# Understanding How Rurality Relates to Residents' Experiences of Accessing Primary Care: An Interview‐Based Study

## TL;DR

This study explores how people in rural and remote areas of Australia experience accessing primary care, revealing unique challenges that increase with geographic isolation.

## Contribution

The study introduces the concept of 'geographic fragility' to explain how access to primary care becomes increasingly burdensome in more remote communities.

## Key findings

- Residents in remote communities face interconnected challenges like provider shortages, travel demands, and cultural misunderstandings.
- Geographic fragility increases with rurality, making health needs weigh against the burden of accessing care.
- Context-specific policies are needed to address access disparities in regional, rural, and remote areas.

## Abstract

To explore the experience of local residents when accessing primary care across different levels of rurality.

Four discrete regional, rural, and remote communities in Queensland, Australia, categorised by the Modified Monash Model classification.

Residents from a regional centre (n = 15), a small rural town (n = 9), and two remote or very remote communities (n = 6).

Semi‐structured interviews using thematic analysis with both deductive and inductive coding.

Common challenges across all levels of rurality included limited primary care provider availability, long wait times, and disrupted care continuity, though their impact varied by the level of rurality. Regional centre residents predominantly experienced availability and timeliness challenges, while the small rural town residents faced availability, timeliness, and geography challenges. The remote and very remote communities experienced interconnected challenges, including a lack of permanent primary care providers, extensive travel, disrupted care continuity, and poor understanding of the community culture by some primary care providers. A key finding was ‘geographic fragility,’ which increased with the level of rurality, where remote community residents had to weigh up whether their health needs justified the burden of accessing primary care.

This study highlights the need for nuanced, context‐specific approaches for improving primary care access across different levels of rurality, with particular attention to geographic fragility in remote and very remote communities. Policy implications include developing targeted workforce strategies, addressing timeliness challenges, and implementing flexible service models to ensure equitable access to primary care for all Australians.

What is already known on this subject?
○Adequate access to primary care is vital for a strong health system, though deficiencies persist for Australia's rural and remote communities.○Healthcare access is multidimensional, of both barriers and enablers.○Research has explored single dimensions of access, though a comprehensive exploration of these across different levels of rurality is lacking.
What does this study add?
○A nuanced understanding of the dimensions of access when accessing primary care across regional, rural, and remote Australian communities.○Demonstration of how perceptions of primary care access vary across different levels of rurality, highlighting the need for contextually tailored approaches to policy design.○Identifies the concept of geographic fragility in smaller and isolated communities, providing novel insights into rural and remote primary care access.

What is already known on this subject?
○Adequate access to primary care is vital for a strong health system, though deficiencies persist for Australia's rural and remote communities.○Healthcare access is multidimensional, of both barriers and enablers.○Research has explored single dimensions of access, though a comprehensive exploration of these across different levels of rurality is lacking.

Adequate access to primary care is vital for a strong health system, though deficiencies persist for Australia's rural and remote communities.

Healthcare access is multidimensional, of both barriers and enablers.

Research has explored single dimensions of access, though a comprehensive exploration of these across different levels of rurality is lacking.

What does this study add?
○A nuanced understanding of the dimensions of access when accessing primary care across regional, rural, and remote Australian communities.○Demonstration of how perceptions of primary care access vary across different levels of rurality, highlighting the need for contextually tailored approaches to policy design.○Identifies the concept of geographic fragility in smaller and isolated communities, providing novel insights into rural and remote primary care access.

A nuanced understanding of the dimensions of access when accessing primary care across regional, rural, and remote Australian communities.

Demonstration of how perceptions of primary care access vary across different levels of rurality, highlighting the need for contextually tailored approaches to policy design.

Identifies the concept of geographic fragility in smaller and isolated communities, providing novel insights into rural and remote primary care access.