Rural Emergency 360°: A mixed-methods analysis of barriers and priorities for equitable emergency care in Québec.

چکیده اصلی

BACKGROUND: Rural emergency departments (EDs) are critical to ensuring equitable access to acute care, yet face persistent systemic challenges. In Québec, Canada, reforms to healthcare governance, funding and resource allocation, and service delivery have transformed rural ED operations. This study aimed to document characteristics, challenges, and improvement priorities for all rural EDs in the province. METHODS: A participatory mixed-methods design was used. 26 rural EDs in Québec were included. Data sources comprised administrative statistics, structured site surveys, individual stakeholder semi structured interviews, and a validation survey of identified local champions. Analyses comprised a triangulation of the quantitative and qualitative data using transversal thematic analysis to determine common issues. Potential solutions identified were validated through stakeholder questionnaires. The study was reported in accordance with the COREQ reporting guideline. RESULTS: Most respondents were women (64%) and professionals with more than 5 years of experience. Four main themes were identified: governance, healthcare organization, access to resources, and professional practice. Governance challenges included reduced local autonomy, administrative complexity, and budgeting models poorly adapted to rural realities. Participants emphasized the need for standardized but locally flexible administrative processes, regional emergency service managers, and rural-sensitive performance metrics. Organizational barriers included geographic isolation, limited access to primary care, and difficulties with interfacility transfers due to referral-center capacity and ambulance shortages. Resource constraints centered on shortages of human resources, diagnostic services and specialty coverage, especially anesthesia, obstetrics, and psychiatry. Professional practice was shaped by the need to maintain broad competencies in low-volume contexts, while contending with professional isolation and proximity to patients. Local champions prioritized expanding telemedicine, strengthening prehospital services, enhancing continuing education, and implementing tailored recruitment strategies. CONCLUSION: This study provides the first province-wide documentation of characteristics, challenges, and improvement priorities for all rural EDs. Findings highlight the need for systemic reforms that restore local decision-making authority, strengthen transfer and prehospital capacity, expand telehealth and specialty access, and support professional development. These results provide a foundation for evidence-based policies and actions to sustain equitable emergency care in rural regions.

ترجمه فارسی چکیده

مراکز خدمات اضطراری روستایی (ED) برای اطمینان از دسترسی عادلانه به مراقبت‌های حاد حیاتی هستند، اما با چالش‌های سیستمیک پایدار روبرو هستند. این مطالعه ویژگی‌ها، چالش‌ها و اولویت‌های بهبود تمام مراکز ED روستایی در استان کبک را مستند کرد. از یک طراحی ترکیبی مشارکتی استفاده شد. داده‌ها شامل آمارهای اداری، نظرسنجی‌های ساختاریافته سایت، مصاحبه‌های نیمه‌ساختاریافته ذینفعان و نظرسنجی تایید چالش‌های محلی بود. تحلیل‌ها شامل تثبیت داده‌های کمی و کیفی برای تعیین مسائل مشترک بود. نتایج چهار موضوع اصلی را نشان دادند: حاکمیت، سازماندهی مراقبت، دسترسی به منابع و عملکرد حرفه‌ای. موانع شامل محدودیت‌های منابع و نیاز به اصلاحات سیستمیک برای حفظ تصمیم‌گیری محلی و دسترسی به خدمات تخصصی بود.

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