Transportation and Accessibility to Medical Care in Ambulatory Children with Renal Diseases

Abstract

The means of transportation from the interior of the country to the hospital in the capital, located in the southernmost part of the country, were considered in a prospective study held in the winter months for 65 unselected consecutive outpatient visits to the hospital of patients with chronic nephropathies. The bus was used for transportation in 50 cases, the railway in 13, and the car in 2. Most of the patients had to use more than two vehicles. Forty-three children (66.15%) traveled directly to the capital (group I) and 22 children (33.8%) had to stay overnight for 1 or 2 nights (group II). Sixteen children of group I (3712%) had to leave home at 5:30 am or earlier. The mean time for the whole trip to the hospital was 2:25 hr (range 1:10 hr to 6 hr) for group I and 22:15 hr (range 11:15 hr to 73:15 hr) for group II. The ratio of patients to total population of the corresponding geographic areas (per 100,000) was: 8.84, 3.91, and 1.30 for the distance from home to hospital, 40 to 100, 101 to 200, and more than 200 km, respectively. These ratios indicate that it is impossible for some children to travel to the capital. For 56.9% of the families, the trip was very expensive; 35.9% of the families required financial help. Ten out of 62 families were known to have missed other appointments due to transportation and financial difficulties. The negative impact of distance and transportation difficulties on clinic attendance by chronic outpatients might be reduced with more logical consultation hours, mail or telephone communications, and with medical care given by properly trained local physicians. Even in small countries like Uruguay, without geographical ruggedness, transportation is one of the most important barriers to medical care.