title: [Travel distance and the utilisation of out-of-hours services].
abstract: BACKGROUND
  It has been documented from a number of out-of-hours primary health care services that the utilisation of the services declines with increasing travel distances. In this study we have investigated the correlation between travel distances and the use of out-of-hours medical services for all Norwegian municipalities that provide such services at a single permanent casualty clinic round the clock. In addition, we have sought to reveal any differences in consultation rates between municipalities that maintain single-municipality or inter-municipal out-of-hours services, as well as between municipalities in which the casualty clinics are co-located with a hospital or located separately.
  
  
  METHODS
  Information on the types of out-of-hours services existing in 2011 was retrieved from the Norwegian Emergency Primary Health Care Registry, and 315 municipalities with single permanent casualty clinic premises were included. Rates for various types of utilisation of these clinics were calculated on the basis of statistics generated from reimbursement claims.
  
  
  RESULTS
  The number of medical consultations and house calls per inhabitant fell by 48 % and 55 % respectively when average travel distance increased from 0 to 50 kilometres. The use of telephone/letter contact was not significantly associated with distances. Single-municipality casualty clinics located outside hospitals had the highest consultation rate for out-of-hours medical services when adjusted for distance.
  
  
  CONCLUSIONS
  This supports previous findings to the fact that distance is a crucial factor for the utilisation of out-of-hours medical services. Establishing inter-municipal casualty clinics and co-locating them with hospitals may contribute to a lower rate of use of out-of-hours medical services.
authors.affiliation: Nasjonalt kompetansesenter for legevaktmedisin Uni Research Helse og RELIS Nord-Norge Universitetssykehuset Nord-Norge.
authors.forename: Guttorm
authors.initials: G
authors.lastname: Raknes
authors.affiliation: Nasjonalt kompetansesenter for legevaktmedisin Uni Research Helse og Institutt for global helse og samfunnsmedisin Universitetet i Bergen.
authors.forename: Tone
authors.initials: T
authors.lastname: Morken
authors.affiliation: Nasjonalt kompetansesenter for legevaktmedisin Uni Research Helse og Institutt for global helse og samfunnsmedisin Universitetet i Bergen.
authors.forename: Steinar
authors.initials: S
authors.lastname: Hunskår
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data*; D002391:Catchment Area, Health; D003153:Community Health Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility; D006801:Humans; D009664:Norway; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries; D019114:Remote Consultation / Q000706:statistics & numerical data; D013997:Time Factors; D014195:Travel