The effect of rurality on ERCP delivery

Introduction: Health inequalities, defined as variances in health status and outcomes are an issue of fundamental importance for Scottish healthcare. With a focus on rural access to secondary care services in UGI surgery, this study aims to explore whether patients from a rural environment receive similar access to an ERCP service, when compared to those from an urban setting.
Method: Retrospective collection from case notes. Data consisting of age, gender, and home postcode were collected from all patients who underwent ERCP for the first time in 2014. Total mileage of their journeys were recorded, allowing for clear distinction between the two groups: accessible rural and remote rural.
Results and discussion: 148 patients underwent ERCP in 2014. Using standardised Scottish population estimates for 2014, 19.9% of the total population for the Highlands and Islands reside within 20 miles of the ERCP service, with 80.1% located further afar. Inverness and Nairn hold merely 19.9% of the population from the entire Highlands and islands, and yet account for 39.1% of all ERCP cases. These results may suggest that living in a remote rural setting reduces the likelihood of being referred for or requiring an ERCP. The inverse care law may suggest that remote rural patients are less likely to be referred for ERCP than their urban counterparts (Hart, JT. The inverse care law. Lancet 1971; 1: 405–412).
Conclusion: Living in a remote rural environment reduces your likelihood of being referred for, or requiring, an ERCP service.

This abstract was presented at the Innovative Solutions in Remote Healthcare - 'Rethinking Remote' conference, 23-24 May 2016, Inverness, Scotland.