Accessibility to delivery care in Hubei Province, China

Socio-demographic and infrastructural variables influencing maternal risk concentration among ever-married women of reproductive age in rural West Bengal, India

BACKGROUND

The risk of a woman dying as a result of pregnancy or childbirth during her lifetime is about one in six in the poorest parts of the world.

OBJECTIVES

The present study aims to determine prevalence of maternal risk and the influencing variables among ever-married women belonging to the reproductive age group (15-49) of Birbhum district, West Bengal.

METHODS

A cohort-based retrospective cross-sectional study was carried out among the sample of 229 respondents through a purposive stratified random sampling method and a pre-designed semi-structured questionnaire. The ordinal logistic regression (OLR) model was taken as a tool of assessment. Before developing the proportional OLR model, we have checked the multicollinearity effect among the predictors and the first-order effect modifier was evaluated as well. We performed data analysis using SPSS version 26.

RESULTS

The result shows that illiterate women (Odds ratios [OR] = 2.81, 95% CI, 0.277-1.791), from lower standard of living (OR = 1.14, 95% CI, -0.845-1.116), married before the age of 15 years (OR = 21.96, 95% CI, -0.55-6.73) and between the age of 15-18 years (OR = 24.51. 95% CI, -0.45-6.85) are more likely to be affected by the higher concentration of maternal risk. Other important predictor is the time of pregnancy registration. Considering the transport and related en-route causalities, the result portraying a clear picture where the distance and travel time becoming significant factors in determining the concentration of maternal risk.

CONCLUSION

Incidences of child marriages should be restricted. Eradicating factors influencing an individual's decision to seek care would be an essential contribution in excluding the dominant maternal risk factors.

Gravity models for potential spatial healthcare access measurement: a systematic methodological review

BACKGROUND

Quantifying spatial access to care-the interplay of accessibility and availability-is vital for healthcare planning and understanding implications of services (mal-)distribution. A plethora of methods aims to measure potential spatial access to healthcare services. The current study conducts a systematic review to identify and assess gravity model-type methods for spatial healthcare access measurement and to summarize the use of these measures in empirical research.

METHODS

A two-step approach was used to identify (1) methodological studies that presented a novel gravity model for measuring spatial access to healthcare and (2) empirical studies that applied one of these methods in a healthcare context. The review was conducted according to the PRISMA guidelines. EMBASE, CINAHL, Web of Science, and Scopus were searched in the first step. Forward citation search was used in the second step.

RESULTS

We identified 43 studies presenting a methodological development and 346 empirical application cases of those methods in 309 studies. Two major conceptual developments emerged: The Two-Step Floating Catchment Area (2SFCA) method and the Kernel Density (KD) method. Virtually all other methodological developments evolved from the 2SFCA method, forming the 2SFCA method family. Novel methodologies within the 2SFCA family introduced developments regarding distance decay within the catchment area, variable catchment area sizes, outcome unit, provider competition, local and global distance decay, subgroup-specific access, multiple transportation modes, and time-dependent access. Methodological developments aimed to either approximate reality, fit a specific context, or correct methodology. Empirical studies almost exclusively applied methods from the 2SFCA family while other gravity model types were applied rarely. Distance decay within catchment areas was frequently implemented in application studies, however, the initial 2SFCA method remains common in empirical research. Most empirical studies used the spatial access measure for descriptive purposes. Increasingly, gravity model measures also served as potential explanatory factor for health outcomes.

CONCLUSIONS

Gravity models for measuring potential spatial healthcare access are almost exclusively dominated by the family of 2SFCA methods-both for methodological developments and applications in empirical research. While methodological developments incorporate increasing methodological complexity, research practice largely applies gravity models with straightforward intuition and moderate data and computational requirements.

Optimization referral rate design for hierarchical diagnosis and treatment system based on accessibility-utilization efficiency bi-objective collaboration: A case study of China

The hierarchical diagnosis and treatment reform of China can guide residents to seek medical treatment in an orderly manner and improve access to medical treatment. Most existing studies on hierarchical diagnosis and treatment used accessibility as the evaluation index to determine the referral rate between hospitals. However, the blind pursuit of accessibility will cause the problem of uneven utilization efficiency of hospitals at different levels. In response to this, we constructed a bi-objective optimization model based on the perspective of residents and medical institutions. This model can give the optimal referral rate for each province considering the accessibility of residents and the utilization efficiency of hospitals, to improve the utilization efficiency and equality of access for hospitals. The results showed that the applicability of bi-objective optimization model is good, and the optimal referral rate based on the model can ensure the maximum benefit of the two optimization goals. In the optimal referral rate model, residents' medical accessibility is relatively balanced overall. In terms of obtaining high-grade medical resources, the accessibility is better in the eastern and central regions, but poorer in the western China. According to the current allocation of medical resources in China, the medical tasks undertaken by high-grade hospitals account for 60%-78%, which are still the main force of medical services. In this way, there is a big gap in realizing the "serious diseases do not leave the county" goal of hierarchical diagnosis and treatment reform.

Measuring accessibility to public services and infrastructure criticality for disasters risk management

Component criticality analysis of infrastructure systems has traditionally focused on physical networks rather than infrastructure services. As an example, a key objective of transport infrastructure is to ensure mobility and resilient access to public services, including for the population, service providers, and associated supply chains. We introduce a new user-centric measure for estimating infrastructure criticality and urban accessibility to critical public services - particularly healthcare facilities without loss of generality - and the effects of disaster-induced infrastructure disruptions. Accessibility measures include individuals' choices of all services in each sector. The approach is scalable and modular while preserving detailed features necessary for local planning decisions. It relies on open data to simulate various disaster scenarios, including floods, seismic, and compound shocks. We present results for Lima, Peru, and Manila, Philippines, to illustrate how the approach identifies the most affected areas by shocks, underserved populations, and changes in accessibility and critical infrastructure components. We capture the changes in people's choices of health service providers under each scenario. For Lima, we show that the floods of 2020 caused an increase in average access times to all health services from 33 minutes to 48 minutes. We identify specific critical road segments for ensuring access under each scenario. For Manila, we locate the 22% of the population who lost complete access to all higher health services due to flooding of over 15 cm. The approach is used to identify and prioritize targeted measures to strengthen the resilience of critical public services and their supporting infrastructure systems, while putting the population at the center of decision-making.

Geographic disparities in access to Medication for Opioid Use Disorder across US census tracts based on treatment utilization behavior

Drug overdose is the leading cause of accidental death in the U.S. with deaths from opioid overdose occurring at a higher rate in rural areas. The gaps in the provision of healthcare services have been exacerbated by the opioid crisis leaving vulnerable populations without access to preventative care and education, harm reduction, both chronic and acute treatment of the symptoms of opioid use disorder (OUD), and long-term psychological support for those with OUD and their families. There has been a call in the literature -and a federal mandate-for increased access to opioid treatment facilities, but to date this access has not been operationalized using best practices in geography. Medication for Opioid Use Disorder (MOUD) with FDA-approved methadone or buprenorphine has been shown to increase treatment retention, reduce opioid use and associated health and societal harms, and reduce opioid related overdose, and as such is considered the most effective treatment for OUD. The objective of this study is to examine U.S. adults' spatial access to MOUD - specifically locations of certified Opioid Treatment Programs (OTPs) and DATA-waived Buprenorphine providers. A gravity-based variant of the enhanced two-step floating catchment area model is employed, where friction of distance is based on previously published willingness to travel distances for patients visiting OTPs, to assess how opioid agonist treatment accessibility varies across the nation. Findings suggest that there are extensive 'treatment deserts' where there is little to no physical access to MOUD, especially in rural areas. The significance of this work lies in the incorporation of treatment utilization behavior in the access metric, and the continued confirmation of gaps in access to OUD services despite federal efforts to improve accessibility.