The interaction between geographical factors and access to out-of-hours primary care. An ongoing meta-ethnographic review of qualitative studies.

Problem

It is known that patients with cancer who live in rural areas have worse outcomes than patients with cancer who live in urban areas. The reasons for this discrepancy have not yet been explained. One possible contributing factor is how rural patients access and receive care during out-of-hours. Access to healthcare is a wide concept affected by multiple factors, one of many being geographical reachability. The WHO define health equity as, “the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification”. This review explores differences and highlights any remediable discrepancies in access to out-of-hours primary care by rural and urban patients. Given the worthiness of health equity this review incorporates results for all patients, not only patients with a cancer diagnosis, as here remains a gap in current literature.This ongoing review aims to identify factors that affect access to out-of-hours primary care for rural and urban patients. Research Questions:1. What factors affect the patient's decision to use out-of-hours primary care services?2. What factors affect the patient's access to out-of-hours primary care services?3. Are there differences in these factors for patients who live in rural versus urban areas?4. What other sociodemographic factors interact with geography to affect access to out-of-hours primary care?

Approach

This qualitative review will take the form of meta-ethnography. A search for relevant papers built around three key terms – out-of-hours primary care, experience of access and geographical factors - was completed on MEDLINE, Embase and CINAHL and wider resources. All papers retrieved have been assessed for inclusion against set criteria by two authors independently. Included studies will be critically appraised though no studies will be excluded on this basis. Data will be extracted on to a standardised form. Reviewers will become familiar with the contents of the studies in order to allow interpretation to build throughout the process. Themes in the findings of individual papers will be drawn. The meta-ethnography will take a "line-of-argument" approach with themes across all studies categorised and their relationship determined. The categories will be reviewed and interpretive synthesis completed.

Findings

This review is ongoing. The process of meta-ethnography will provide an accurate and rich picture based on current literature of access to out-of-hours primary care and geographical factors.

Consequences

This qualitative review will identify foci for further research. It may identify key areas for service change. For example, with a current drive towards information technology solutions there may be ability to use information technology to address some of the barriers raised. The findings may also have implications for access to in-hours healthcare.