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Objective: To examine if telephones overcome geographical barriers to accessing primary care out-of-hours by parents of young children. Methods:Mixed methods including quantitative analysis of 5697 calls about children aged 0-4 years, 30 hours of observation at primary care centres, eight interviews with parents and a review of 80 telephone call recordings. Results: Call rates for children (0-4 years) decreased with increasing distance: the 20% of people who lived furthest from a primary care centre made fewer calls, 570 per 1000 patients/year (95% CI 558 to 582) than the 20% living closest, 652 (95% CI 644 to 661). Overall, call rates decreased with increasing rurality. Qualitative analysis suggested that this geographical variation was linked to familiarity with the system (notably previous contact with health services) and the availability of services, legitimacy of demand (particularly for children) and negotiation about mode of care. Conclusions: People already disadvantaged by their distance from facilities or socioeconomic circumstances may continue to be at a disadvantage when services are provided by telephone. © The Royal Society of Medicine Press Ltd 2010.

Original publication




Journal article


Journal of Health Services Research and Policy

Publication Date





21 - 27