济、文化和技术相关的挑战。本综述的目的是探讨偏远地区与医疗保健方面社会人口劣势相关的因素，并描述一些测量和分析偏远程度的方法，同时引用文献中的例子，特别是针对加拿大。作为偏远程度的替代指标，直接距离或旅行时间的简单测量与更复杂的测量方法相关性较好，并且可以针对特定的医疗保健服务（例如，三级产科服务）进行测量。这些指标也可以作为服务可用性的一般指标，用于测量不同规模的人口中心。更复杂的偏远程度指标还可以将可用交通方式和特定服务的可用性纳入指数中，例如加拿大偏远程度指数。由于偏远地区是健康的一个重要独立预测因素，因此需要进行仔细的预测建模，因为其可能存在复杂的非线性关系、卫生系统区域边界产生的边缘效应，以及与其他社会人口因素和原住民人口比例的协变关系。为了克服偏远地区带来的劣势，需要在卫生服务提供、政策和技术方面进行创新。卫生资源的分配必须充足，并且需要支持远程监测、专家临床支持和人工智能算法等创新技术进步，同时还需要发展适当的技术基础设施，以针对偏远地区。通过这些措施，可以克服偏远地区对公平健康造成的障碍。
