ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2008
Does distance matter? Geographical variation in GP out-of-hours service use: an observational study.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Distances to emergency departments and non-urgent utilization of medical services: a systematic review.Global health action · 2024Pooled it
- Economic evaluations on centralisation of specialised healthcare services: a systematic review of methods.BMJ open · 2016Pooled it
- Geospatial Visualisation of Distance to General Practitioner Facilities with Population Density Patterns in the United Kingdom.Epidemiologia (Basel, Switzerland) · 2026Article
- Urban-rural disparities in spatiotemporal accessibility of pharmacy care: a case study of Vermont, USA.BMC health services research · 2025Article
- Point-of-care C-reactive protein testing in general practice out-of-hours services: tool or trap?The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Implementation of remote units in two large out-of-hours emergency primary care districts in Norway.Scandinavian journal of primary health care · 2025Observational
- The overlooked challenges facing out-of-hours primary care in the NHS: a missed opportunity in policy.BJGP open · 2025Article
- Evaluating spatial access to primary care and health disparities in a rural district of Sri Lanka: Implications for strategic health policy interventions.PLOS global public health · 2025Article
- Rural and Urban patients' Requirements and Experiences of Out-of-hours medical care after cancer (RUREO): a questionnaire study.BMJ open · 2023Article
- Association of travel time with mental health service use in primary health care according to contact type - a register-based study in Kainuu, Finland.BMC health services research · 2022Article
- The role of area level social deprivation on childhood and adolescent consultation rate in primary care: a population based, cohort study.BMC primary care · 2022Article
- Observational
- Multilevel modeling of geographic variation in general practice consultations.Health services research · 2021Article
- Investigating the impact of distance on the use of primary care extended hours.International journal of population data science · 2021Article
- GIS-based approaches on the accessibility of referral hospital using network analysis and the spatial distribution model of the spreading case of COVID-19 in Jakarta, Indonesia.BMC health services research · 2020Article
- Spatial Inequality Hides the Burden of Dog Bites and the Risk of Dog-Mediated Human Rabies.The American journal of tropical medicine and hygiene · 2020Article
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- Does deprivation affect the demand for NHS Direct? Observational study of routine data from Wales.BMJ open · 2019Observational
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Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGP cooperatives are typically based in emergency primary care centres, and patients are frequently required to travel to be seen. Geography is a key determinant of access, but little is known about the extent of geographical variation in the use of out-of-hours services.
aimTo examine the effects of distance and rurality on rates of out-of-hours service use. DESIGN OF STUDY: Geographical analysis based on routinely collected data on telephone calls in June (n=14 482) and December (n=19 747), and area-level data.
settingOut-of-hours provider in Devon, England serving nearly 1 million patients.
methodStraight-line distance measured patients' proximity to the primary care centre. At area level, rurality was measured by Office for National Statistics Rural and Urban Classification (2004) for output areas, and deprivation by The Index of Multiple Deprivation (2004).
resultsCall rates decreased with increasing distance: 172 (95% confidence interval [CI]=170 to 175) for the first (nearest) distance quintile, 162 (95% CI=159 to 165) for the second, and 159 (95% CI=156 to 162) per thousand patients/year for the third quintile. Distance and deprivation predicted call rate. Rates were highest for urban areas and lowest for sparse villages and hamlets. The greatest urban/rural variation was in patients aged 0-4 years. Rates were higher in deprived areas, but the effect of deprivation was more evident in urban than rural areas.
conclusionThere is geographical variation in out-of-hours service use. Patients from rural areas have lower call rates, but deprivation appears to be a greater determinant in urban areas. Geographical barriers must be taken into account when planning and delivering services.
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