title: Rural patients' experiences accessing surgery in British Columbia.
abstract: BACKGROUND
  More than 33% of Canadians live in rural areas. The vulnerability of rural surgical patients makes them particularly sensitive to barriers to accessing health care. This study aims to describe rural patients' experiences accessing local nonspecialist, family physician-surgeon care and regional specialist surgical care when no local surgical care was available.
  
  
  METHODS
  We conducted a qualitative pilot study of self-selected patients. Interviews were analyzed using a modified Delphi technique and NVivo qualitative software.
  
  
  RESULTS
  The needs of rural surgical patients were reflective of Maslow's hierarchy of needs: physiologic, safety and security, community belonging and self-esteem/self-actualization. Rural patients expressed a strong desire for individualized care in a familiar environment. When such care was not available, patients found it difficult to meet even basic physiologic needs. Maternity patients and marginalized populations were particularly vulnerable.
  
  
  CONCLUSIONS
  Rural patients seem to prefer individualized care in a familiar environment to address more of their qualitative emotional, psychological and cultural needs rather than only the physiologic needs of surgery. Larger studies are needed to delineate more clearly the qualitative aspects of surgical care.
authors.affiliation: Department of Family Practice (Research Division), University of British Columbia, Vancouver, BC. saffron2@tellus.net
authors.forename: Nancy
authors.initials: N
authors.lastname: Humber
authors.forename: Paul
authors.initials: P
authors.lastname: Dickinson
mesh_terms: D000328:Adult; D000368:Aged; D001955:British Columbia; D003697:Delphi Technique; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D010865:Pilot Projects; D057285:Precision Medicine; D012041:Regional Medical Programs; D019035:Rural Health Services; D012424:Rural Population; D013514:Surgical Procedures, Operative