title: Differences in access to services in rural emergency departments of Quebec and Ontario.
abstract: BACKGROUND
  Rural emergency departments (EDs) are important safety nets for the 20% of Canadians who live there. A serious problem in access to health care services in these regions has emerged. However, there are considerable geographic disparities in access to trauma center in Canada. The main objective of this project was to compare access to local 24/7 support services in rural EDs in Quebec and Ontario as well as distances to Levels 1 and 2 trauma centers.
  
  
  METHODS
  Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities. There were 26 rural EDs in Quebec and 62 in Ontario meeting these criteria. Data were collected from ministries of health, local health authorities, and ED statistics. Fisher's exact test, the t-test or Wilcoxon-Mann-Whitney test, were performed to compare rural EDs of Quebec and Ontario.
  
  
  RESULTS
  All selected EDs of Quebec and Ontario agreed to participate in the study. The number of EDs visits was higher in Quebec than in Ontario (19 322 ± 6 275 vs 13 446 ± 8 056, p = 0.0013). There were no significant differences between Quebec and Ontario's local population and small town population density. Quebec's EDs have better access to advance imaging services such as CT scanner (77% vs 15%, p < .0001) and most the consultant support and ICU (92% vs 31%, p < .0001). Finally, more than 40% of rural EDs in Quebec and Ontario are more than 300 km away from Levels 1 and 2 trauma centers.
  
  
  CONCLUSIONS
  Considering that Canada has a Universal health care system, the discrepancies between Quebec and Ontario in access to support services are intriguing. A nationwide study is justified to address this issue.
authors: Department of Family and Emergency Medicine, Laval University, Quebec, Quebec, Canada; Research Chair in Emergency Medicine, Laval University-CHAU Hôtel-Dieu de Lévis Hospital, Lévis City, Quebec, Canada.
authors: Richard
authors: R
authors: Fleet
authors: Department of Family and Emergency Medicine, Laval University, Quebec, Quebec, Canada.
authors: Christina
authors: C
authors: Pelletier
authors: Department of Family and Emergency Medicine, Laval University, Quebec, Quebec, Canada.
authors: Jérémie
authors: J
authors: Marcoux
authors: Research Chair in Emergency Medicine, Laval University-CHAU Hôtel-Dieu de Lévis Hospital, Lévis City, Quebec, Canada.
authors: Julie
authors: J
authors: Maltais-Giguère
authors: Department of Family and Emergency Medicine, Laval University, Quebec, Quebec, Canada; Research Chair in Emergency Medicine, Laval University-CHAU Hôtel-Dieu de Lévis Hospital, Lévis City, Quebec, Canada.
authors: Patrick
authors: P
authors: Archambault
authors: Department of Family and Emergency Medicine, Laval University, Quebec, Quebec, Canada.
authors: Louis David
authors: LD
authors: Audette
authors: Faculty of medicine, University of British Columbia and Department of Emergency Medicine, Penticton regional Hospital, Penticton, British Columbia, Canada.
authors: Jeff
authors: J
authors: Plant
authors: Department of Family and Emergency Medicine, Laval University, Quebec, Quebec, Canada.
authors: François
authors: F
authors: Bégin
authors: Research Chair in Emergency Medicine, Laval University-CHAU Hôtel-Dieu de Lévis Hospital, Lévis City, Quebec, Canada.
authors: Fatoumata Korika
authors: FK
authors: Tounkara
authors: Department of Family and Emergency Medicine, Laval University, Quebec, Quebec, Canada; Department of Emergency Medicine, CSSS Alphonse Desjardins-Hôtel-Dieu de Lévis Hospital, Lévis, Quebec, Canada.
authors: Julien
authors: J
authors: Poitras
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D009864:Ontario; D010820:Physicians / Q000600:supply & distribution*; D011792:Quebec; D019035:Rural Health Services / Q000600:supply & distribution*; D012424:Rural Population; D011795:Surveys and Questionnaires