A descriptive study of access to services in a random sample of Canadian rural emergency departments

Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

doi:10.1136/bmjopen-2013-003876

Cited by 28 publications

(48 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, 67% of rural women deliver in urban hospitals: 17% are more than 120 min driving distance from their hospital of birth [20]. It must also be noted that even when hospital emergency departments exist in rural and remote locations, they do not always provide the whole range of services and do not always have the same wealth of resources and equipment as urban emergency departments [21].…”

Section: Canadamentioning

confidence: 99%

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries

Rechel

Džakula

Durán³

et al. 2016

Health Policy

View full text Add to dashboard Cite

Our study reviewed policies in 8 high-income countries (Australia, Canada, United States, Italy, Spain, United Kingdom, Croatia and Estonia) in Europe, Australasia and North America with regard to hospitals in rural or remote areas. We explored whether any specific policies on hospitals in rural or remote areas are in place, and, if not, how countries made sure that the population in remote or rural areas has access to acute inpatient services. We found that only one of the eight countries (Italy) had drawn up a national policy on hospitals in rural or remote areas. In the United States, although there is no singular comprehensive national plan or vision, federal levers have been used to promote access in rural or remote areas and provide context for state and local policy decisions. In Australia and Canada, intermittent policies have been developed at the sub-national level of states and provinces respectively. In those countries where access to hospital services in rural or remote areas is a concern, common challenges can be identified, including the financial sustainability of services, the importance of medical education and telemedicine and the provision of quick transport to more specialized services.

show abstract

Section: Canadamentioning

confidence: 99%

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries

Rechel

Džakula

Durán³

et al. 2016

Health Policy

View full text Add to dashboard Cite

show abstract

“…If advanced imaging is required, 44% of these rural EDs would need to transfer their patients upwards of 300 km to a nearby trauma centre resulting in significant delays to definitive care. 3 This is even more concerning in the context of rural residents having a higher prevalence of acute and chronic illness as well as greater risk for trauma and trauma death compared to their urban counterparts. 4,5 A potential solution may exist with an imaging modality that is cost-effective, noninvasive, easily accessible, contrast-free, requires no special preparation of the patient, decreases time to diagnosis, 6 decreases patient ED length of stay, 7 decreases time to operative care, 8 and improves acute care outcomes 9 -that is, point-of-care ultrasound (PoCUS).…”

Section: Introductionmentioning

confidence: 99%

Barriers to point-of-care ultrasound use in rural emergency departments

Micks

Sue

Rogers

2016

CJEM

View full text Add to dashboard Cite

Over the past few decades, point-of-care ultrasound (PoCUS) has come to play a major role in the practice of emergency medicine. Despite its numerous benefits, there has been a slow uptake of PoCUS use in rural emergency departments. Surveys conducted across Canada and the United States have identified a lack of equipment, training, funding, quality assurance, and an inability to maintain skills as major barriers to PoCUS use. Potential solutions include expanding residency training in ultrasound skills, extending funding for PoCUS training to rural physicians in practice, moving PoCUS training courses to rural sites, and creating telesonography training for rural physicians. With these barriers identified and solutions proposed, corrective measures must be taken so that the benefits of PoCUS are extended to patients in rural Canada where, arguably, it has the greatest potential for benefit when access to advanced imaging is not readily available.

show abstract

“…For example, only 5% of hospitals had access to a paediatrician, 26% had access to a surgeon and less than one-third had access to ultrasound equipment (28%), a computerised tomography scanner (20%) or an intensive care unit (17%). 53 Studies of community hospitals in England and Scotland typically reported on the provision of non-acute inpatient services, particularly post-acute geriatric care, rehabilitation services and palliative care. 7,[54][55][56][57][58] Indeed, several UK community hospitals provide exclusively, or largely, non-acute inpatient care to chronically ill or older populations.…”

Section: Range Of Services Provided By Community Hospitalsmentioning

confidence: 99%

Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies

Pitchforth

Nolte

Corbett

et al. 2017

Health Serv Deliv Res

View full text Add to dashboard Cite

BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

A descriptive study of access to services in a random sample of Canadian rural emergency departments

Cited by 28 publications

References 29 publications

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries

Barriers to point-of-care ultrasound use in rural emergency departments

Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies

Contact Info

Product

Resources

About