Letters to the Editor
Travel Time and the Use of Psychiatric Outpatient Clinic Services in Coastal Northern Norway
Dear Editor:
Studies from other countries have found that travel time is of importance to the utilization of psychiatric services, suggesting that most patients will not travel over 30 minutes for service (1). Northern Norway is sparsely inhabited, and inhabitants are accustomed to travelling. We examined whether travel time was of importance to service utilisation at the out- patient clinic at Stokmarknes, Nordland. The catchment area comprises 2368 km2 and had 31 629 inhabitants in 1997 (2). The population is ethnic Norwegian, with a minority population of Samis and African and Asian refugees. Types of employment include administration, education, health services, private business, fishing, farming, and the military; 46% of the population live in 5 towns, with the remainder living in sparsely populated areas. The clinic also gives occasional consultations (that is, less than 10%) in general practitioner (GP) offices outside of Stokmarknes.
We retrospectively compared the clinic’s record of patients treated from 1992 to 1996 with publicly available population figures (2). Travel time was calculated from zip codes and from information gathered from local bus and ferry companies. Geographical factors made 35 minutes a natural division point.
Of the inhabitants, 10 996 (34.8%) had a travel time of 35 minutes or less
(group 1). The remaining 20 633 inhabitants (65.2%) exceeded a travel time
of 35 minutes (group 2). Of 1834 patients treated, 51.9% had a travel time
of 35 minutes or less. A significantly higher proportion living within
35 minutes of the clinic had used the clinic’s services (8.6% vs 4.3%,
P2 = 250, P < 0.001). The mean travel time in group 1 was 22.1 minutes
(range 0 to 35 minutes); in group 2, it was 99.5 minutes (range 50 to 130
minutes). The mean age in group 1 was lower than in group 2 (40.5 vs 43.5
years). The percentage of women in group 1 was nonsignificantly higher
(59.4% vs 56.4%, P2 = 1.70).
In Norway, the number and level of activities in smaller local clinics has increased, following the belief that smaller local facilities are preferable to, and more accessible than, larger central facilities. However, little effort has been made to study whether local facilities are in fact sufficiently accessible to people in the catchment area. Although north Norwegians are accustomed to travelling longer distances to obtain specialized medical services, we find that travel time remains important to the use of psychiatric outpatient services. Though we lack information, we believe that a combination of fewer referrals and more missed appointments explains why the rate of utilization is lower in group 2 than in group 1. Other possible explanations are differences in mental health, tendency of people with mental illness to drift toward the towns, and higher tolerability toward persons with mental illness among GPs and other people in the periphery.
References
1. Rössler W, Riecher A, Löffler W, Fälkenheuer B. Community care in child psychiatry. An empirical approach using the concept of travel time. Soc Psychiatry Psychiatr Epidemiol 1991;26:28–33.
2. Statistics Norway. Statistical yearbook of Norway 1997. Oslo: Statistics Norway; 1997
Kristoffer Skarsvåg, MD
Rolf Wynn, MD, PhD
Tromsø, Norway
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