Rural Emergency 360°: A mixed-methods analysis of barriers and priorities for equitable emergency care in Québec
10 affiliations
- 1Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Quebec, Canada
- 2VITAM-Centre de recherche en santé durable, Québec, Quebec, Canada
- 3Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Quebec, Canada
- 4CISSS du Bas-Saint-Laurent, Rimouski, Quebec, Canada
- 5Hub d’innovation en médecine rurale, Living Lab Charlevoix - Vitam Research Centre, Québec, Quebec, Canada
- 6Department of Psychology, UQAM, Montréal, Quebec, Canada
- 7Faculté de médecine, Université Laval, Québec, Quebec, Canada
- 8Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
- 9Département de science politique, Faculté des sciences sociales, Université Laval, Québec, Quebec, Canada
- 10HUPR-Centre de recherche sur le potentiel humain, Montréal, Quebec, Canada
Abstract
Background: Rural emergency departments (EDs) are critical to ensuring equitable access to acute care, yet face persistent systemic challenges. In Québec, Canada, reforms to healthcare governance, funding and resource allocation, and service delivery have transformed rural ED operations. This study aimed to document characteristics, challenges, and improvement priorities for all rural EDs in the province. Methods: A participatory mixed-methods design was used. 26 rural EDs in Québec were included. Data sources comprised administrative statistics, structured site surveys, individual stakeholder semi structured interviews, and a validation survey of identified local champions. Analyses comprised a triangulation of the quantitative and qualitative data using transversal thematic analysis to determine common issues. Potential solutions identified were validated through stakeholder questionnaires. The study was reported in accordance with the COREQ reporting guideline. Results: Most respondents were women (64%) and professionals with more than 5 years of experience. Four main themes were identified: governance, healthcare organization, access to resources, and professional practice. Governance challenges included reduced local autonomy, administrative complexity, and budgeting models poorly adapted to rural realities. Participants emphasized the need for standardized but locally flexible administrative processes, regional emergency service managers, and rural-sensitive performance metrics. Organizational barriers included geographic isolation, limited access to primary care, and difficulties with interfacility transfers due to referral-center capacity and ambulance shortages. Resource constraints centered on shortages of human resources, diagnostic services and specialty coverage, especially anesthesia, obstetrics, and psychiatry. Professional practice was shaped by the need to maintain broad competencies in low-volume contexts, while contending with professional isolation and proximity to patients. Local champions prioritized expanding telemedicine, strengthening prehospital services, enhancing continuing education, and implementing tailored recruitment strategies. Conclusion: This study provides the first province-wide documentation of characteristics, challenges, and improvement priorities for all rural EDs. Findings highlight the need for systemic reforms that restore local decision-making authority, strengthen transfer and prehospital capacity, expand telehealth and specialty access, and support professional development. These results provide a foundation for evidence-based policies and actions to sustain equitable emergency care in rural regions.
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BibTeX
@article{fleet2026rural,
title = {{Rural Emergency 360°: A mixed-methods analysis of barriers and priorities for equitable emergency care in Québec}},
author = {Richard Fleet and Catherine Turgeon-Pelchat and Fatoumata Korika Tounkara and Gilles Dupuis and Jean-Paul Fortin and Jocelyn Gravel and Mathieu Ouimet and Julie Théberge and France Légaré and Hassane Alami},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0342965},
url = {https://doi.org/10.1371/journal.pone.0342965},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Rural Emergency 360°: A mixed-methods analysis of barriers and priorities for equitable emergency care in Québec
AU - Richard Fleet
AU - Catherine Turgeon-Pelchat
AU - Fatoumata Korika Tounkara
AU - Gilles Dupuis
AU - Jean-Paul Fortin
AU - Jocelyn Gravel
AU - Mathieu Ouimet
AU - Julie Théberge
AU - France Légaré
AU - Hassane Alami
PY - 2026
DA - 2026/09/18
JO - PLOS One
DO - 10.1371/journal.pone.0342965
UR - https://doi.org/10.1371/journal.pone.0342965
AB - Background: Rural emergency departments (EDs) are critical to ensuring equitable access to acute care, yet face persistent systemic challenges. In Québec, Canada, reforms to healthcare governance, funding and resource allocation, and service delivery have transformed rural ED operations. This study aimed to document characteristics, challenges, and improvement priorities for all rural EDs in the province. Methods: A participatory mixed-methods design was used. 26 rural EDs in Québec were included. Data sources comprised administrative statistics, structured site surveys, individual stakeholder semi structured interviews, and a validation survey of identified local champions. Analyses comprised a triangulation of the quantitative and qualitative data using transversal thematic analysis to determine common issues. Potential solutions identified were validated through stakeholder questionnaires. The study was reported in accordance with the COREQ reporting guideline. Results: Most respondents were women (64%) and professionals with more than 5 years of experience. Four main themes were identified: governance, healthcare organization, access to resources, and professional practice. Governance challenges included reduced local autonomy, administrative complexity, and budgeting models poorly adapted to rural realities. Participants emphasized the need for standardized but locally flexible administrative processes, regional emergency service managers, and rural-sensitive performance metrics. Organizational barriers included geographic isolation, limited access to primary care, and difficulties with interfacility transfers due to referral-center capacity and ambulance shortages. Resource constraints centered on shortages of human resources, diagnostic services and specialty coverage, especially anesthesia, obstetrics, and psychiatry. Professional practice was shaped by the need to maintain broad competencies in low-volume contexts, while contending with professional isolation and proximity to patients. Local champions prioritized expanding telemedicine, strengthening prehospital services, enhancing continuing education, and implementing tailored recruitment strategies. Conclusion: This study provides the first province-wide documentation of characteristics, challenges, and improvement priorities for all rural EDs. Findings highlight the need for systemic reforms that restore local decision-making authority, strengthen transfer and prehospital capacity, expand telehealth and specialty access, and support professional development. These results provide a foundation for evidence-based policies and actions to sustain equitable emergency care in rural regions.
SN - 1932-6203
ER -