title: Accessibility and health service utilization for asthma in Norfolk, England.
abstract: BACKGROUND
  Good access to health services may be important for effective asthma management amongst patients. Previously, we found elevated asthma mortality in parts of England with poor access to acute hospitals. A possible explanation is that barriers of access to care may lead to residents of more remote areas having a lower propensity to utilize health services, with the result that their asthma is poorly controlled. Here, we examine the relationship between utilization and the geographical accessibility of health services amongst self-reported asthmatics in a rural county of England.
  
  
  METHODS
  The study involved analysis by logistic regression of questionnaire responses from a 10 per cent population sample of 9764 adults aged between 20 and 44 years, and resident within the catchment area of Norwich Health Authority.
  
  
  RESULTS
  Utilization behaviour was associated with the smoking status of respondents, and levels of car ownership in their ward of residence. After controlling for these factors, respondents reporting asthma were less likely to have ever visited a general practitioner if they lived outside a settlement containing a surgery (odds ratio (OR) 3.07, 95 per cent confidence interval (CI) 1.11-8.48, p = 0.03), and the likelihood of consultation declined with distance from a surgery (OR for a 1 minute increase in travel time 0.79, 95 per cent CI 0.66-0.94, p < 0.01). Those living further from an acute hospital unit were also less likely to have consulted a hospital doctor in the previous 12 months (OR for a 1 minute increase in travel time 0.95, 95 per cent CI 0.9-0.99, p = 0.01).
  
  
  CONCLUSIONS
  Our finding of lower levels of health service utilization amongst some self-reported asthmatics living further from health facilities suggests that the condition of some individuals might be poorly treated, which could increase the risk of fatality.
authors.affiliation: School of Environmental Sciences, University of East Anglia, Norwich.
authors.forename: A P
authors.initials: AP
authors.lastname: Jones
authors.forename: G
authors.initials: G
authors.lastname: Bentham
authors.forename: B D
authors.initials: BD
authors.lastname: Harrison
authors.forename: D
authors.initials: D
authors.lastname: Jarvis
authors.forename: R M
authors.initials: RM
authors.lastname: Badminton
authors.forename: N J
authors.initials: NJ
authors.lastname: Wareham
mesh_terms: D000328:Adult; D001249:Asthma / Q000453:epidemiology*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio