Access to primary care for socioeconomically disadvantaged older people in rural areas: a realist review

Rural population in the U.S. have higher smoking prevalence rates and consume a higher number of cigarettes per day. Socioeconomically disadvantaged smokers, such as those who reside in rural areas, are less likely to use and have access to evidence-based tobacco cessation treatments than the general population of smokers. Randomized controlled studies are needed to examine the effectiveness of evidence-based smoking cessation interventions among rural residents. Of particular interest are interventions that overcome barriers to smoking cessation treatment such as poor access to primary care, travel, time, lack of health insurance, an inability to pay out-of-pocket expenses for pharmacotherapy, and communal norms that influence smoking cessation.

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The geographic accessibility of pharmacies in Nova Scotia

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163512473062 ◽

2013 ◽

Vol 146 (1) ◽

pp. 39-46 ◽

Cited By ~ 18

Author(s):

Michael R. Law ◽

Deborah Heard ◽

Judith Fisher ◽

Jay Douillard ◽

Greg Muzika ◽

...

Keyword(s):

Primary Care ◽

Nova Scotia ◽

Rural Areas ◽

Urban Areas ◽

Walking Distance ◽

Community Pharmacies ◽

Geographic Proximity ◽

Geographic Access ◽

Access To Primary Care ◽

Urban And Rural Areas

Introduction: Geographic proximity is an important component of access to primary care and the pharmaceutical services of community pharmacies. Variations in access to primary care have been found between rural and urban areas in Canadian and international jurisdictions. We studied access to community pharmacies in the province of Nova Scotia. Methods: We used information on the locations of 297 community pharmacies operating in Nova Scotia in June 2011. Population estimates at the census block level and network analysis were used to study the number of Nova Scotia residents living within 800 m (walking) and 2 km and 5 km (driving) distances of a pharmacy. We then simulated the impact of pharmacy closures on geographic access in urban and rural areas. Results: We found that 40.3% of Nova Scotia residents lived within walking distance of a pharmacy; 62.6% and 78.8% lived within 2 km and 5 km, respectively. Differences between urban and rural areas were pronounced: 99.2% of urban residents lived within 5 km of a pharmacy compared with 53.3% of rural residents. Simulated pharmacy closures had a greater impact on geographic access to community pharmacies in rural areas than urban areas. Conclusion: The majority of Nova Scotia residents lived within walking or short driving distance of at least 1 community pharmacy. While overall geographic access appears to be lower than in the province of Ontario, the difference appears to be largely driven by the higher proportion of rural dwellers in Nova Scotia. Further studies should examine how geographic proximity to pharmacies influences patients’ access to traditional and specialized pharmacy services, as well as health outcomes and adherence to therapy. Can Pharm J 2013;146:39-46.

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Rural primary care: a scoping review

European Journal of Public Health ◽

10.1093/eurpub/ckz185.338 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Bosmans ◽

W G W Boerma ◽

P P Groenewegen

Keyword(s):

Primary Care ◽

Scoping Review ◽

Rural Areas ◽

Grey Literature ◽

Rural And Remote ◽

Remote Areas ◽

Rural Primary Care ◽

Care Workers ◽

Rural And Remote Areas ◽

Access To Primary Care

Abstract Background Access to primary care is unequally distributed. Especially in rural and remote areas access to primary care services is problematic. As many countries, large and small, recognize the challenge of providing accessible and good quality primary care and implement different strategies to address this challenge, there are opportunities for cross-national learning. The main aim of this report is to provide information on best practices and solutions to counter the risk of a primary care vacuum in rural and remote areas. Methods In this scoping review of the literature on primary care in rural areas we made an inventory of evidence from research of the past 10 years. The research literature from January 2008 to June 2018 was captured through searches of the databases of Medline, Cochrane and EMBASE. In addition, we included relevant grey literature from within the WHO European region. Results The following four groups of strategies have been identified and can be used to address rural primary care shortages: substituting roles within multidisciplinary primary care teamssmart recruitment, retention and training strategies focused on staff in rural areasimplementing technological innovations in information and communicationas a short term solution: promoting the mobility of health care workers and patients Conclusions The evidence base with regard to interventions to improve access to primary care in rural areas is narrow, lacking sufficient methodologically sound research, making definitive conclusions about their effectiveness impossible. Additionally, the available evidence is biased towards programmes targeting physicians. Nevertheless, the literature does offer indications of promising intervention types, and provides valuable recommendations for their implementation. Key messages Implementation of strategies should always be accompanied by systematic monitoring of outcomes. Interventions should include primary care workers other than physicians.

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P66 Barriers to accessing primary care for socio-economically disadvantaged older people living in rural areas: a qualitative study

10.1136/jech-2017-ssmabstracts.167 ◽

2017 ◽

Author(s):

RT Turley ◽

JF Ford ◽

TP Porter ◽

TS Shakespeare ◽

GW Wong ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Older People ◽

Rural Areas ◽

Economically Disadvantaged

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Family Medicine as a Model of Primary Health Services Delivery: A Pilot Study in Almaty, Kazakhstan

Central Asian Journal of Global Health ◽

10.5195/cajgh.2015.209 ◽

2015 ◽

Vol 4 (1) ◽

Author(s):

Dilara Orynbassarova

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Pilot Study ◽

Family Medicine ◽

Rural Areas ◽

Family Doctor ◽

Family Doctors ◽

Primary Health ◽

Access To Primary Care

Introduction. Advanced models of delivering primary health care are being implemented in various countries of the world. This is especially true for countries undergoing a healthcare transition in Central Asia, such as Kazakhstan, which obtained independence from Soviet Union in 1991. The Kazakhstan National Program of Health Reform, implemented between 2005-2010, aimed to create an effective system of primary care. One of the key directions of healthcare reform implemented in Kazakhstan included the development of family medicine, which has become cutting-edge agenda for Kazakhstan Health Ministry over the past 10 years. While many papers have been published about the importance of family medicine and primary healthcare models, few have focused on analyzing family medicine effectiveness in Kazakhstan and its impact on access to family doctor services and patient satisfaction. The key aims of this pilot investigation were 1) to assess the model’s impact on access to primary care and patients’ satisfaction, and 2) to explore the model’s effectiveness in some Central Asian and transitional countries in the literature. Methods. This pilot study was based on semi-structured interviews and questionnaires about the perception and impact of the primary care model to 86 respondents aged 19-51 (54% females, 46% males). The majority of respondents were Almaty city residents (71%), while the rest were Almaty Province rural residents (22%) and residents of other Kazakhstan regions (7%).Results. Respondents from rural areas associated general practitioners, or family doctors, with community clinics (also referred to as feldsher posts). Even though urban area respondents use family doctor services, they were more likely to get those services in private rather than public clinics. Rural residents appear to have better access to primary care providers than urban residents participating in our study. Also, respondents from rural areas were more satisfied with services provided by family doctors than respondents from urban areas.Conclusions. This pilot study helped to improve our understanding of primary health care reforms implemented in Kazakhstan, a topic that is not traditionally covered in international literature. This pilot study suggests that primary care is more effectively implemented in rural areas of Kazakhstan (Almaty Province); however, future full-scale research in this area is needed to fully understand the complexity of primary healthcare access in Kazakhstan.

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