Abstract:
INTRODUCTION:The 'Commission on the Future of Health Care in Canada' recognized that people living in rural and remote areas of Canada are at a disadvantage in health status, access to care and health professionals, and it considers the fight against these problems as a national priority. Although some attention has been paid to the prevalence of chronic diseases, very few studies have studied specifically the management and health issues in populations with chronic diseases in relation to rurality. The objective of this study was to describe systematic gaps across rural and urban populations in incidence, mortality, morbidity, material and human resources utilization, and drug management for three important chronic diseases: atherosclerosis, osteoporosis and diabetes. METHODS:Three retrospective population-based cohort studies were used. Three study populations were selected: an atherosclerotic population including patients newly hospitalized for a myocardial infarction (MI), an osteoporotic population including the at risk population who have suffered from a fragility fracture (FF) and, finally, a diabetic population that includes only incident cases of diabetes patients. For each of the three chronic diseases, variables were selected and classified in six categories: incidence, mortality, morbidity, material resources utilization, physician consultation and drug treatment. The Statistical Area Classification (SAC) was used as the rurality definition and contains six categories including two urban areas--Census Metropolitan Areas (CMA), or metropolitan areas, and Census Agglomeration (CA), or small towns--and four rural areas: Strong, Moderate, Weak and No Metropolitan influenced zones (MIZ), depending on the proportion of the workforce that commutes to urban areas. Each disease-related variable was described using age- and sex-adjusted rates. For comparing rates between rurality classes, the adjusted relative risks were calculated using the CMA as the reference group. The X2 was used to test for the equality of risks. RESULTS:A common pattern was identified from this study: for all three studied diseases, the material resources utilization rates and the specialist (other than internist) consultation rates were almost always statistically lower in small towns and rural areas when compared with metropolitan areas. Mortality rates and drug utilization rates were very similar among regions, except for hormone replacement therapy in women where utilization rates were higher in small towns and rural areas compared with metropolitan areas. Among observations that were not common to all three chronic diseases, the first is that MI incidence was greater in small towns and in Weak MIZ compared with metropolitan areas, fragility fractures seem to be marginally more frequent in small towns but less frequent in rural areas compared with metropolitan areas, while an increased incidence rate of diabetes is observed in remote region and a smaller risk in moderate MIZ compared with metropolitan areas. For both atherosclerosis and diabetes, morbidity rates were always statistically higher in small towns and in rural areas. This was not the case for patients with osteoporotic fractures where similar morbidity rates across regions were observed, except in strong MI which show the lowest morbidity rate. CONCLUSIONS:There was substantially lower utilization of specialized services in non-metropolitan areas for all three diseases (myocardial infarction, osteoporosis, and diabetes). However, this did not translate into consistent differences in mortality and morbidity outcomes. This suggests that the impact of differential care utilization is specific to each disease, with indications that some important services may be under-utilized in rural areas, while others may be over-utilized in urban areas without improvement in outcomes.
journal_name
Rural Remote Healthjournal_title
Rural and remote healthauthors
Vanasse A,Courteau J,Cohen AA,Orzanco MG,Drouin Csubject
Has Abstractpub_date
2010-10-01 00:00:00pages
1548issue
4issn
1445-6354pii
1548journal_volume
10pub_type
杂志文章abstract:CONTEXT:Solomon Islands is a small developing island state located in the south-western Pacific Ocean. A population of approximately 680 000 people live on more than one-third of the 992 islands that make up the country. Approximately 80% of the population reside in rural areas, many in remote, difficult to reach and p...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH5787
更新日期:2020-08-01 00:00:00
abstract:CONTEXT:In February 2008, a new partnership between Maine Medical Center and Tufts University School of Medicine was formed to create a model medical school program. ISSUE:Major forces for change included: the increasing physician workforce needs of Maine, the need to increase access for medical education for Maine st...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2010-04-01 00:00:00
abstract:CONTEXT:Finding providers to work in the hospitals and clinics in the small towns of the USA is a significant struggle. In the traditional model, the primary care doctor sees patients in the inpatient setting in addition to a clinic practice. In the usual hospitalist model, providers specialize to work only in the inpa...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH4419
更新日期:2018-08-01 00:00:00
abstract:INTRODUCTION:Rates of mental health issues are increasing, coupled with insufficient resources to provide appropriate support. This is a particular challenge for rural areas in Australia that face significant social inequities including a scarcity of health resources. E-health initiatives are often proposed to maximise...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH5103
更新日期:2019-08-01 00:00:00
abstract:INTRODUCTION:The need for family physicians in rural areas across the USA and Canada is a longstanding issue that has been well documented. Since family physicians constitute the largest population of rural practitioners, the problem has been exacerbated by a sharp decline in medical students' interest in the field of ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH5341
更新日期:2020-01-01 00:00:00
abstract:INTRODUCTION:Health care and research in rural populations are often limited due to poor infrastructure and small sample sizes. However, such populations have a need for medical care and can be of great value when studying the health effects of lifestyle and genetic factors. The Northern Sweden Population Health Study ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2010-04-01 00:00:00
abstract:INTRODUCTION:Behavioral determinants can enable or hinder motivation towards registration and donorship and, subsequently, action or inertia towards organ donation. Nevertheless, there is limited information about the role of self-efficacy in relation to organ donation awareness and presumed consent among individuals a...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH5241
更新日期:2019-10-01 00:00:00
abstract:CONTEXT:Entry to practice medical programs (graduate- and undergraduate-entry) in Australia are under considerable pressure to provide clinical training as a result of increased student numbers. At the same time modern medical curricula require the development of active placements in expanded settings to achieve gradua...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract:INTRODUCTION:Indigenous children in Australia have higher dental caries levels than their non-Indigenous counterparts. Indigenous communities in South Australia's mid-north region have identified dental health as one of their top health priorities. In response to this, an oral health program based at the Pika Wiya Heal...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2007-04-01 00:00:00
abstract:INTRODUCTION:Skin infections including scabies and impetigo have a high burden and cause significant morbidity in remote Aboriginal communities in Australia. Nevertheless, there is limited knowledge about community, healthcare practitioner and service provider perspectives on skin infections and treatment preferences. ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH5227
更新日期:2019-09-01 00:00:00
abstract:CONTEXT:Exposure of undergraduate medical students to general practice and community healthcare services is common practice in the international medical curricula. Nevertheless, proponents of the hospital and biotechnology based paradigm, which is still dominant within the medical academic environment, question both th...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2013-01-01 00:00:00
abstract:CONTEXT:Diabetes mellitus is a healthcare burden in India. Seventy-four percent of India's population lives in rural areas with limited access to healthcare resources. Telemedicine can play a big role in screening people with diabetes at grassroots level. In the telescreening model, single field 45-degree photographs a...
journal_title:Rural and remote health
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2014-01-01 00:00:00
abstract:INTRODUCTION:The mental health of older adults is of increasing concern in an aging population and GPs are frequently the gatekeepers to specialist mental health services. Psychotherapy, social interventions and bibliotherapy all have an evidence-base for treating depression and anxiety in the elderly, as does pharmaco...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract:CONTEXT:In India 60-70% of the population live in rural villages. The rural population suffers from a burden of disease and disorders due to the non-availability of appropriate healthcare personnel and facilities. Since 1950, the Indian Government has responded with a series of five-year plans but has been unable to ad...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2005-04-01 00:00:00
abstract:INTRODUCTION:The environmental degradation following crude oil exploration in the Niger Delta has resulted in poverty for local rural dwellers. For those who are ill, if herbal treatments and/or self-medication with orthodox drugs are unsuccessful, the only alternative is expensive medical treatment in clinics. Surgica...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract::The poor health of Indigenous Australians is highlighted by the fact that their life expectancy is 17 years less than that of non-Indigenous Australians. The cause of this health disparity is multifactorial, and includes the under use of health services and medications. Distance, cost, and embarrassment, or fear of se...
journal_title:Rural and remote health
pub_type: 杂志文章,评审
doi:
更新日期:2007-04-01 00:00:00
abstract:INTRODUCTION:Hokianga Hospital is a small rural hospital in the far north of New Zealand serving a predominantly Maori population of 6500. The hospital, an integral part of a comprehensive primary healthcare service, provides continuous acute in-hospital and emergency care. Point-of-care (POC) biochemistry has been ava...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH4934
更新日期:2019-04-01 00:00:00
abstract:INTRODUCTION:The views of health managers and physicians working in non-metropolitan areas of Western Australia (WA) were sought about which telehealth services are most needed. METHOD:Chief executives and nurse managers of rural hospitals were sent a simple, open-ended questionnaire and asked to consider the current ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2009-07-01 00:00:00
abstract:INTRODUCTION:An unbalanced geographical distribution of physicians leads to important differences in healthcare outcomes and difficulties in accessing healthcare services in rural areas. As in many other countries in the world, the geographical distribution of physicians in Turkey is unbalanced. Although there has been...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2015-07-01 00:00:00
abstract:INTRODUCTION:Ensuring access to oral health services is crucial for improving the oral health of rural and remote populations. A logical step towards addressing oral health disparities and underutilization of services in rural areas is to ensure the availability of the dental workforce. Geographical information systems...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2016-01-01 00:00:00
abstract:INTRODUCTION:Mondana Clinic is a small rural clinic located in the Napo river region of the Amazon basin in Ecuador. Since its opening in 1997 the clinic has grown to be the primary health care facility for approximately 3000 individuals. METHODS:A retrospective study was performed tabulating the ambulatory diagnosis,...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2001-01-01 00:00:00
abstract:CONTEXT:This article explores the relevance of the body of military psychology knowledge to the management and support of those living and working in rural/remote industries and locations, particularly within Australia. ISSUES:For those who live and work in rural/remote settings, there are social, occupational, health...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2016-10-01 00:00:00
abstract:INTRODUCTION:In the perspectives of implementation of policy, the top-down and bottom-up perspectives of policy-making dominate the discourse. However, service delivery and therefore the experience of the policy by the citizen ultimately depend on the civil servant at the front line to implement the policy. Lipsky name...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2016-01-01 00:00:00
abstract::The provision of health services to rural and remote communities has been the source of much concern and debate in recent times. One aspect of this is the universal problem of insufficient medical practitioners in rural areas and the associated issues of recruitment and retention. Rural communities can play an importa...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2004-04-01 00:00:00
abstract:INTRODUCTION:The prevalence of obesity is greater among adults living in rural compared to urban areas of the USA. Greater obesity risk among rural adults persists after adjusting for obesity-related behaviors and sociodemographic factors. With the rural-urban obesity disparity greatest among younger adults, it is impo...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/rrh3984
更新日期:2017-01-01 00:00:00
abstract:INTRODUCTION:A lack of education capacity to support the development of medical supply management competency is a major issue affecting Pacific Islands countries (PICs). Limited human resources and underdeveloped medicines supply management competency are two significant impediments to reaching the health-related Mille...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2014-01-01 00:00:00
abstract:INTRODUCTION:A person's capability to access services and achieve good eye health is influenced by their behaviours, perceptions, beliefs and experiences. As evidence from Papua New Guinea (PNG) about people's lived experience with vision impairment is limited, the purpose of the present study was to better understand ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2016-10-01 00:00:00
abstract::Many rural Australian communities continue to endure a prolonged drought. The mental health effects of short-term natural disaster are well known; those of a long-term and chronic natural disaster such as drought are less well understood. However, in addition to immediate distress there are likely to be feelings of lo...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2008-07-01 00:00:00
abstract:INTRODUCTION:In Italy the course to become a general practitioner (GP) lasts 3 years and includes both theoretical and practical study. Different from the theoretical part, until recently the practical activity has not been assessed at all. The Emilia Romagna Regional Health Authority has developed a special program ca...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2016-07-01 00:00:00
abstract:INTRODUCTION:The chronic diseases associated with overweight and obesity are major contributors to the excess disease burden of Aboriginal Australians. Surveillance of overweight and obesity is required to monitor these conditions, and to develop and evaluate interventions to improve health and wellbeing. Remote Aborig...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2012-01-01 00:00:00