PDF(Pubmed)
Abstract：
BACKGROUND: Limited access to specialist medical services is a major barrier to healthcare in rural areas. We compared rural-urban specialist doctor consultations outside hospital by older adults (≥ 60 years) across South Australia.
METHODS: Cross-sectional data were available from the South Australia\'s Department of Health. The Modified Monash Model (MM1-7) of remoteness was used to categorize data into rural (MM 3-4), remote (MM5-7), and urban (MM1-MM2) of participants in urban and non-urban South Australia. The analysis was conducted on older adults (n = 20,522), self-reporting chronic physical and common mental health conditions.
RESULTS: Specialist doctor consultation in the past 4 weeks was 14.6% in our sample. In multivariable analysis, increasing age (odds ratio 1.3, 95% CI: 1.2-1.4), higher education (odds ratio 1.5, 95% CI: 1.3-1.9), physical health conditions [diabetes (odds ratio 1.2, 95% CI: 1.1-1.3); cancer (odds ratio1.8, 95% CI: 1.7-2.0); heart disease (odds ratio 1.9, 95% CI: 1.6-2.1)], and common mental disorders [depression (odds ratio 1.3, 95% CI: 1.1-1.5); anxiety (odds ratio 1.4, 95% CI: 1.1-1.6)] were associated with higher specialist care use. Specialist care use among rural (odds ratio 0.8, 95% CI: 0.6-0.9), and remote (odds ratio 0.8, 95% CI: 0.7-0.9) older people was significantly lower than their urban counterparts after controlling for age, education, and chronic disease.
CONCLUSIONS: Our findings demonstrate a disparity in the use of out of hospital specialist medical services between urban and non-urban areas.
METHODS: Cross-sectional data were available from the South Australia\'s Department of Health. The Modified Monash Model (MM1-7) of remoteness was used to categorize data into rural (MM 3-4), remote (MM5-7), and urban (MM1-MM2) of participants in urban and non-urban South Australia. The analysis was conducted on older adults (n = 20,522), self-reporting chronic physical and common mental health conditions.
RESULTS: Specialist doctor consultation in the past 4 weeks was 14.6% in our sample. In multivariable analysis, increasing age (odds ratio 1.3, 95% CI: 1.2-1.4), higher education (odds ratio 1.5, 95% CI: 1.3-1.9), physical health conditions [diabetes (odds ratio 1.2, 95% CI: 1.1-1.3); cancer (odds ratio1.8, 95% CI: 1.7-2.0); heart disease (odds ratio 1.9, 95% CI: 1.6-2.1)], and common mental disorders [depression (odds ratio 1.3, 95% CI: 1.1-1.5); anxiety (odds ratio 1.4, 95% CI: 1.1-1.6)] were associated with higher specialist care use. Specialist care use among rural (odds ratio 0.8, 95% CI: 0.6-0.9), and remote (odds ratio 0.8, 95% CI: 0.7-0.9) older people was significantly lower than their urban counterparts after controlling for age, education, and chronic disease.
CONCLUSIONS: Our findings demonstrate a disparity in the use of out of hospital specialist medical services between urban and non-urban areas.
摘要：
背景：获得专科医疗服务的机会有限是农村地区医疗保健的主要障碍。我们比较了南澳大利亚州老年人（≥60岁）在医院外进行的城乡专科医生咨询。
方法：横断面数据可从南澳大利亚州卫生部获得。改进的莫纳什模型(MM1-7)用于将数据分类为农村(MM3-4)，远程（MM5-7），以及南澳大利亚城市和非城市参与者的城市（MM1-MM2）。这项分析是对老年人(n=20,522)进行的，自我报告慢性身体和常见心理健康状况。
结果：在我们的样本中，过去4周的专家咨询为14.6%。在多变量分析中，年龄增加（比值比1.3，95%CI：1.2-1.4），高等教育(比值比1.5，95%CI：1.3-1.9)，身体健康状况[糖尿病（比值比1.2，95％CI：1.1-1.3）;癌症（比值比1.8，95％CI：1.7-2.0）;心脏病（比值比1.9，95％CI：1.6-2.1）]，和常见的精神障碍[抑郁(比值比1.3,95%CI:1.1-1.5);焦虑(比值比1.4,95%CI:1.1-1.6)]与更高的专科护理使用率相关.农村地区的专科护理使用情况(比值比0.8，95%CI：0.6-0.9)，和偏远（赔率比0.8，95％CI：0.7-0.9）老年人在控制年龄后明显低于城市同龄人，教育,和慢性疾病。
结论：我们的研究结果表明，城市和非城市地区在使用院外专科医疗服务方面存在差异。
方法：横断面数据可从南澳大利亚州卫生部获得。改进的莫纳什模型(MM1-7)用于将数据分类为农村(MM3-4)，远程（MM5-7），以及南澳大利亚城市和非城市参与者的城市（MM1-MM2）。这项分析是对老年人(n=20,522)进行的，自我报告慢性身体和常见心理健康状况。
结果：在我们的样本中，过去4周的专家咨询为14.6%。在多变量分析中，年龄增加（比值比1.3，95%CI：1.2-1.4），高等教育(比值比1.5，95%CI：1.3-1.9)，身体健康状况[糖尿病（比值比1.2，95％CI：1.1-1.3）;癌症（比值比1.8，95％CI：1.7-2.0）;心脏病（比值比1.9，95％CI：1.6-2.1）]，和常见的精神障碍[抑郁(比值比1.3,95%CI:1.1-1.5);焦虑(比值比1.4,95%CI:1.1-1.6)]与更高的专科护理使用率相关.农村地区的专科护理使用情况(比值比0.8，95%CI：0.6-0.9)，和偏远（赔率比0.8，95％CI：0.7-0.9）老年人在控制年龄后明显低于城市同龄人，教育,和慢性疾病。
结论：我们的研究结果表明，城市和非城市地区在使用院外专科医疗服务方面存在差异。
