School of Medicine, University of Limerick, Limerick, Ireland.
The Irish College of General Practitioners, Dublin, Ireland.
Rural Remote Health. 2024 Oct;24(4):8843. doi: 10.22605/RRH8843. Epub 2024 Oct 22.
Rural communities can experience more barriers to accessing health care than their urban counterparts, largely due to fewer healthcare staff and services, and geographical isolation. The purpose of this study is to examine the availability of GP practices in rural communities across the Mid-West of Ireland and the potential impact of practice closure on patient access.
GP clinic locations were identified in Ireland's Mid-West, specifically counties Limerick and Clare. Administrative subdivisions of both counties, Small Areas (SAs), were identified and their XY geographic centre coordinates recorded. SAs were indexed into six levels of rurality according to Irish Central Statistics Office urban/rural classifications (1, cities; 2, satellite urban towns; 3, independent urban towns; 4, rural areas with high urban influence; 5, rural areas with moderate urban influence; 6, highly rural/remote areas). The direct linear distance from the centre of each SA to its respective closest GP clinic was calculated. Simulated closure of each GP clinic was assessed programmatically by removing practices from the overall dataset and calculating the new direct linear distance from each SA to the next closest GP clinic.
The majority of the SAs in County Clare (63%) and County Limerick (66%) are classified as rural (rurality index ≥4), with the exception of Limerick City, where all SAs were defined as urban. Rural SAs have longer travel distances to GP clinics than their urban counterparts, and these distances are greater with increasing rurality of a population. Simulated closure of GP clinics revealed increasing travel distances to the next closest clinic with increasing level of rurality in a stepwise fashion (r2=0.31).
Rural community dwellers across the Mid-West of Ireland face longer travel distances to GP clinics than their urban counterparts. Thus rural communities will be, on average, more adversely affected should their local GP clinic close. While these findings are unsurprising, our methodology calculates a discrete number that can be used to rank vulnerability of local communities. Rural areas are particularly vulnerable to GP clinic closure, and maintaining a solid foundation of primary care in these areas will require careful service and workforce planning.
农村社区在获得医疗保健方面可能比城市社区面临更多的障碍，这主要是由于医疗人员和服务较少，以及地理位置偏远。本研究的目的是检查爱尔兰中西部农村社区的全科医生诊所的可用性，以及诊所关闭对患者就诊的潜在影响。
在爱尔兰中西部，特别是利默里克和克莱尔两县，确定了全科医生诊所的位置。确定了这两个县的行政区划（小地区，SAs），并记录了它们的 XY 地理中心坐标。根据爱尔兰中央统计局的城市/农村分类（1.城市；2.卫星城市城镇；3.独立城市城镇；4.具有高度城市影响的农村地区；5.具有中度城市影响的农村地区；6.高度农村/偏远地区），将 SAs 索引到六个农村程度级别。从每个 SA 的中心到其各自最近的全科医生诊所的直接直线距离被计算出来。通过从整体数据集中删除诊所并计算每个 SA 到下一个最近的全科医生诊所的新的直接直线距离，对每个全科医生诊所的模拟关闭进行了程序评估。
克莱尔县（63%）和利默里克县（66%）的大多数 SAs 被归类为农村（农村指数 ≥4），只有利默里克市除外，该市所有 SAs 都被定义为城市。农村 SAs 到全科医生诊所的旅行距离比城市 SAs 长，并且随着人口农村程度的增加，这些距离也会增加。随着农村程度的逐步增加，模拟关闭全科医生诊所显示出到下一个最近诊所的旅行距离增加（r2=0.31）。
爱尔兰中西部农村社区的居民到全科医生诊所的旅行距离比城市居民长。因此，如果他们当地的全科医生诊所关闭，农村社区将平均受到更大的不利影响。虽然这些发现并不出人意料，但我们的方法计算了一个离散的数字，可以用来对当地社区的脆弱性进行排名。农村地区特别容易受到全科医生诊所关闭的影响，因此需要谨慎的服务和劳动力规划来维持这些地区的基层医疗服务。
