Differences in access to services in rural emergency departments of Quebec and Ontario

PLoS One. 2015 Apr 15;10(4):e0123746. doi: 10.1371/journal.pone.0123746. eCollection 2015.


Introduction: Rural emergency departments (EDs) are important safety nets for the 20% of Canadians who live there. A serious problem in access to health care services in these regions has emerged. However, there are considerable geographic disparities in access to trauma center in Canada. The main objective of this project was to compare access to local 24/7 support services in rural EDs in Quebec and Ontario as well as distances to Levels 1 and 2 trauma centers.

Materials and methods: Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities. There were 26 rural EDs in Quebec and 62 in Ontario meeting these criteria. Data were collected from ministries of health, local health authorities, and ED statistics. Fisher's exact test, the t-test or Wilcoxon-Mann-Whitney test, were performed to compare rural EDs of Quebec and Ontario.

Results: All selected EDs of Quebec and Ontario agreed to participate in the study. The number of EDs visits was higher in Quebec than in Ontario (19 322 ± 6 275 vs 13 446 ± 8 056, p = 0.0013). There were no significant differences between Quebec and Ontario's local population and small town population density. Quebec's EDs have better access to advance imaging services such as CT scanner (77% vs 15%, p < .0001) and most the consultant support and ICU (92% vs 31%, p < .0001). Finally, more than 40% of rural EDs in Quebec and Ontario are more than 300 km away from Levels 1 and 2 trauma centers.

Conclusions: Considering that Canada has a Universal health care system, the discrepancies between Quebec and Ontario in access to support services are intriguing. A nationwide study is justified to address this issue.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Emergency Service, Hospital / statistics & numerical data*
  • Health Services Accessibility / organization & administration*
  • Humans
  • Ontario
  • Physicians / supply & distribution*
  • Quebec
  • Rural Health Services / supply & distribution*
  • Rural Population
  • Surveys and Questionnaires

Grant support

The research project was supported in part by a Junior 1 Clinician –Scientist award from the FRQS (RF), the Research Chair Emergency Medicine Laval University – CHAU Hôtel-Dieu de Lévis Hospital and the Hôtel-Dieu de Lévis Hospital research fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.