Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency.
BACKGROUND
Examining how to deliver primary health care (PHC) services and increase their accessibility (regardless of geographic location) from the patient's perspective is needed. We conducted seven focus groups with people (n = 50) living in rural communities, in British Columbia, Canada, as they reflected on priorities for and use of PHC.


METHODS
In addition to discussing their priorities for PHC services, participants completed a brief questionnaire designed to collect information regarding socio-demographics, health status and utilization of primary healthcare providers. Descriptive statistics were obtained from questionnaire data. Focus group data were coded using an evaluation framework specifically developed for PHC; a thematic content analysis was then conducted on the coded data.


RESULTS
In total, 80% of participants had been patients of the same provider for more than one year and had an average of two chronic conditions. Participants described the challenges posed by geographical location in terms of: (1) making tradeoffs; (2) management, information, and relationship continuity of care; and (3) efficiency with health care delivery. Additional out-of-pocket expenses were associated with traveling to regional centers for health services. Those living in rural communities, especially people needing additional health services to manage their health problems, made tradeoffs between their safety of having to travel during times of poor road conditions and having their healthcare needs met.


CONCLUSIONS
Challenges to timely access to a regular healthcare provider, continuity of information and management of people's chronic disease conditions, and linkages to specialist services and diagnostic tests pose challenges for those living in rural communities. The geographic location of rural communities compounds the extent to which these people are able to access timely and continuous PHC.
Wong
Sabrina T
ST
University of British Columbia, Vancouver, Canada. sabrina.wong@nursing.ubc.ca
Regan
Sandra
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001955:British Columbia; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D017144:Focus Groups; D005843:Geography; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult