Measuring potential spatial access to primary health care physicians using a modified gravity model (original) (raw)
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Journal of Remote Sensing & GIS, 2023
This is a systematic review of literature on geographic access methods to primary care in non-urban settings. The review aimed to explore the use, application, and operationalization of FCA methods and their ability to identify variations in access in non-urban areas. The review included 32 papers on physical access to primary care, with most studies using secondary data and the E2SFCA method. The E2SFCA method was found to be more sensitive in identifying deficits in rural access. However, many studies lacked clear definitions and there was no clear consensus concerning the definition of a primary care provider. The conclusion suggests that healthcare policymakers and providers should consider rural populations’ unique transportation needs when designing healthcare access initiatives, and future research should compare these methods and develop recommendations for improving access to primary care for rural populations.
BMJ Open
ObjectivesPrevious studies on geographical disparities in healthcare access have been limited by not accounting for the healthcare provider’s capacity, a key determinant of supply and demand relationships.DesignThis study proposed a spatial coverage modelling approach to evaluate disparities in hospital care access using Canadian Institute for Health Information data in 2007.SettingThis study focusses on accessibility of inpatient and emergency cares at both levels of individual hospital and the administrative regions of Local Health Integration Network (LHIN) levels.MeasuresWe integrated a set of traffic and geographical data to precisely estimate travel time as a measure of the level of accessibility to the nearest hospital by three scenarios: walking, driving and a combination of the both. We estimated population coverage rates, using hospital capacities and population in the catchments, as a measure of the level of the healthcare availability. Hospital capacities were calculated...
Health Care : Current Reviews, 2023
This study assess the relationship between the deficiency of medical care accessibility in rural areas, with a particular focus on the most susceptible and vulnerable segments of the population. The study employed the Enhanced Two-Step Floating Catchment Area (E2SFCA) methodology and examined its implications for the Spatial Mismatch Theory in line with the Central Place Theory. The results indicates that the Central Place Theory appears more suitable for elucidating access levels and that the provision and accessibility of primary care services remain inextricably intertwined with, and dependent upon, the existence of sufficient road infrastructure. As such, individuals residing at substantial distances from the primary road network may experience severely compromised access to such services. This study contributes to our understanding of the challenges facing rural populations in accessing essential medical care and highlights the need for further research and policy interventions...
An integrated approach to measuring potential spatial access to health care services
Socio-economic Planning Sciences, 1992
In recent years there have been several attempts to develop quantitative measures of potential spatial access to health care services which, despite their limitations, offer many positive ideas that can perhaps be integrated into a logically consistent and generally acceptable index. It is in this vein that the current paper presents an integrated approach, drawing partially from past contributions, to measuring potential spatial access to health care services. The final access index is derived as the culmination of a series of individual measures, starting with an initial gravity formulation and progressing through successive stages as new elements, consistent with the definition and conceptualization of potential spatial access, are introduced. Application of the proposed index to the ambulatory medical care system of the Akron, Ohio SMSA, demonstrates the validity of the measure, and its suitability as a potential health care planning tool.
International Journal of Health Geographics
Background: The potential spatial access to urban health services is an important issue in health geography, spatial epidemiology and public health. Computing geographical accessibility measures for residential areas (e.g. census tracts) depends on a type of distance, a method of aggregation, and a measure of accessibility. The aim of this paper is to compare discrepancies in results for the geographical accessibility of health services computed using six distance types (Euclidean and Manhattan distances; shortest network time on foot, by bicycle, by public transit, and by car), four aggregation methods, and fourteen accessibility measures. Methods: To explore variations in results according to the six types of distance and the aggregation methods, correlation analyses are performed. To measure how the assessment of potential spatial access varies according to three parameters (type of distance, aggregation method, and accessibility measure), sensitivity analysis (SA) and uncertainty analysis (UA) are conducted. Results: First, independently of the type of distance used except for shortest network time by public transit, the results are globally similar (correlation >0.90). However, important local variations in correlation between Cartesian and the four shortest network time distances are observed, notably in suburban areas where Cartesian distances are less precise. Second, the choice of the aggregation method is also important: compared with the most accurate aggregation method, accessibility measures computed from census tract centroids, though not inaccurate, yield important measurement errors for 10% of census tracts. Third, the SA results show that the evaluation of potential geographic access may vary a great deal depending on the accessibility measure and, to a lesser degree, the type of distance and aggregation method. Fourth, the UA results clearly indicate areas of strong uncertainty in suburban areas, whereas central neighbourhoods show lower levels of uncertainty. Conclusion: In order to accurately assess potential geographic access to health services in urban areas, it is particularly important to choose a precise type of distance and aggregation method. Then, depending on the research objectives, the choices of the type of network distance (according to the mode of transportation) and of a number of accessibility measures should be carefully considered and adequately justified.
Spatial and Spatio-temporal Epidemiology, 2017
This research is focused on methodological challenges and considerations associated with the estimation of the geographical aspects of access to healthcare with a focus on rural and remote areas. With the assumption that GIS-based accessibility measures for rural healthcare services will vary across geographic units of analysis and estimation techniques, which could influence the interpretation of spatial access to rural healthcare services. Estimations of geographical accessibility depend on variations of the following three parameters: 1) quality of input data; 2) accessibility method; and 3) geographical area. This research investigated the spatial distributions of physiotherapists (PTs) in comparison to family physicians (FPs) across Saskatchewan, Canada. The three-steps floating catchment areas (3SFCA) method was applied to calculate the accessibility scores for both PT and FP services at two different geographical units. A comparison of accessibility scores to simple healthcare provider-to-population ratios was also calculated. The results vary considerably depending on the accessibility methods used and the choice of geographical area unit for measuring geographical accessibility for both FP and PT services. These findings raise intriguing questions regarding the nature and extent of technical issues and methodological considerations that can affect GIS-based measures in health services research and planning. This study demonstrates how the selection of geographical areal units and different methods for measuring geographical accessibility could affect the distribution of healthcare resources in rural areas. These methodological issues have implications for determining where there is reduced access that will ultimately impact health human resource priorities and policies.
Small-Area Estimation of Spatial Access to Care and Its Implications for Policy
ABSTRACT Local or small-area estimates to capture emerging trends across large geographic regions are critical in identifying and addressing community-level health interventions. However, they are often unavailable due to lack of analytic capabilities in compiling and integrating extensive datasets and complementing them with the knowledge about variations in state-level health policies. This study introduces a modeling approach for small-area estimation of spatial access to pediatric primary care that is data rich and mathematically rigorous, integrating data and health policy in a systematic way. We illustrate the sensitivity of the model to policy decision making across large geographic regions by performing a systematic comparison of the estimates at the census tract and county levels for Georgia and California. Our results show the proposed approach is able to overcome limitations of other existing models by capturing patient and provider preferences and by incorporating possible changes in health policies. The primary finding is systematic underestimation of spatial access, and inaccurate estimates of disparities across population and across geography at the county level with respect to those at the census tract level
Geography of Health Care Access: Measurement, Analyses and Integration
2016
In recent decades, the health care delivery system in the United States has been greatly transformed and more widely examined. Even with one of the most developed health care systems in the world, the United States still experiences great spatial disparity in health care access. Increasing diversity of class, culture, and ethnicity also has a significant impact on health disparity. The goal of this chapter is to address the spatial disparity of health care access using a network-based health accessibility index method (NHAIM) in a Geographic Information System (GIS) environment. Ensuring a desired level of accessibility for patients is the goal of the health care delivery system, through which health care service providers are supplied to populations in need. GIS is able to incorporate geographical physical barriers, network-based travel time, and transportation costs required for measuring access to health care services. In this study, we develop a NHAIM to examine the spatial disp...
Social Science & Medicine, 2017
Equitable access and distribution of health care services for rural and remote populations is a substantial challenge for health workforce planners and policy makers. Geospatial examination of access to health care considers both need and supply dimensions together to determine spatial access scores which contribute to a greater understanding of potential inequity in accessibility. This geospatial investigation explores geographic variation in accessibility to primary health care services utilizing combined access scores for family physicians and nurse practitioner services in urban and rural communities in the Canadian Prairie provinces of Saskatchewan and Alberta. An index of access scores was developed using a floating catchment area framework and a census subdivision geographic unit. Information about family physician and nurse practitioner practice locations and spatial population data were obtained from the Canadian Institute for Health Information and Statistics Canada respectively. Alberta has a better overall provincial access score than Saskatchewan for family physicians and nurse practitioners combined (11.37 vs. 9.77). The results demonstrate that nurse practitioner services are likely addressing primary care access gaps due to reduced numbers of family physician services in certain geographical areas. Combined access scores reveal inequalities in the distribution of primary health care services relative to the proportion of population aged 65 + across both provinces, particularly in rural and remote communities. This study contributes to health services research by exploration of combined access scores for family physician and nurse practitioner services in relation to the distribution of seniors. These findings provide insight into which areas may be in need of increased primary health care services with a focus on both of these health professional groups. The findings of this research will serve as a foundational model for future expansion of the methods to other health care provider groups and to other population health need indicators provincially and nationally.