title: Does distance matter? Geographical variation in GP out-of-hours service use: an observational study.
abstract: BACKGROUND
  GP cooperatives are typically based in emergency primary care centres, and patients are frequently required to travel to be seen. Geography is a key determinant of access, but little is known about the extent of geographical variation in the use of out-of-hours services.
  
  
  OBJECTIVE
  To examine the effects of distance and rurality on rates of out-of-hours service use.
  
  
  METHODS
  Geographical analysis based on routinely collected data on telephone calls in June (n=14 482) and December (n=19 747), and area-level data.
  
  
  METHODS
  Out-of-hours provider in Devon, England serving nearly 1 million patients.
  
  
  METHODS
  Straight-line distance measured patients' proximity to the primary care centre. At area level, rurality was measured by Office for National Statistics Rural and Urban Classification (2004) for output areas, and deprivation by The Index of Multiple Deprivation (2004).
  
  
  RESULTS
  Call rates decreased with increasing distance: 172 (95% confidence interval [CI]=170 to 175) for the first (nearest) distance quintile, 162 (95% CI=159 to 165) for the second, and 159 (95% CI=156 to 162) per thousand patients/year for the third quintile. Distance and deprivation predicted call rate. Rates were highest for urban areas and lowest for sparse villages and hamlets. The greatest urban/rural variation was in patients aged 0-4 years. Rates were higher in deprived areas, but the effect of deprivation was more evident in urban than rural areas.
  
  
  CONCLUSIONS
  There is geographical variation in out-of-hours service use. Patients from rural areas have lower call rates, but deprivation appears to be a greater determinant in urban areas. Geographical barriers must be taken into account when planning and delivering services.
authors.affiliation: School of Nursing & Midwifery, Southampton General Hospital, University of Southampton, Southampton. j.c.turnbull@soton.ac.uk
authors.forename: Joanne
authors.initials: J
authors.lastname: Turnbull
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.forename: Val
authors.initials: V
authors.lastname: Lattimer
authors.forename: Catherine
authors.initials: C
authors.lastname: Pope
authors.forename: David
authors.initials: D
authors.lastname: Culliford
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D000368:Aged; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D005194:Family Practice / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013997:Time Factors; D019037:Urban Health Services / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data