title: The influence of a "culture of referral" on access to care in rural settings after myocardial infarction.
abstract: Access to care is an issue for rural people who require tertiary care following a myocardial infarction (MI). Access to specialized cardiac health services is contingent upon referral to tertiary care in urban centers. Using a critical ethnographic approach, rural women, their nurses and physicians were interviewed to explore how rurality affected women's referral and access to care following a MI. Findings reflect that a previously undocumented culture of referral that was shaped by human factors influenced access to care. The culture of referral reflected an urban-centric approach to the provision of cardiovascular services and a medical hierarchy within the referral system. The findings extend conceptual understandings of access to health care in relation to rural populations.
authors.affiliation: Faculty of Health Sciences, McMaster University, 1200 Main Street West, HSC 2J20D, Hamilton, Ontario, Canada L8N 3Z5. caldwep@mcmaster.ca
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Caldwell
authors.forename: Heather M
authors.initials: HM
authors.lastname: Arthur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009203:Myocardial Infarction / Q000534:rehabilitation*; D009864:Ontario; D012017:Referral and Consultation; D012424:Rural Population