Keywords: Postural hypotension, blood pressure measurement, rural practice, primary care
Background:
Staff perceptions of rurality may affect the care they deliver, for example, through assumptions about feasibility of investigations in their setting.
Aim of the study:
1. Explore consistency of judgements regarding practice setting where multiple survey responses were received from practices.
2. Establish impact of inconsistency on observed associations with postural hypotension (PH) outcomes, as an example.
Methodology:
We surveyed primary care clinicians regarding their management of PH between August and December 2022. We used setting definitions of urban (secondary care in same town), semi-rural (secondary care in another town; public transport available), or rural/remote (secondary care involves substantial journey; public transport difficult).
Standard deviations (SDs) of numerically encoded setting responses within practices were inspected to assess inconsistency. Responses were compared to Office for National Statistics (ONS) Rural-Urban Classifications using χ2 tests. Associations of the two setting classifications with survey outcomes for PH were compared.
Results:
Responses were received from 703 participants in 242 individual practices; median (range) 1 (1 to 18) participant per practice). ONS data were matched for 595 responses. Observed SDs for individual practices settings confirmed inconsistency. All survey rural/remote responses and 1.5% of urban responses mapped to the ONS rural category; survey semi-rural responses mapped 77.5% to urban, 22.5% to rural ONS categories (p<0.001). Lower measurement rates for PH were reported for survey rural/remote settings than for other settings (p=0.022), whereas ONS settings did not differ (p=0.379). Survey rural/remote settings were associated with fewer repetitions of PH measurements than other settings but ONS settings did not differ (p=0.047 vs. 0.926).
Conclusions:
Clinicians are inconsistent in judging practice setting. Perceived rurality may affect services offered to patients, perhaps due to considerations of practicality, as exemplified here with measurement of PH. Defining rurality is complex; validated definitions are required to improve generalisability of findings and to avoid erroneous associations between practice setting and service outcomes.
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