The inverse care law as applied to general practice clinics in the Irish Midwest: examining effects through simulated practice closure

Michael O'callaghan, Eric Harbour, Fintan Stanley, Liam Glynn

Keywords: Rural medicine, healthcare access, health equity, rural and remote, primary care, general practitioner, health informatics

Background:

The inverse care law, proposed by Julian Tudor Hart in 1971, states “the availability of good medical care tends to vary inversely with the need for it in the population served”. Tudor Hart held that this law operates in both socioeconomically deprived and/or geographically remote settings.
Modern computing methods facilitate analysis and mapping of large datasets, which can be used to test such hypotheses.

Research questions:

This study aims to examine the inverse care law and resilience of differing areas in Ireland's Midwest to GP clinic closure.

Method:

All GP clinic locations in Ireland’s Midwest counties Limerick and Clare were identified. Administrative boundaries (Small Areas (SAs)) were identified from open data resources and divided into six levels of rurality. The direct linear distance from the centre of each SA to its respective closest GP clinic was measured. Simulated “closing” of each GP clinic was carried out using a computer program, which removed practices sequentially from the overall dataset before re-calculating all distances.

Results:

GP clinics (n=112) were mapped across 1,287 SAs. As expected, GP clinics cluster in more urban areas. The majority of the SAs in Co. Clare (63%) and Co. Limerick (66%) are rural. Rural SAs had significantly longer travel distances to GP clinics than urban SAs, and these distances increase further as distance from an urban centre increases. Due to sparseness of GP clinics in rural locations, simulated closure of GP clinics revealed increasing travel distance to the next closest clinic with increasing level of rurality, in a stepwise fashion (r2=0.31).

Conclusions:

Due to lack of alternative GP clinic supply, rural communities are more adversely affected by local GP clinic closure. Our methods are replicable and may encourage policy makers to focus on ensuring rural general practice is supported.

Points for discussion:

novel methodology for identifying areas most adversely impacted by health service closure

next steps include incorporating social deprivation of small areas into calculations

study involves assumptions about closest clinic being available to and preferred by all those within a community – requires further study also

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