The experience of primary health care users: a rural-urban paradox.
BACKGROUND
We sought to assess the care experience of primary health care users, to determine whether users' assessments of their experience vary according to the geographical context in which services are obtained, and to determine whether the observed variations are consistent across all components of the care experience.


METHODS
We examined the experience of 3389 users of primary care in 5 administrative regions in Quebec, focusing on accessibility, continuity, responsiveness and reported use of health services.


RESULTS
We found significant variations in users' assessments of the specific components of the care experience. Access to primary health care received positive evaluations least frequently, and continuity of information received the approval of the highest percentage of users. We also found significant variations among geographical contexts. Positive assessments of the care experience were more frequently made by users in remote rural settings; they became progressively less frequent in near-urban rural and near-urban settings, and were found least often in urban settings. We observed these differences in almost all of the components of the care experience.


CONCLUSIONS
Given the relatively greater supply of services in urban areas, this analysis has revealed a rural-urban paradox in the care experience of primary health care users.
Lamarche
Paul A
PA
Department of Health Administration, Universitéde Montréal, Mont-Royal Pavilion, 1420 Mont-Royal Blvd., Montréal QCH2V4P3. paul.lamarche@umontreal.ca
Pineault
Raynald
R
Haggerty
Jeannie
J
Hamel
Marjolaine
M
Levesque
Jean-Frédéric
JF
Gauthier
Josée
J
D006297:Health Services Accessibility / Q000592:standards; D006302:Health Services Research; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011792:Quebec; D012424:Rural Population; D014505:Urban Population