The distribution of maternity services across rural and remote Australia: does it reflect population need?

Margaret I Rolfe; Deborah Anne Donoghue; Jo M Longman; Jennifer Pilcher; Sue Kildea; Sue Kruske; Jude Kornelsen; Stefan Grzybowski; Lesley Barclay; Geoffrey Gerard Morgan

doi:10.1186/s12913-017-2084-8

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The distribution of maternity services across rural and remote Australia: does it reflect population need?

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The distribution of maternity services across rural and remote Australia: does it reflect population need?

Margaret I Rolfe, Deborah Anne Donoghue, Jo M Longman, Jennifer Pilcher, Sue Kildea, Sue Kruske, Jude Kornelsen, Stefan Grzybowski, Lesley Barclay and Geoffrey Gerard Morgan

BMC health services research, Vol.17, 163

23/02/2017

DOI: https://doi.org/10.1186/s12913-017-2084-8

PMID: 28231830

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Abstract

Catchment area (health)

Geographic information systems

Health services research

Healthcare disparities

Maternity Hospitals

Rural health services

Background Australia has a universal health care system and a comprehensive safety net. Despite this, outcomes for Australians living in rural and remote areas are worse than those living in cities. This study will examine the current state of equity of access to birthing services for women living in small communities in rural and remote Australia from a population perspective and investigates whether services are distributed according to need. Methods Health facilities in Australia were identified and a service catchment was determined around each using a one-hour road travel time from that facility. Catchment exclusions: metropolitan areas, populations above 25,000 or below 1,000, and a non-birthing facility within the catchment of one with birthing. Catchments were attributed with population-based characteristics representing need: population size, births, demographic factors, socio-economic status, and a proxy for isolation - the time to the nearest facility providing a caesarean section (C-section). Facilities were dichotomised by service level – those providing birthing services (birthing) or not (no birthing). Birthing services were then divided by C-section provision (C-section vs no C-section birthing). Analysis used two-stage univariable and multivariable logistic regression. Results There were 259 health facilities identified after exclusions. Comparing services with birthing to no birthing, a population is more likely to have a birthing service if they have more births, (adjusted Odds Ratio (aOR): 1.50 for every 10 births, 95% Confidence Interval (CI) [1.33-1.69]), and a service offering C-sections 1 to 2 h drive away (aOR: 28.7, 95% CI [5.59-148]). Comparing the birthing services categorised by C-section vs no C-section, the likelihood of a facility having a C-section was again positively associated with increasing catchment births and with travel time to another service offering C-sections. Both models demonstrated significant associations with jurisdiction but not socio-economic status. Conclusions Our investigation of current birthing services in rural and remote Australia identified disparities in their distribution. Population factors relating to vulnerability and isolation did not increase the likelihood of a local birthing facility, and very remote communities were less likely to have any service. In addition, services are influenced by jurisdictions.

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Title: The distribution of maternity services across rural and remote Australia: does it reflect population need?
Creators: Margaret I Rolfe - University of Sydney
Deborah Anne Donoghue - University of Sydney
Jo M Longman - University of Sydney
Jennifer Pilcher - University of Sydney
Sue Kildea - University of Queensland
Sue Kruske - Institute for Urban Indigenous Health
Jude Kornelsen - University of British Columbia
Stefan Grzybowski - University of British Columbia
Lesley Barclay - University of Sydney
Geoffrey Gerard Morgan - University of Sydney
Publication Details: BMC health services research, Vol.17, 163
Publisher: BioMed Central
Grant note: The National Health and Medical Research Council of Australia funded this project as a Special Interest Project grant no 1024868.
Identifiers: 991013101613002368
Copyright: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).
Academic Unit: Faculty of Health
Language: English
Resource Type: Journal article

The distribution of maternity services across rural and remote Australia: does it reflect population need?

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