Self reported patterns of health service utilization: an urban-rural comparison in South Australia
ABSTRACT To compare self-reported patterns of health service utilisation among residents of urban and rural South Australia. DESIGN, SETTING AND MAIN OUTCOME MEASURES: Secondary analysis of data generated by computer-assisted telephone interviews of 7377 adults done in 1995-6. Respondents were asked if they had used each of 18 different health services during the previous 12 months. Residence was classified in three ways: (1) capital city versus rest of the state, (2) by the Rural, Remote and Metropolitan Areas classification (RRMA) and (3) by the Accessibility and Remoteness Index for Australia classification (ARIA).
General practitioner services were most frequently used, by approximately 89% of respondents. Only 4% reported not using any service. Comparing capital city with rest of the state, modest but statistically significant differences in utilisation (P < 0.01) were measured for nine services. In eight of these nine, utilisation was higher among rural residents. Analysing by RRMA, eight services were reportedly used differently and seven of these were the same as those identified from the capital city versus rest of state comparison. Across the five ARIA categories, six previously identified services were reported as being used differentially. Overall, rural residents had a higher than expected rate of moderate and high level of health service use.
Self-reported use of a range of health services was broadly similar across urban and rural South Australia, with most cases of higher use were reported from rural areas rather than urban areas. Similar results were obtained when residence was classified in the three different ways.
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ABSTRACT: This study examines differences in uptake of the Medicare items rolled out in 2006 under the ‘Better Access Scheme’ (BAS) between rural and non-rural Australian women. It compares differences in women's uptake of the BAS services by area of residence (ARIA+) across time using the Australian Longitudinal Study of Women's Health (ALSWH) survey data linked to Medicare data. Women aged 28–33 years at the time the BAS was introduced that responded to the self-reported question on depression/anxiety and consented to linkage of their survey data with Medicare data (n = 4316). Participants were grouped by ARIA+ according to BAS use, diagnoses of anxiety/depression but no BAS use and other eligible women. Across all areas, women born 1973–1978 with a self-reported diagnosis of depression/anxiety or having treatment under the BAS had a significantly lower mean mental health score compared to other women. Significantly more women living in non-rural areas had used at least one service provided under the BAS initiative compared to women in outer regional, inner regional or remotes areas (21% versus 18% versus 13% versus 7%, respectively), and across all areas, 12% of women reported having a diagnosis of depression/anxiety but not been treated under the BAS. While there is a gradual uptake of the new BAS services, a large percentage of women who have a diagnosis of depression/anxiety have not been treated under the BAS. The data suggest that women in urban areas have been better able to take up the services compared to non-urban women.Australian Journal of Rural Health 06/2014; 22(3). DOI:10.1111/ajr.12109 · 1.34 Impact Factor
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ABSTRACT: The purpose was to examine the odds of presenting with localised as opposed to more advanced cancer by place of residence to gain evidence for planning early detection initiatives. Design, settings and participant's cases of invasive cancer reported to the NSW population-based Cancer Registry for the 1980-2008 diagnostic periods. Main outcome measure(s) between 1980 and 2008, 293,848 of reported cases (40.2%), had localised cancer at diagnosis. Logistic regression analysis was undertaken to determine the odds of localised cancer by place of residence for all cancers sites combined while adjusting for age, sex, period of diagnosis, socioeconomic status, migrant status and prognosis (as inferred from cancer type). Multivariate logistic regression analysis indicated that patients from rural areas were less likely than urban patients to present with localised cancer after adjusting for other socio-demographic factors and prognosis by cancer type (regardless of how rurality was classified). The difference ranged from 4% for remote (OR = 0.96, 95% CI 0.95-0.98) to 14% (OR = 0.86, 95% CI 0.79-0.84) for very remote compared with highly accessible areas. It is estimated that a maximum of 4,205 fewer cases of localised cancer occurred in patients from rural areas over the study period than expected from the stage distribution for urban patients. Residents aged between 30 and 74 years of age at diagnosis and those living in high socioeconomic status areas were more likely to present with localised cancer. By contrast, people aged 75 years or older at diagnosis, migrants from non-English-speaking countries and people diagnosed in more recent diagnostic periods were less likely to present with localised cancer. Targeted strategies that specifically encourage earlier diagnosis and treatment that may subsequently influence better survival are required to increase the proportion of NSW residents presenting with localised cancer at diagnosis.Cancer Causes and Control 11/2011; 23(2):255-62. DOI:10.1007/s10552-011-9873-x · 2.96 Impact Factor