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Crighton EJ, Ouédraogo AM, Sawada M, Mestre TA. Patterns and determinants of health care utilization among people with Parkinson's disease: A population-based analysis in Ontario, Canada. PLoS One 2024; 19:e0305062. [PMID: 38905210 PMCID: PMC11192415 DOI: 10.1371/journal.pone.0305062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 05/22/2024] [Indexed: 06/23/2024] Open
Abstract
In Ontario, despite the increasing prevalence of Parkinson's disease (PD), barriers to access-to-care for people with Parkinson's disease (PwP) and their caregivers are not well understood. The objective of this study is to examine spatial patterns of health care utilization among PwP and identify factors associated with PD-related health care utilization of individuals in Ontario. We employed a retrospective, population-based study design involving administrative health data to identify PwP as of March 31, 2018 (N = 35,482) using a previously validated case definition. An enhanced 2-step floating catchment area method was used to measure spatial accessibility to PD care and a descriptive spatial analysis was conducted to describe health service utilization by geographic area and specialty type. Negative binomial regression models were then conducted to identify associated geographic, socioeconomic, comorbidity and demographic factors. There was marked spatial variability in PD-related service utilization, with neurology and all provider visits being significantly higher in urban areas (CMF>1.20; p<0.05) and family physician visits being significantly higher (CMF >1.20; p<0.05) in more rural areas and remote areas. More frequent visits to family physicians were associated with living in rural areas, while less frequent visitation was associated with living in areas of low spatial accessibility with high ethnic concentration. Visits to neurologists were positively associated with living in areas of high spatial accessibility and with high ethnic concentration. Visits to all providers were also positively associated with areas of high spatial accessibility. For all outcomes, less frequent visits were found in women, older people, and those living in more deprived areas as years living with PD increased. This study demonstrates the importance of geographic, socioeconomic and individual factors in determining PwP's likelihood of accessing care and type of care provided. Our results can be expected to inform the development of policies and patient care models aimed at improving accessibility among diverse populations of PwP.
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Affiliation(s)
- Eric J. Crighton
- Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | | | - M. Sawada
- Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
- Laboratory for Applied Geomatics and GIS Science (LAGGISS), Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
| | - Tiago A. Mestre
- Parkinson Disease and Movement Disorder Clinic, Department of Medicine, Division of Neurology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Brauer L, Geraedts M. Exploring regional healthcare utilisation and quality of care for endometriosis in rural areas in Hesse, Germany: a mixed methods study protocol. BMJ Open 2023; 13:e074259. [PMID: 37620261 PMCID: PMC10450047 DOI: 10.1136/bmjopen-2023-074259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The need of a regional healthcare monitoring in order to evaluate quality and utilisation of health services in smaller scale is internationally and in Germany well established. Little is known about variation in healthcare in rural German areas, especially for women's health. In particular, endometriosis is highly prevalent and known to be unsatisfactorily treated. Thus, this study aims to investigate utilisation and quality of care, the influence of structural determinants on quality and the patient's experiences on endometriosis healthcare in rural Hesse. METHODS AND ANALYSIS We will use a mixed methods approach to ensure reliable mapping of the care situation for endometriosis patients in seven counties in Central and Eastern Hesse. First, retrospective secondary utilisation data and quality indicators will be used to describe possible regional variation in the treatment of endometriosis in the outpatient and inpatient sector. Second, we compare structural determinants of regions with quality of care. Third, we conduct qualitative, semistructured interviews with endometriosis patients on their perspective and experiences in those chosen rural regions. Data will then be analysed using descriptive statistics, small area variation analyses and multifactorial analyses of variance (ANOVAs). The interview will be interpreted using the experience-focused phenomenological approach. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of Philipps-University Marburg. Utilisation data and structural determinants are anonymised and partly aggregated. The interview will use tokens for pseudonymisation to prevent the collected data from being assigned to an individual person. Also, informed consent will be obtained from patients.The results of this study will be reported to the scientific community in peer-reviewed journals and at conferences. A summary of the key findings will be provided to the interviewed patients and the Endometriosis Association Germany.
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Affiliation(s)
- Lara Brauer
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Hessen, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Hessen, Germany
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Zhang S, Chen W, Li Q, Li M. Evaluation and development strategy of urban-rural integration under ecological protection in the Yellow River Basin, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:92674-92691. [PMID: 37493910 DOI: 10.1007/s11356-023-28950-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/19/2023] [Indexed: 07/27/2023]
Abstract
The problem of imbalanced urban-rural development in China is becoming increasingly serious. Urban-rural integration (URI) is an inevitable way to narrow the urban-rural gap and promote rural development. The Yellow River Basin (YRB) is an important barrier to China's ecological security and plays a crucial role in promoting ecological protection and in high-quality development strategies. Therefore, this article constructs an evaluation index system for URI from five dimensions: economic integration, social integration, ecological integration, element integration, and spatial integration. The simulated annealing-projection pursuit model and time degree are used to analyze the dynamic urban-rural integration level (URIL) of 373 counties from 2000 to 2019. Building upon this foundation, this study classifies four types of URI zones and proposes development strategies tailored to each zone. The results indicate (1) that the URIL in the YRB continues to increase, and that there has been a significant increase in high-level integration areas since 2010. (2) The URIL exhibits a distinct spatial clustering pattern, characterized by lower levels in the upper reaches, and higher levels in the middle and lower reaches. (3) There exists a spatial disparity between economic development and the ecological environment, and it is particularly noticeable in the lower reaches regions. These results contribute to a better understanding of URI in the YRB and provide a reference for the sustainable development of URI in various regions.
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Affiliation(s)
- Sun Zhang
- College of Economics and Management, Northwest A&F University, Yangling, 712100, Shaanxi, China
| | - Wei Chen
- College of Economics and Management, Northwest A&F University, Yangling, 712100, Shaanxi, China.
| | - Qiao Li
- College of Economics and Management, Northwest A&F University, Yangling, 712100, Shaanxi, China
| | - Meng Li
- College of Economics and Management, Northwest A&F University, Yangling, 712100, Shaanxi, China
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Bihin J, De Longueville F, Linard C. Spatial accessibility to health facilities in Sub-Saharan Africa: comparing existing models with survey-based perceived accessibility. Int J Health Geogr 2022; 21:18. [PMID: 36369009 PMCID: PMC9652128 DOI: 10.1186/s12942-022-00318-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mapping geographical accessibility to health services is essential to improve access to public health in sub-Saharan Africa. Different methods exist to estimate geographical accessibility, but little is known about the ability of these methods to represent the experienced accessibility of the population, and about the added-value of sophisticated and data-demanding methods over simpler ones. Here we compare the most commonly used methods to survey-based perceived accessibility in different geographical settings. Methods Modelled accessibility maps are computed for 12 selected sub-Saharan African countries using four methods: Euclidean distance, cost-distance considering walking and motorized speed, and Kernel density. All methods are based on open and large-scale datasets to allow replication. Correlation coefficients are computed between the four modelled accessibility indexes and the perceived accessibility index extracted from Demographic and Health Surveys (DHS), and compared across different socio-geographical contexts (rural and urban, population with or without access to motorized transports, per country). Results Our analysis suggests that, at medium spatial resolution and using globally-consistent input datasets, the use of sophisticated and data-demanding methods is difficult to justify as their added value over a simple Euclidian distance method is not clear. We also highlight that all modelled accessibilities are better correlated with perceived accessibility in rural than urban contexts and for population who do not have access to motorized transportation. Conclusions This paper should guide researchers in the public health domain for knowing strengths and limits of different methods to evaluate disparities in health services accessibility. We suggest that using cost-distance accessibility maps over Euclidean distance is not always relevant, especially when based on low resolution and/or non-exhaustive geographical datasets, which is often the case in low- and middle-income countries.
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Weinhold I, Wende D, Schrey C, Militzer-Horstmann C, Schang L, Sundmacher L. Assessing patients’ acceptable and realised distances to determine accessibility standards for the size of catchment areas in outpatient care. Health Policy 2022; 126:1180-1186. [DOI: 10.1016/j.healthpol.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/18/2022] [Accepted: 08/22/2022] [Indexed: 11/04/2022]
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Study on Spatial–Temporal Evolution Characteristics and Restrictive Factors of Urban–Rural Integration in Northeast China from 2000 to 2019. LAND 2022. [DOI: 10.3390/land11081195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With the rapid development of urbanization and the widening gap between urban and rural areas, how to effectively enhance the balanced development of urban and rural areas as well as promote the integrated development of urban and rural areas have become heated topics. Based on the basic theory of urban–rural integration and spatial balance, this paper establishes a comprehensive evaluation system. Using a coupling coordination model and an obstacle degree model, this paper selects 32 indicators from aspects of economy, society and ecology to measure the development level of urban–rural integration in 34 prefecture-level cities in Northeast China from 2000 to 2019. We also analyze the spatial pattern, evolution type characteristics and obstacle factors of urban–rural relations. The results show that: (1) The growth rate of urban development in Northeast China is higher than that of rural development. Except for rural ecology, all dimensions of urban and rural areas have increased year by year, but there are large spatial differences within the region. (2) The urban–rural integration development level of Northeast China is growing constantly and the types of urban and rural coordination are all rising to a higher level. Areas with high urban–rural coordination levels are concentrated in the Harbin–Changchun urban agglomeration and the central and southern Liaoning urban agglomeration, with obvious agglomeration effects. (3) In the coordinated development of urban and rural areas, the restrictive degree of the rural social subsystem was higher than that of the urban subsystem. The restrictive factors in the coordinated development of urban and rural areas are relatively stable, and include per capita consumption expenditure, per capita public budget expenditure, books in public libraries per thousand people, etc. (4) The functions of rural social elements should be enhanced, and the social urban–rural integrated development mechanism should be established to promote the integrated development of urban and rural society.
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Hrudey I, Minow A, Walter S, March S, Swart E, Stallmann C. Regional Utilization of Preventive Services in the 55-Plus Age Group: Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e33512. [PMID: 35019847 PMCID: PMC8792768 DOI: 10.2196/33512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Germany, the proportion of people with chronic diseases and multimorbidity is increasing. To counteract the emergence and worsening of age-related conditions, there is a need for preventive care structures and measures. The preventive services that are financed by statutory health insurance (SHI; eg, vaccinations, cancer screening) are only used by part of the German population. There are no current findings about the utilization of these services by older adults in the eastern German federal state of Saxony-Anhalt, which is particularly strongly affected by demographic change. OBJECTIVE The aim of this study is to investigate the actual utilization and determinants of, reasons for, and barriers to utilization of preventive services financed by the SHI in Saxony-Anhalt in the 55-plus age group. METHODS In this study, a convergent mixed methods design is used. The actual use of preventive services will be shown by means of (1) a claims data analysis looking at data on statutory outpatient medical care from both the Central Research Institute of Ambulatory Health Care in Germany (Zi) and the Association of Statutory Health Insurance Dentists in Saxony-Anhalt (KZV LSA). The determinants, attitudes, and behaviors associated with use will be analyzed through (2) a cross-sectional survey as well as (3) qualitative data from semistructured interviews with residents of Saxony-Anhalt and from focus group discussions with physicians. (4) A stock take and systematic evaluation of digitally available informational material on colorectal cancer screening, by way of example, provides an insight into the information available as well as its quality. The conceptual framework of the study is the behavioral model of health services use by Andersen et al (last modified in 2014). RESULTS (1) The Zi and KZV LSA are currently preparing the requested claims data. (2) The survey was carried out from April 2021 to June 2021 in 2 urban and 2 rural municipalities (encompassing a small town and surrounding area) in Saxony-Anhalt. In total, 3665 people were contacted, with a response rate of 25.84% (n=954). (3) For the semistructured interviews, 18 participants from the 4 different study regions were recruited in the same period. A total of 4 general practitioners and 3 medical specialists participated in 2 focus group discussions. (4) For the systematic evaluation of existing informational material on colorectal cancer screening, 37 different informational materials were identified on the websites of 16 health care actors. CONCLUSIONS This study will provide current and reliable data on the use of preventive services in the 55-plus age group in Saxony-Anhalt. It will yield insights into the determinants, reasons, and barriers associated with their utilization. The results will reveal the potential for preventive measures and enable concrete recommendations for action for the target population of the study. TRIAL REGISTRATION German Clinical Trials Register DRKS00024059; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024059. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33512.
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Affiliation(s)
- Ilona Hrudey
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Annemarie Minow
- Department of Social Work, Health and Media, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany
- Department of Studies and Teaching Medicine, University of Lübeck, Lübeck, Germany
| | - Svenja Walter
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Stefanie March
- Department of Social Work, Health and Media, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany
| | - Enno Swart
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christoph Stallmann
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Genowska A, Jamiołkowski J, Szafraniec K, Fryc J, Pająk A. Health Care Resources and 24,910 Deaths Due to Traffic Accidents: An Ecological Mortality Study in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115561. [PMID: 34067502 PMCID: PMC8197000 DOI: 10.3390/ijerph18115561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022]
Abstract
Background: Deaths due to traffic accidents are preventable and the access to health care is an important determinant of traffic accident case fatality. This study aimed to assess the relation between mortality due to traffic accidents and health care resources (HCR), at the population level, in 66 sub-regions of Poland. Methods: An area-based HCR index was delivered from the rates of physicians, nurses, and hospital beds. Associations between mortality from traffic accidents and the HCR index were tested using multivariate Poisson regression models. Results: In the sub-regions studied, the average mortality from traffic accidents was 11.7 in 2010 and 9.3/100.000 in 2015. After adjusting for sex, age and over time trends in mortality, out-of-hospital deaths were more frequently compared to hospitalized fatal cases (incidence rate ratio (IRR) = 1.68, 95% CI 1.45–1.93). Compared to sub-regions with high HCR, mortality from traffic accidents was higher in sub-regions with low and moderate HCR (IRR = 1.25, 95% CI 1.11–1.42 and IRR = 1.19, 95% CI 1.02–1.38, respectively), which reflected the differences in out-of-hospital mortality most pronounced in car accidents. Conclusions: Poor HCR is an important factor that explains the territorial differentiation of mortality due to traffic accidents in Poland. The high percentage of out-of-hospital deaths indicates the importance of preventive measures and the need for improvement in access to health care to reduce mortality due to traffic accidents.
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Affiliation(s)
- Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, 15-295 Bialystok, Poland
- Correspondence: (A.G.); (J.F.)
| | - Jacek Jamiołkowski
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland;
| | - Krystyna Szafraniec
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, 31-066 Krakow, Poland; (K.S.); (A.P.)
| | - Justyna Fryc
- Faculty of Medicine, Medical University of Bialystok, 15-540 Bialystok, Poland
- Correspondence: (A.G.); (J.F.)
| | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, 31-066 Krakow, Poland; (K.S.); (A.P.)
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