The rural care needs index: a potential tool for "have-not" communities.

S ince the early 1990s, re searchers have attempted to define and measure “rurality” in the context of rural and remote medical care. At a general level, Wootton raised the question of the fit, or lack thereof, between the training of physicians and the dynamics of rural practice. Larsen Soles described the challenge posed by the rural “continuum” (that diversity of places between what we understand to be remote and what we understand to be urban) and how it influences the availability of tools and supports, as well as how one practises. Training and practice were key to Helm’s observations about the intimacy of rural practice; Montgomery’s review of the personal, community and professional factors that support successful rural practice; and MacLellan’s description of how rural Canada “needs the generalist with defined competencies, constantly fluctuating between primary, secondary and tertiary levels of care.” Attempts at measuring rurality from a health care or delivery perspective are similarly important and complex. Pong and Pitblado highlighted how descriptions of overor underserviced rural areas are challenged by the lack of an objective “optimal ratio” of physicians to patients in different settings. Aird and Kerr critiqued the Rurality Index for Ontario by raising a number of factors not addressed in that ranking system, such as the ability to provide general surgery, obtain locums and access needed equipment. A benchmark in measuring rurality across British Columbia is the work done by Leduc, who argued for the need “to provide a standard of comparison that can be used by researchers, educators, administrators and rural physicians.” Leduc’s General Practice Rurality Index comprises a host of variables, including health facilities, staff and equipment; number of general practitioners and specialists; remoteness; availability of transportation; presence and level of training of a range of paramedical support services and staff; community social and economic characteristics; and population levels and characteristics. Olatunde and colleagues’ Simplified General Practice Rurality Index focuses on just 3 factors: remoteness from an advanced referral centre, remoteness from a basic referral centre and drawing population. These authors’ work was supported by research at Montana State Univer sity that had already concluded how just 2 variables, population and distance to the nearest emergency care facility, were adequate for developing a rurality index. The simplicity of the Montana State University Rurality Index meant that its results were easy to comprehend and readily explained to local residents and decision-makers alike.