Gulline Hannah, Carmody Sarah, Yates Mark, Bevins Amelia, Brodtmann Amy, Loi Samantha M, Lim Yen Ying, Macklin Heather, Glennen Karen, Woodward Michael, Ayton Scott, Ayton Darshini
Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia.
Ballarat Clinical School, School of Medicine, Faculty of Health, Deakin University, Victoria, Australia.
Int J Equity Health. 2025 Mar 17;24(1):74. doi: 10.1186/s12939-025-02434-1.
The limited allocation of resources to rural and regional communities is a major contributor to healthcare inequities in Australia. Distribution of health service resources between metropolitan and rural communities commonly sees highly populated areas prioritised over more sparsely populated and geographically vast areas. As such, challenges impacting dementia diagnosis, management, and care in metropolitan areas are experienced more acutely in rural areas. This study aimed to examine equity of access to dementia diagnosis, management, and care services amongst people who experienced the process of dementia diagnosis as a patient or significant other (partner/spouse, adult children, siblings, and friends) throughout rural and metropolitan Australia.
This exploratory qualitative study consisted of thirty-three online semi-structured interviews with thirty-seven people with experience of the dementia diagnosis process as a patient and/or significant other. Interviews explored symptoms of dementia, health professionals consulted, tests conducted, and challenges faced throughout the diagnosis and post-diagnosis process. Rurality was defined by the Australian Statistical Geography Standard Remoteness Areas (ASGS-RA) and the Modified Monash Model (MMM). Thematic analysis was conducted, with Russell's (2013) Dimensions of Access framework (geography, affordability, availability, acceptability, accommodation, awareness, and timeliness) guiding data analysis.
Participants were distributed across various regions of Australia: seven interviews from inner regional Australia, five interviews from outer regional Australia, and twenty-one interviews from metropolitan areas. Disparities in access between metropolitan and rural areas emerged in five key dimensions: 1) geography impeding ability to access services; 2) affordability of travel expenses; 3) availability of healthcare and support services; 4) acceptability of available health professionals and services; and 5) awareness of local services and resources. The dimensions of accommodation and timeliness of care were experienced as challenges irrespective of location, with lengthy appointment wait times and difficulty navigating complex systems. However, rurality often compounded the challenges in dementia diagnosis, management, and care.
Significant health inequities persist between rural and metropolitan communities that must be prioritised in endeavours to promote equitable dementia diagnosis, management, and care. Targeted action to address disparities is vital to mitigate the impact of rurality, particularly as clinical practice evolves with research advancements.
澳大利亚农村和偏远地区资源分配有限，是导致该国医疗保健不平等的主要因素。城市和农村社区之间的卫生服务资源分配通常优先考虑人口密集地区，而不是人口更为稀少、地域广阔的地区。因此，在农村地区，影响痴呆症诊断、管理和护理的挑战更为严峻。本研究旨在调查在澳大利亚农村和城市地区，作为患者或重要他人（伴侣/配偶、成年子女、兄弟姐妹和朋友）经历痴呆症诊断过程的人群在获得痴呆症诊断、管理和护理服务方面的公平性。
这项探索性定性研究包括对37名有痴呆症诊断过程经历的患者和/或重要他人进行33次在线半结构化访谈。访谈探讨了痴呆症症状、咨询的医疗专业人员、进行的测试以及诊断和诊断后过程中面临的挑战。农村地区由澳大利亚统计地理标准偏远地区（ASGS - RA）和改良莫纳什模型（MMM）定义。采用主题分析法，以拉塞尔（2013年）的获取维度框架（地理、可负担性、可及性、可接受性、适应性、认知度和及时性）指导数据分析。
参与者分布在澳大利亚的各个地区：澳大利亚内陆地区有7次访谈，澳大利亚外陆地区有5次访谈，城市地区有21次访谈。城市和农村地区在五个关键维度上出现了获取差异：1）地理因素阻碍了获得服务的能力；2）差旅费的可负担性；3）医疗保健和支持服务的可及性；4）现有医疗专业人员和服务的可接受性；5）对当地服务和资源的认知度。无论身处何地，适应性和护理及时性方面都面临挑战，包括预约等待时间过长以及在复杂系统中导航困难。然而，农村地区往往使痴呆症诊断、管理和护理方面的挑战更加复杂。
农村和城市社区之间存在显著的卫生不平等，在促进公平的痴呆症诊断、管理和护理工作中必须优先解决。针对性地采取行动解决差异对于减轻农村地区的影响至关重要，尤其是随着临床实践随着研究进展而不断发展。
