The application of spatial measures to analyse health service accessibility in Australia: a systematic review and recommendations for future practice

BACKGROUND

Australia's inequitable distribution of health services is well documented. Spatial access relates to the geographic limitations affecting the availability and accessibility of healthcare practitioners and services. Issues associated with spatial access are often influenced by Australia's vast landmass, challenging environments, uneven population concentration, and sparsely distributed populations in rural and remote areas. Measuring access contributes to a broader understanding of the performance of health systems, particularly in rural/remote areas. This systematic review synthesises the evidence identifying what spatial measures and geographic classifications are used and how they are applied in the Australian peer-reviewed literature.

METHODS

A systematic search of peer-reviewed literature published between 2002 and 2022 was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Search terms were derived from three major topics, including: [1] Australian population; [2] spatial analysis of health service accessibility; and [3] objective physical access measures.

RESULTS

Database searches retrieved 1,381 unique records. Records were screened for eligibility, resulting in 82 articles for inclusion. Most articles analysed access to primary health services (n = 50; 61%), followed by specialist care (n = 17; 21%), hospital services (n = 12; 15%), and health promotion and prevention (n = 3; 4%). The geographic scope of the 82 articles included national (n = 33; 40%), state (n = 27; 33%), metropolitan (n = 18; 22%), and specified regional / rural /remote area (n = 4; 5%). Most articles used distance-based physical access measures, including travel time (n = 30; 37%) and travel distance along a road network (n = 21; 26%), and Euclidean distance (n = 24; 29%).

CONCLUSION

This review is the first comprehensive systematic review to synthesise the evidence on how spatial measures have been applied to measure health service accessibility in the Australian context over the past two decades. Objective and transparent access measures that are fit for purpose are imperative to address persistent health inequities and inform equitable resource distribution and evidence-based policymaking.

Public transport access to NHS dental care in Great Britain

Objective Access to transport is a common barrier to oral health. Greater dependence on public transport has shown delayed oral healthcare, lack of usual source of care and greater unmet health needs. This study examined the spatial accessibility of the population of Great Britain to public transport in providing access to oral healthcare.Methods A total of 8,791 dental practices in Great Britain were identified and geocoded. There were 10,444 rail, metro and light rail stops and 348,961 bus and tram stops. Geographic information systems were utilised to integrate the dental practice locations and public transport points to respective census tracts of each nation containing population data, deprivation measures, and classification of rural and urban areas.Results Almost all dental clinics in Great Britain were located within 400 m of bus and tram stops or 800 m of a rail, metro or light rail stop. Similarly, in Scotland and England, 92% lived within any public transport (within 400m of bus and tram stops or 800m of a rail, metro or light rail stop), and in Wales, 84.2% lived within any public transport stop. However, only 75.1%, 79.6% and 60.4% of the population of Scotland, England and Wales had access to a high-frequency bus stop, respectively. In Scotland, England and Wales, 40.7%, 33.7% and 38.3% of rural residents did not have access to any public transport and only 4.9%, 7.5% and 14.6% of the rural residents had access to an optimal bus stop, respectively. In Wales, 19.5% of older adults do not have access to a bus stop.Conclusion Some transport-disadvantaged groups do not have adequate access to public transport services. There is a compelling need to address public transport integration with oral health facilities to ensure equality in accessing integral services.

Access to health care after dental trauma in children: A quantitative and qualitative evaluation

BACKGROUND/AIMS

The aim of this study was to evaluate the accessibility of proper and on-time treatment after dental trauma in children and to explore the affecting factors via parents' and health professionals' perspectives. The study is important to understand how to improve access to dental treatment after trauma.

MATERIALS AND METHOD

The method included quantitative and qualitative parts. For the quantitative method, parents of dental trauma patients who applied to Ege University, Department of Pedodontics during January 2015-June 2016 were the target group. One hundred and forty parents answered the questionnaire on trauma experiences. The participation rate was 62.78%. Questions covered variables such as first admitted health institution, time to go there, access to diagnostics, treatment methods, referral from institution, and sociodemographic characteristics of the family. On-time and proper treatment access was defined using an algorithm for treatment priority of the case, total time to reach treatment, and the correct intervention. For the qualitative method, ten parents and thirty health professionals were interviewed in-depth using a semi-structured question guide. Thematic analysis was applied to the interview texts.

RESULTS

The percentage of patients who accessed on-time and proper treatment was 19.29%. Logistic regression analysis showed that admission to the university clinic first increased the access to treatment by 14.135 times. For the qualitative evaluation, treatment access was summarized into three main themes: (a) physical accessibility of dental health services, (b) a quality dental health service as an outcome, and (c) communication among parties.

CONCLUSION

The level of accessing proper and on-time treatment was quite inadequate. It is suggested that distribution of dental care centers should be increased and dental centers where competent dentists work should be established. Performance-based payment should be reorganized and cooperation between medical and dental institutions should be encouraged.

Understanding the role of the public transport network in the greater Sydney area in providing access to dental care

Objective The aim of this study was to examine the spatial accessibility of the aged and older adult population of the greater Sydney region to the bus public transport network, and the proximity of this transportation route to public and private dental services. Methods This study used geographic information systems (GIS) to examine, at a population level, the spatial accessibility of the public transport network and dental provider locations. The prime focus of the present study was on the aging population residing within 50 km of the General Post Office of metropolitan Sydney. Retirees (aged ≥65 years) and older adults (aged ≥85 years) were the two subsets of the aging population. Results Sydney’s bus network is currently supplying bus transport to both older and disadvantaged groups, facilitating the needs of more than half a million older people. Regardless of socioeconomic status, 12% of the entire population, 11.5% of retirees and 10.8% of older adults resided 500 m away from accessible medium-frequency bus stops. Approximately 40% of the overall population consisted of people of lower socioeconomic status living within 500 m of a medium-frequency bus stop, whereas 60% of the population were of a high socioeconomic status and lived within 500 m of a medium-frequency bus stop. Conclusion Metropolitan Sydney has a transport system that is substantial and robust, and appears to offer relatively similar spatial accessibility for all socioeconomic groups. This system is an example of great urban planning, where the distribution of bus stops is evenly positioned in both high-density areas and areas of low socioeconomic status. What is known about the topic? Older adults and disadvantaged people suffer from higher levels of dental disease compared with the rest of the population. Older adults and disadvantaged people are more likely to rely on public transport to access healthcare services, including dental care. The Australian population is aging rapidly. What does this paper add? Although a previous study examined the accessibility to services via the train network, this is the first analysis of the spatial accessibility to dental services via the bus network in Sydney. Most older adults and disadvantaged people in Sydney enjoy acceptable spatial access to the public transport network, and thereby to dental practices. Urban planning, in terms of determining healthcare service locations and the public transport network, needs to consider the distribution of older adults and disadvantaged populations. What are the implications for practitioners? Practitioners are more likely to attract older adult patients to their practices or clinics if these are located within easy access to the public transport network.

The equity of access to primary dental care in São Paulo, Brazil: A geospatial analysis

OBJECTIVES

Brazil is one of the largest countries in the world, in terms of geography and population. Most Brazilians reside in the south and south-eastern regions, with notable numbers in the regions' megacities, such as São Paulo city. Healthcare provision in such a complex environment is difficult. Thus, a clear understanding of the distribution - or rather, the maldistribution - of these services is fundamental for optimising the allocation of human and financial resources to areas of greatest privation. The present study aimed to determine the distribution of primary dental clinics in São Paulo city.

METHODS

A total of 4,101 primary dental clinics in São Paulo city were identified and geocoded. Clinic locations were integrated with the city's 19,128 constituent census tracts - each containing sociodemographic data for the 11,252,204 residents - using Geographic Information Systems (GIS).

RESULTS

Approximately two-thirds (64.8%) of the population resided within 0.5 km of a primary dental clinic, and a further 23.9% were within 1 km. Populations more than 1 km out were typically characterised as sociodemographically disadvantaged. Primary dental clinics were also more sparsely distributed in the city's peripheral census tracts than central census tracts.

CONCLUSION

Primary dental clinics are maldistributed in São Paulo city, with disadvantaged populations having less spatial access than their advantaged counterparts.

Is there an association between spatial accessibility of outpatient care and utilization? Analysis of gynecological and general care

Background

In rural regions with a low population density, distances to health care providers as well as insufficient public transport may be barriers for the accessibility of health care. In this analysis it was examined whether the accessibility of gynecologists and GPs, measured as travel time both by car and public transport has an influence on the utilization of health care in the rural region of Western Pomerania in Northern Germany.

Methods

Utilization data was obtained from the population based Study of Health in Pomerania (SHIP). Utilization was operationalized by the parameter “at least one physician visit during the last 12 months”. To determine travel times by car and by public transport, network analyses were conducted in a Geographic Information System (GIS). Multivariate logistic regression models were calculated to identify determinants for the utilization of gynecologists and GPs.

Results

There is no significant association between the accessibility by car or public transport and the utilization of gynecologists and GPs. Significant predictors for the utilization of gynecologists in the regression model including public transport are age (OR 0.960, 95% CI 0.950–0.971, p < 0.0001), social class (OR 1.137, 95% CI 1.084–1.193, p < 0.0001) and having persons ≥18 years in the household (OR 2.315, 95% CI 1.116–4.800, p = 0.0241).

Conclusions

In the examined region less utilization of gynecologists is not explainable with long travel times by car or public transport.

The approaches to measuring the potential spatial access to urban health services revisited: distance types and aggregation-error issues

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.