title: The rural - urban divide in ambulatory care of gastrointestinal diseases in Taiwan.
abstract: BACKGROUND
  The utilization of medical care for gastrointestinal diseases increased over the past decade worldwide. The aim of the study was to investigate the difference between rural and urban patients in seeking medical service for gastrointestinal diseases at ambulatory sector in Taiwan.
  
  
  METHODS
  From the one-million-people cohort datasets of the National Health Insurance Research Database, the utilization of ambulatory visits for gastrointestinal diseases in 2009 was analyzed. Rural patients were compared with urban and suburban patients as to diagnosis, locality of visits and choice of specialists.
  
  
  RESULTS
  Among 295,056 patients who had ambulatory visits for gastrointestinal diseases in 2009, rural patients sought medical care for gastrointestinal diseases more frequently than urban and suburban patients (1.60 ± 3.90 vs. 1.17 ± 3.02 and 1.39 ± 3.47). 83.4% of rural patients with gastrointestinal diseases were treated by non-gastroenterologists in rural areas. Rural people had lower accessibility of specialist care, especially for hepatitis, esophageal disorders and gastroduodenal ulcer.
  
  
  CONCLUSIONS
  The rural-urban disparity of medical care for gastrointestinal diseases in Taiwan highlighted the importance of the well communication between rural physicians and gastroenterologists. Besides the establishment of the referral system, the medical teleconsultation system and the arrangement of specialist outreach clinics in rural areas might be helpful.
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, No, 201, Sec., 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
authors.forename: Yi-Hsuan
authors.initials: YH
authors.lastname: Lin
authors.forename: Yen-Han
authors.initials: YH
authors.lastname: Tseng
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Ming-Hwai
authors.initials: MH
authors.lastname: Lin
authors.forename: Li-Fang
authors.initials: LF
authors.lastname: Chou
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000628:therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D019037:Urban Health Services / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Healthcare disparities, Gastroenterology, Rural health services, Utilization