La percepción local del acceso a los servicios de salud en las áreas rurales. El caso del pirineo navarro / Local perception of access to health services in rural areas. The case of the Navarrese Pyrenees

Fundamento: Mientras las inequidades en la protección dela salud son cada vez más reconocidas, la disparidad rural/urbana en el acceso a los servicios sanitarios es con frecuencia ignorada. Las regiones rurales acumulan junto alos efectos del hábitat (dispersión, tamaño poblacional),importantes desequilibrios demográficos (envejecimiento)y desventajas socioeconómicas que definen barreras parala accesibilidad. Este trabajo analiza la percepción local delacceso a los servicios sanitarios para identificar los factoresque facilitan y dificultan una atención primaria continua y elseguimiento de las derivaciones. Material y métodos: Estudio cualitativo realizado en losvalles de Aezkoa, Salazar y Roncal (Navarra) entre 2012 y2016. La accesibilidad se analizó a través de siete dimensiones: disponibilidad, geografía, asequibilidad, acomodación,puntualidad, aceptabilidad y conocimiento/conciencia. Seentrevistó a 21 personas expertas (personal sanitario), informantes clave (relacionados con los cuidados y el desarrollo local) y perfiles sociológicos. La información recabada se contrastó con un marco conceptual específicamentepropuesto para facilitar la evaluación de políticas de accesibilidad rural. Resultados: Los resultados muestran el peso otorgado ala geografía, la disponibilidad de servicios, así como al entorno sociológico envejecido. La accesibilidad se define enfunción del tiempo frente a la distancia y la disponibilidadde alternativas de movilidad. Conclusiones: Es necesario considerar políticas inclusivasque atiendan la particularidad de las poblaciones ruralesy sus territorios. El envejecimiento supone una pérdida deaccesibilidad general y condiciona la demanda de servicios.En los entornos rurales y remotos dependen de la automovilidad privada como el principal recurso y estrategia parael acceso a la salud.(AU)

Background: While there is a growing recognition of theinequities in health protection, the rural/urban disparityin access to health services is often ignored. Rural regionsaccumulate not only habitat effects (dispersion, population size) but also significant demographic imbalances(ageing) and obvious socio-economic disadvantages thatdefine barriers to accessibility. This paper analyses localperceptions of access to health services in order to identify factors that facilitate and hinder continuous primarycare and follow-up of referrals. Methods: Qualitative study conducted in the valleys ofAezkoa, Salazar and Roncal (Navarre) between 2012 and2016. Accessibility was analysed through seven dimen-sions: availability, geography, affordability, accommodation, timeliness, acceptability, and knowledge/awareness.A total of 21 indepth interviews were carried out with experts (health care personnel), key informants (related tocare and local development) and sociological profiles. Theinformation collected was checked against a conceptualframework specifically designed to facilitate the evaluation of rural accessibility policies. Results: The results showed the weight given to geography, the availability of services, as well as the agingsociological environment. Accessibility was defined as afunction of time versus distance and the availability of mobility alternatives. Conclusion: It is necessary to consider inclusive policiesthat address the particular features of rural populationsand their territories. Ageing means a loss of general accessibility and influences demands for services. In ruraland remote environments, people depend on privateself-mobility as the main resource and strategy for accessto health.(AU)

[Local perception of access to health services in rural areas. The case of the Navarrese Pyrenees].

INTRODUCTION: While there is a growing recognition of the inequities in health protection, the rural/urban disparity in access to health services is often ignored. Rural regions accumulate not only habitat effects (dispersion, population size) but also significant demographic imbalances (ageing) and obvious socio-economic disadvantages that define barriers to accessibility. This paper analyses local perceptions of access to health services in order to identify factors that facilitate and hinder continuous primary care and follow-up of referrals. METHODS: Qualitative study conducted in the valleys of Aezkoa, Salazar and Roncal (Navarre) between 2012 and 2016. Accessibility was analysed through seven dimensions: availability, geography, affordability, accommodation, timeliness, acceptability, and knowledge/awareness. A total of 21 in-depth interviews were carried out with experts (health care personnel), key informants (related to care and local development) and sociological profiles. The information collected was checked against a conceptual framework specifically designed to facilitate the evaluation of rural accessibility poli-cies. RESULTS: The results showed the weight given to geo-graphy, the availability of services, as well as the aging sociological environment. Accessibility was defined as a function of time versus distance and the availability of mobility alternatives. CONCLUSIONS: It is necessary to consider inclusive policies that address the particular features of rural populations and their territories. Ageing means a loss of general accessibility and influences demands for services. In rural and remote environments, people depend on private self-mobility as the main resource and strategy for access to health.