The Impact of Rurality and Geography on Healthcare Service Access for Children with Asthma

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Wilson, Jennifer
Asthma , Pediatric , Healthcare service access , Rural , Geography , Emergency department use
Background: Asthma is a highly prevalent chronic disease amongst the Ontario pediatric population; however, the extent to which rural status and distance are associated with unplanned emergency department (ED) use by this population is largely unknown. Objective: To explore the impact of rurality and geographical distance to services on healthcare utilization by analyzing the use of general practitioner/family physician (GP/FP), specialist and unplanned ED services. Methods: A population level retrospective cohort study of Ontario children ages 5-14 with newly diagnosed asthma was conducted using health administrative data from the Institute for Clinical Evaluative Sciences (ICES). Bivariate descriptive statistics were used to assess healthcare use depending on rurality and distance to services. Adjusted logistic regression models were used to analyze the association between unplanned ED use with rural status and distance to GP/FP and specialist healthcare services, while controlling for confounders. Results: In total, 19,732 individuals met the inclusion criteria. Rurality and geographical distance to services were significantly associated with GP/FP, specialist and unplanned ED use. Rural participants were more likely to visit a GP/FP (OR 1.74, 95% CI 1.50-2.01) and less likely to visit a specialist (OR 0.56, 95% CI 0.49-0.64) in comparison to urban participants. Distance to a GP/FP or specialist was weakly associated with the number of healthcare provider visits; rs=-0.04 and rs=-0.09 respectively. Individuals who lived in rural locations (OR 2.00, 95% CI 1.64-2.44) and travelled >50km to a GP/FP (OR 1.25, 95% CI 1.06-1.48) or specialist (OR 1.20, 95% CI 1.05-1.38) were more likely to utilize an ED. Conclusion: Children with asthma utilize healthcare services differently based on rural status and distance to services. Rural children were more likely to utilize GP/FP services, less likely to utilize specialist services and more likely to have an unplanned ED visit when compared to urban children. Children who resided further (>50km) from a healthcare provider were less likely to have a GP/FP or specialist visit when compared to those who resided closer (≤50km). To ensure equitable access to care, there is a need to accommodate for these factors in the planning and provision of asthma healthcare services.
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