Rural area in a European country from a health care point of view: an adaption of the Rural Ranking Scale

Abstract

BackgroundIn many countries, rural areas are facing a shortage of general practitioners (GPs). Appropriate strategies to address this challenge are needed. From a health care delivery point of view, the term rural area is often poorly defined. However rural areas have to be adequately defined to ensure specific strategies are tailored to these environments. The aims of this study were to translate the New Zealand 6-item Rural Ranking Scale (RRS), to culturally adapt it and to implement it to identify rural areas from a health care delivery perspective. Therefore we aimed to validate the RRS by defining cut-off scores for urban, semi-rural and rural areas in Germany.MethodsAfter receiving permission, two researchers independently translated the RRS. In a consensus meeting, four items were identified that had to be culturally adapted. The modified RRS-Germany (mRRS-G) was sent to 724 GPs located in urban, semi-rural and rural areas to validate the “rurality” scoring system for conditions in Germany.ResultsFour items, “travelling time to next major hospital”, “on-call duty”, “regular peripheral clinic” and “on-call for major traumas” had to be adapted due to differences in the health care system. The survey had a response rate of 33.7%. A factor analysis showed a three dimensional structure of the mRRS-G scale with a poor internal consistency. Nevertheless, the three items regarding “on-call duty”, “next major hospital” and “most distant boundary covered by your practice” were identified as significant predictors for rurality. The adapted cut-off point for rurality in Germany was 16. From this study’s participants, 9 met the RRS cut-off point for rurality (a score of 35 or more).ConclusionCompared with New Zealand rurality scores based on this tool, German scores are far less rural from a health care delivery point of view. We consider that the construct of rurality has more aspects than those assessed by the mRRS-G. Nevertheless, rural areas from a health care delivery viewpoint can be effectively defined using mRRS-G and therefore it can support tailored strategies against GPs shortage.

General practitioners in German metropolitan areas – distribution patterns and their relationship with area level measures of the socioeconomic status

“…In general, studies have shown that GPs as well as other medical specialties tend to be located in urban areas [5, 6]. The data presented in our study revealed higher GP densities on city level: in our study the overall physician-to-population ratio (PPR) was 1:1550 (SD: 139.3).…”

“…This spatial distribution has been shown to depend on numerous socioeconomic and demographical factors: Large demographic studies identified a shortage of providers located in the countryside and a relative oversupply in metropolitan areas leading to a mismatch of demand and supply [5, 6]. Similar to the GP distribution (supply), population sizes (demand) vary geographically: people are migrating towards large urban centers to pursue job opportunities or further education [7].…”

Schätzen Entscheider im Gesundheitswesen die Niederlassungssituation falsch ein?

“…[21]. In anderen Untersuchungen wurde festgestellt, dass Ärzte, die auf dem Land aufgewachsen sind, sich dort eher niederlassen als Städter [19,22,23].…”

"A Community-Based Intervention for Increasing Access to Health Information in Rural Settings"

“…Despite their poorer health status and greater health-related needs (Strasser, 2003;Bennett , Olatosi and Probst, 2008), residents of rural and remote sett ings have limited access to health services (Goodridge and Marciniuk, 2016), healthcare workforce (Steinhaeuser et al, 2014), and health information (Carlson et al, 2006;Smith, Humphreys and Wilson, 2008), especially in low and middle income countries such as Romania (Vlădescu et al, 2016). In this context, when facing health risk situations, rural residents commonly rely on family networks and friends for support and advice (Wathen and Harris, 2007).…”