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Zhao J, Luo M, Tan X, Zhu Z, Zhang M, Liu J, Lin W, Yang Y, Li X, Zeng W, Gong D, Rong Z, Huang Z, Zheng W, Guo H, Zeng S, Sun L, Xiao J. Spatial accessibility and inequality analysis of rabies-exposed patients to rabies post-exposure prophylaxis clinics in Guangzhou City, China. Int J Equity Health 2024; 23:122. [PMID: 38877457 PMCID: PMC11179278 DOI: 10.1186/s12939-024-02207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/29/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The incidence of rabies exposure is high and increasing in China, leading to an urgent demand of rabies post-exposure prophylaxis (PEP) clinics for the injured. However, the spatial accessibility and inequality of rabies-exposed patients to rabies PEP clinics is less known in China. METHODS Based on rabies exposure data, PEP clinic data, and resident travel origin-destination (OD) matrix data in Guangzhou City, China, we first described the incidence of rabies exposure in Guangzhou from 2020 to 2022. Then, the Gaussian two-step floating catchment area method (2SFCA) was used to analyze the spatial accessibility of rabies-exposed patients to rabies PEP clinics in Guangzhou, and the Gini coefficient and Moran's I statistics were utilized to evaluate the inequality and clustering of accessibility scores. RESULTS From 2020 to 2022, a total of 524,160 cases of rabies exposure were reported in Guangzhou, and the incidence showed a significant increasing trend, with an average annual incidence of 932.0/100,000. Spatial accessibility analysis revealed that the overall spatial accessibility scores for three scenarios (threshold of driving duration [d0] = 30 min, 45 min, and 60 min) were 0.30 (95% CI: 0.07, 0.87), 0.28 (95% CI: 0.11, 0.53) and 0.28 (95% CI: 0.14, 0.44), respectively. Conghua, Huangpu, Zengcheng and Nansha districts had the higher accessibility scores, while Haizhu, Liwan, and Yuexiu districts exhibited lower spatial accessibility scores. The Gini coefficient and Moran's I statistics showed that there were certain inequality and clustering in the accessibility to rabies PEP clinics in Guangzhou. CONCLUSIONS This study clarifies the heterogeneity of spatial accessibility to rabies PEP clinics, and provide valuable insights for resource allocation to achieve the WHO target of zero human dog-mediated rabies deaths by 2030.
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Affiliation(s)
- Jianguo Zhao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Min Luo
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xiaohua Tan
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zhihua Zhu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Meng Zhang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Jun Liu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Wenqing Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Yuwei Yang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Dexin Gong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zitong Huang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wenyuan Zheng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
- Department of Public Health and Preventive Medicine, School of Medicine, Ji'nan University, Guangzhou, 510632, China
| | - Huijie Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Siqing Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Limei Sun
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
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Buhler M, Shah T, Perry M, Tennant M, Kruger E, Milosavljevic S. Geographic accessibility to physiotherapy care in Aotearoa New Zealand. Spat Spatiotemporal Epidemiol 2024; 49:100656. [PMID: 38876567 DOI: 10.1016/j.sste.2024.100656] [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: 01/22/2024] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 06/16/2024]
Abstract
Disparities in care access for health conditions where physiotherapy can play a major role are abetting health inequities. Spatial analyses can contribute to illuminating inequities in health yet the geographic accessibility to physiotherapy care across New Zealand has not been examined. This population-based study evaluated the accessibility of the New Zealand physiotherapy workforce relative to the population at a local scale. The locations of 5,582 physiotherapists were geocoded and integrated with 2018 Census data to generate 'accessibility scores' for each Statistical Area 2 using the newer 3-step floating catchment area method. For examining the spatial distribution and mapping, accessibility scores were categorized into seven levels, centered around 0.5 SD above and below the mean. New Zealand has an above-average physiotherapy-to-population ratio compared with other OECD countries; however, this workforce is maldistributed. This study identified areas (and locations) where geographic accessibility to physiotherapy care is relatively low.
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Affiliation(s)
- Miranda Buhler
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin North, Dunedin 9016, New Zealand.
| | - Tayyab Shah
- Canadian Hub for Applied and Social Research, University of Saskatchewan, 9 Campus Dr Room 260, Saskatoon, SK S7N 5A5, Canada
| | - Meredith Perry
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin North, Dunedin 9016, New Zealand
| | - Marc Tennant
- The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Estie Kruger
- School of Allied Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Stephan Milosavljevic
- School of Rehabilitation Science, University of Saskatchewan, 104 Clinic Pl, Saskatoon, SK S7N 2Z4, Canada
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Arabadjis SD, Sweeney SH. Residuals in space: Potential pitfalls and applications from single-institution survival analysis. Spat Spatiotemporal Epidemiol 2024; 49:100646. [PMID: 38876556 DOI: 10.1016/j.sste.2024.100646] [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: 09/12/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 06/16/2024]
Abstract
In practice, survival analyses appear in pharmaceutical testing, procedural recovery environments, and registry-based epidemiological studies, each reasonably assuming a known patient population. Less commonly discussed is the additional complexity introduced by non-registry and spatially-referenced data with time-dependent covariates in observational settings. In this short report we discuss residual diagnostics and interpretation from an extended Cox proportional hazard model intended to assess the effects of wildfire evacuation on risk of a secondary cardiovascular events for patients of a specific healthcare system on the California's central coast. We describe how traditional residuals obscure important spatial patterns indicative of true geographical variation, and their impacts on model parameter estimates. We briefly discuss alternative approaches to dealing with spatial correlation in the context of Bayesian hierarchical models. Our findings/experience suggest that careful attention is needed in observational healthcare data and survival analysis contexts, but also highlights potential applications for detecting observed hospital service areas.
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Affiliation(s)
- Sophia D Arabadjis
- Department of Geography, University of California, Santa Barbara, CA 93106-2150, United States of America.
| | - Stuart H Sweeney
- Department of Geography, University of California, Santa Barbara, CA 93106-2150, United States of America.
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Zhang C, Yan Y, Zhu X, Li L, Li Y, Wang G, He F, Song Y, Liu Y, Zhang N. Evaluating the spatial accessibility and spatial layout optimization of HIV/AIDS healthcare services in Shandong Province, China. Sci Rep 2024; 14:11258. [PMID: 38755199 PMCID: PMC11099158 DOI: 10.1038/s41598-024-61484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
Improving access to HIV/AIDS healthcare services is of great concern to government and policymakers striving to strengthen overall public health. How to reasonably allocate HIV/AIDS healthcare resources and maximize the equality of access to healthcare services across subdistrict areas has become an urgent problem to be solved. However, there is limited research on this topic in China. It is necessary to evaluate spatial accessibility to improve the accessibility and equity of HIV/AIDS healthcare services. In this study, the improved multi-modal two-step floating catchment area (2SFCA) and inverted 2SFCA (i2SFCA) methods are used to measure the spatial accessibility of HIV/AIDS healthcare services and the crowdedness of the healthcare sites in Shandong Province, China. Then, the theoretical supply and the optimal spatial distribution of resources are calculated and visualized by minimizing the accessibility gaps between demand locations. This study showed that the spatial accessibility of HIV/AIDS service resources in Shandong Province was concentrated and unevenly distributed, and the accessibility scores in the marginal areas of prefecture-level cities were significantly lower than those in other areas. Regions with a large number of doctors had significantly higher levels of spatial accessibility. The ART accessibility scores in the southwest of Shandong Province were higher than those in other regions. As the travel friction coefficient increased, the accessibility scores formed an approximately circular cluster distribution centered on the healthcare sites in geographical distribution. More ART drugs needed to be supplied in marginal areas and more doctors were needed to work on HIV/AIDS in urban areas to address the spatial distribution imbalance of HIV/AIDS healthcare services. This study profoundly analyzed the spatial accessibility of HIV/AIDS healthcare services and provided essential references for decision-makers. In addition, it gives a significant exploration for achieving the goal of equal access to HIV/AIDS healthcare services in the future.
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Affiliation(s)
- Chao Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, China
| | - Yujie Yan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, China
| | - Xiaoyan Zhu
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China
| | - Ling Li
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China
| | - Yajun Li
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China
| | - Guoyong Wang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China
| | - Fenfen He
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, Xi'an, China
| | - Yining Song
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, China
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, China.
- Climate Change and Health Center, Shandong University, Jinan, Shandong Province, China.
| | - Na Zhang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China.
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Hinton L, Dakin FH, Kuberska K, Boydell N, Willars J, Draycott T, Winter C, McManus RJ, Chappell LC, Chakrabarti S, Howland E, George J, Leach B, Dixon-Woods M. Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders. BMJ Qual Saf 2024; 33:301-313. [PMID: 35552252 PMCID: PMC11041557 DOI: 10.1136/bmjqs-2021-014329] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND High-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it. METHODS This UK-wide study involved interviews and an online survey inviting free-text responses with: those who were or had been pregnant since March 2020; maternity professionals and managers of maternity services and system-level stakeholders. Recruitment used network-based approaches, professional and community networks and purposively selected hospitals. Analysis of interview transcripts was based on the constant comparative method. Free-text survey responses were analysed using a coding framework developed by researchers. FINDINGS Participants included 106 pregnant women and 105 healthcare professionals and managers/stakeholders. Analysis enabled generation of a framework of the domains of quality that appear to be most relevant to stakeholders in remote antenatal care: efficiency and timeliness; effectiveness; safety; accessibility; equity and inclusion; person-centredness and choice and continuity. Participants reported that remote care was not straightforwardly positive or negative across these domains. Care that was more transactional in nature was identified as more suitable for remote modalities, but remote care was also seen as having potential to undermine important aspects of trusting relationships and continuity, to amplify or create new forms of structural inequality and to create possible risks to safety. CONCLUSIONS This study offers a provisional framework that can help in structuring thinking, policy and practice. By outlining the range of domains relevant to remote antenatal care, this framework is likely to be of value in guiding policy, practice and research.
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Affiliation(s)
- Lisa Hinton
- THIS Institute (The Healthcare Improvement Studies), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Francesca H Dakin
- Nuffield Department of Primary Health Care Sciences, Oxford University, Oxford, UK
| | - Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Tim Draycott
- Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Richard J McManus
- Nuffield Department of Primary Health Care Sciences, Oxford University, Oxford, UK
| | - Lucy C Chappell
- Maternal and Fetal Research Unit Division of Women's Health, St Thomas' Hospital, London, UK
| | | | - Elizabeth Howland
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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6
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Moss JL, Geyer NR, Lengerich EJ. Patterns of Cancer-Related Healthcare Access across Pennsylvania: Analysis of Novel Census Tract-Level Indicators of Persistent Poverty. Cancer Epidemiol Biomarkers Prev 2024; 33:616-623. [PMID: 38329390 DOI: 10.1158/1055-9965.epi-23-1255] [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: 10/11/2023] [Revised: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Persistent poverty census tracts have had ≥20% of the population living below the federal poverty line for 30+ years. We assessed the relationship between persistent poverty and cancer-related healthcare access across census tracts in Pennsylvania. METHODS We gathered publicly available census tract-level data on persistent poverty, rurality, and sociodemographic variables, as well as potential access to healthcare (i.e., prevalence of health insurance, last-year check-up), realized access to healthcare (i.e., prevalence of screening for cervical, breast, and colorectal cancers), and self-reported cancer diagnosis. We used multivariable spatial regression models to assess the relationships between persistent poverty and each healthcare access indicator. RESULTS Among Pennsylvania's census tracts, 2,789 (89.8%) were classified as non-persistent poverty, and 316 (10.2%) were classified as persistent poverty (113 did not have valid data on persistent poverty). Persistent poverty tracts had lower prevalence of health insurance [estimate = -1.70, standard error (SE) = 0.10], screening for cervical cancer (estimate = -4.00, SE = 0.17) and colorectal cancer (estimate = -3.13, SE = 0.20), and cancer diagnosis (estimate = -0.34, SE = 0.05), compared with non-persistent poverty tracts (all P < 0.001). However, persistent poverty tracts had higher prevalence of last-year check-up (estimate = 0.22, SE = 0.08) and screening for breast cancer (estimate = 0.56, SE = 0.15; both P < 0.01). CONCLUSIONS Relationships between persistent poverty and cancer-related healthcare access outcomes differed in direction and magnitude. Health promotion interventions should leverage data at fine-grained geographic units (e.g., census tracts) to motivate focus on communities or outcomes. IMPACT Future studies should extend these analyses to other states and outcomes to inform public health research and interventions to reduce geographic disparities.
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Affiliation(s)
- Jennifer L Moss
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Eugene J Lengerich
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Burridge L, Jones R, Borg SJ, O'Loghlen JJ, Geraghty TJ. Methodologies to measure access to care post-discharge in adults with serious injury-related disability: a scoping review. Disabil Rehabil 2024; 46:1266-1273. [PMID: 37021354 DOI: 10.1080/09638288.2023.2192974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE This scoping review examined the methodologies used to measure access to care in serious injury-related disability populations, for whom access to care post-discharge has significant implications for patient outcomes and rehabilitation trajectories. METHODS Four electronic databases were searched for literature published between 1 January 2000 and 15 February 2022. Relevant articles needed to relate to access to care in adult community-dwelling trauma and rehabilitation populations. RESULTS The initial search identified 679 articles. Following de-duplication, the title/abstract screening was completed on 533 articles, and 56 full-text articles were reviewed. Thirty-eight articles met the eligibility criteria and were included in this review. Of the 38 studies included, there was large heterogeneity in the methodologies used to measure access to care. Two articles used multidimensional measures of access to care. CONCLUSIONS There is an urgent need to establish the use of multidimensional measures as standard practice in access-to-care research. Failure to account for the multidimensional nature of access to care limits the full realisation of access for people with serious injury-related disability and prevents the implementation of processes that could improve access to health, rehabilitation, and support services and enhance the quality of care for individuals with a serious injury-related disability.
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Affiliation(s)
- L Burridge
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
| | - R Jones
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - S J Borg
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
| | - J J O'Loghlen
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
| | - T J Geraghty
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
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Obeidat B, Alourd S. Healthcare equity in focus: bridging gaps through a spatial analysis of healthcare facilities in Irbid, Jordan. Int J Equity Health 2024; 23:52. [PMID: 38475828 DOI: 10.1186/s12939-024-02120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
In the Irbid Governorate, Jordan, equitable healthcare facility distribution is vital to ensuring healthcare accessibility and improving public health outcomes. This study investigated the spatial distribution, accessibility, and conformity of healthcare facilities to the Ministry of Health standards to identify areas requiring improvement. Using geographic information systems (GIS), three spatial analyses were conducted: nearest neighbor analysis, buffer analysis, and service area analysis. These analyses comprehensively assessed the healthcare landscape, revealing a random spatial distribution pattern of healthcare facilities; and indicating an absence of structured organization. The buffer analysis revealed concentrations in specific regions, while others were underserved. The Service Area Analysis revealed significant healthcare access challenges, especially in remote areas. The healthcare resource distribution of the Irbid governorate fell short of national and international standards, emphasizing the need for improvements. To address these disparities, policymakers and healthcare authorities should focus on equitably redistributing resources, tailoring allocation to local needs, improving remote area infrastructure, and refining government policies. Continuous monitoring and evaluation are imperative to ensure alignment with international standards and achieve healthcare equity. The insights from this case study provide valuable guidance for regions facing similar healthcare distribution challenges.
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Affiliation(s)
- Bushra Obeidat
- Department of Architecture, College of Architecture and Design, Jordan University of Science and Technology, 3030, Irbid, 22110, Jordan.
| | - Sally Alourd
- Department of Architecture, College of Architecture and Design, Jordan University of Science and Technology, 3030, Irbid, 22110, Jordan
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Sun X, Cheng Y, Tao Z. Spatial accessibility and equity of residential care facilities in Beijing from 2010 to 2020. Health Place 2024; 86:103219. [PMID: 38467103 DOI: 10.1016/j.healthplace.2024.103219] [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: 10/07/2023] [Revised: 01/19/2024] [Accepted: 02/18/2024] [Indexed: 03/13/2024]
Abstract
In recent years, the aging population in Beijing has rapidly increased and the demand for residential care facilities (RCFs) has also risen. As RCFs have quickly developed, the question of whether residential care resources dynamically match the changes in the demand of the elderly population is an urgent issue that must be addressed. This study analyzes the spatiotemporal variation in the supply and demand of RCFs, applies a Gaussian two-step floating catchment area method with a multi-level search radius to measure the spatial accessibility of RCFs in Beijing in 2010 and 2020, and evaluates the equity of spatial accessibility. The results show that the elderly population was decentralized from the central urban area to New Urban Development Area. However, the distribution of RCF beds shows further agglomeration towards the central urban area. The accessibility of residential care resources in the central urban area and New Urban Development Area has increased, while accessibility in Ecological Protection Area has decreased. The spatial disparities in accessibility have been reduced and the spatial equity in accessibility has been improved over the past decade. The findings provide policy recommendations for the future allocation of RCFs by considering the spatiotemporal changes in the distribution of the supply and demand of residential care resources.
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Affiliation(s)
- Xinxin Sun
- Faculty of Geographical Science, Beijing Normal University, No.19, Xinjiekouwai St., Beijing, China
| | - Yang Cheng
- Faculty of Geographical Science, Beijing Normal University, No.19, Xinjiekouwai St., Beijing, China.
| | - Zhuolin Tao
- Faculty of Geographical Science, Beijing Normal University, No.19, Xinjiekouwai St., Beijing, China
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Li X, Vojnovic I, Ligmann-Zielinska A. Spatial accessibility and travel to pharmacy by type in the Detroit region. J Am Pharm Assoc (2003) 2024:102052. [PMID: 38401841 DOI: 10.1016/j.japh.2024.102052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Community pharmacies are a critical part of the health care provision system. Yet less is understood about the spatial accessibility to pharmacies and how people travel to reach these services. OBJECTIVES This study compared spatial accessibility and actual travel to different types of pharmacies among selected neighborhoods in the Detroit region. METHODS Three types of neighborhoods were selected and compared, including two lower income Black urban neighborhoods of high-density and four upper income White suburbs (two of low density and two of high density). Spatial accessibility was computed by pharmacy type and compared among neighborhoods using ANOVA. Pharmacy trips reported in a travel survey were geocoded and linked with community pharmacies in a list generated from ReferenceUSA business data. Destination choices were mapped and the relationship between spatial accessibility and actual distance traveled was examined using ordinary least squares regressions. RESULTS On average, urban residents in Detroit had higher access to local independent pharmacies (0.74 miles to the nearest one) but relatively lower access to national chains (1.35 miles to the nearest one), which most residents relied on. Urban residents also tended to shop around more for services even among national chains. In fact, they bypassed nearby local independent pharmacies and traveled long distances to use farther pharmacies, primarily national chains. The average trip distance to pharmacy was 2.1 miles for urban residents, but only 1.1 miles and 1.5 miles for residents in high-density suburbs and low-density suburbs, respectively. CONCLUSION Supposedly good spatial access considering all pharmacies together may mask excessive burden in reaching the pharmacy services needed in low-income minority urban communities, as shown in the case of Detroit. Thus, when mapping pharmacy deserts, it is important to distinguish spatial accessibility among different pharmacy types.
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Stacherl B, Sauzet O. Chronic disease onset and wellbeing development: longitudinal analysis and the role of healthcare access. Eur J Public Health 2024; 34:29-34. [PMID: 37802926 PMCID: PMC10843952 DOI: 10.1093/eurpub/ckad167] [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] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Experiencing the onset of a chronic disease is a serious health event impacting living conditions and wellbeing. Investigating wellbeing development and its predictors is crucial to understand how individuals adapt to chronic illnesses. This study (i) analyzed the impact of a chronic disease on wellbeing development, and (ii) explored spatial healthcare access as potential moderating factor. METHODS Data were obtained from the German Socio-economic Panel, a nationally representative household survey. A prospective sample of 3847 individuals was identified for whom the onset of cancer, cardiopathy, diabetes or stroke was observed between 2008 and 2020. Mixed models using an interrupted time series approach were performed to identify immediate level changes and longitudinal trend changes in wellbeing (operationalized with health and life satisfaction) after disease onset. Further, spatial access to healthcare (operationalized by two-stage floating catchment area measures) as potential moderating factor was examined using interaction effects. RESULTS Chronic disease onset had an immediate negative level impact on health and life satisfaction. For health satisfaction, a negative pre-onset wellbeing trend was offset (but not reversed). A small positive trend was observed for life satisfaction after disease onset. Spatial access to healthcare was not associated with the magnitude of wellbeing reduction at onset. CONCLUSIONS Health and life satisfaction levels drop with the onset of a chronic disease with no recovery trend for health and little recovery for life satisfaction, implying persistently lower wellbeing levels after a chronic illness onset. Spatial access to healthcare does not affect the wellbeing change after disease onset.
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Affiliation(s)
- Barbara Stacherl
- Socio-economic Panel, German Institute for Economic Research (DIW Berlin), Berlin, Germany
| | - Odile Sauzet
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany
- Department of Business Administration and Economics, Bielefeld University, Bielefeld, Germany
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Zhang L, Hou XY, Liu Y. Measuring Mental Health Service Accessibility for Indigenous Populations: a Systematic Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01899-6. [PMID: 38270837 DOI: 10.1007/s40615-023-01899-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
Indigenous populations have experienced inequality of accessing mental health services compared with their non-Indigenous counterparts, although the way of measuring mental health service accessibility for Indigenous populations is unclear. This systematic review examines measures of mental health service accessibility for Indigenous people, including the diversity of mental health services that are available to them and the barriers to accessing mental healthcare. Using a systematic search procedure, we identified 27 studies that explored Indigenous populations' mental health service access. Our review shows that 18 studies used interview-based methods to explore how Indigenous people use mental health services, and only nine studies used quantitative methods to measure the uptake of mental health services. While advanced methods for quantifying geographical access to healthcare services are widely available, these methods have not been applied in the current literature to explore the potential access to mental health services by Indigenous populations. This is partially due to limited understanding of how Indigenous populations seek mental healthcare, barriers that prevent Indigenous people from accessing diverse types of mental health services, and scarcity of data that are available to researchers. Future research could focus on developing methods to support spatially explicit measuring of accessibility to mental health services for Indigenous populations.
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Affiliation(s)
- Lihong Zhang
- School of the Environment, The University of Queensland, Brisbane, Queensland, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Yan Liu
- School of the Environment, The University of Queensland, Brisbane, Queensland, Australia.
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13
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Song C, Wang X, Ge E, Shi X, Pan J. Editorial: Applications of geospatial information technologies and spatial statistics in health services research. Front Public Health 2024; 11:1349985. [PMID: 38239794 PMCID: PMC10794292 DOI: 10.3389/fpubh.2023.1349985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Chao Song
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China
| | - Xiuli Wang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities and West China Research Centre for Rural Health Development, Sichuan University, Chengdu, China
| | - Erjia Ge
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xun Shi
- Department of Geography, Dartmouth College, Hanover, NH, United States
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- China Center for South Asian Studies, Sichuan University, Chengdu, China
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Pan J, Deng Y, Yang Y, Zhang Y. Location-allocation modelling for rational health planning: Applying a two-step optimization approach to evaluate the spatial accessibility improvement of newly added tertiary hospitals in a metropolitan city of China. Soc Sci Med 2023; 338:116296. [PMID: 37879131 DOI: 10.1016/j.socscimed.2023.116296] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
The inequity of access to healthcare services is still one of the most long-lasting problems confronted by worldwide countries. Under such context where maldistributed healthcare resources have posed huge challenges in achieving cross-regional efficiency and equity of healthcare services, rational allocation of newly added healthcare resources has become rather critical to policy makers. To address this issue, we applied a two-step optimization approach to investigate the spatial allocation of newly added tertiary general healthcare resources in Chengdu, a metropolitan city of China. The case study of Chengdu was utilized as an example to illustrate the feasibility of such spatial optimization approach in practice in terms of supporting regional health planning related decision-making procedures in China, as well as evaluating the performance of healthcare resource allocation related strategies actually implemented. Using current and historical health planning data, we sought to optimize tertiary general hospitals' locations to maximize population coverage of healthcare services in the first step, and to achieve equitable access to healthcare services among different residential locations via assigning the capacity (beds) to each hospital in the second step. Results suggested that the spatial optimization of newly added healthcare resources would theoretically enhance both efficiency and equity substantially. Specifically, if implemented in practice, such optimized spatial allocation of healthcare resources would theoretically contribute to improved efficiency as reflected by a 5% increase and a 15% increase in population coverage and the weighted median value of spatial accessibility, respectively. In addition, this would contribute to achieve enhanced equity as reflected by a 27% decrease in the weighted standard deviation of spatial access. These findings are anticipated to offer valuable policy implications to inform the spatial allocation decisions of healthcare resources in China as well as other countries confronted with similar challenges, and the two-step optimization approach could be applied to facilitate future rational health plannings.
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Affiliation(s)
- Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; School of Public Administration, Sichuan University, Chengdu, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China.
| | - Yufan Deng
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
| | - Yili Yang
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
| | - Yumeng Zhang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
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15
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Stacherl B, Sauzet O. Gravity models for potential spatial healthcare access measurement: a systematic methodological review. Int J Health Geogr 2023; 22:34. [PMID: 38041129 PMCID: PMC10693160 DOI: 10.1186/s12942-023-00358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
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.
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Affiliation(s)
- Barbara Stacherl
- Socio-Economic Panel (SOEP), German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 11017, Berlin, Germany
| | - Odile Sauzet
- School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
- Department of Business Administration and Economics, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
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Ohashi K, Osanai T, Bando K, Fujiwara K, Tanikawa T, Tani Y, Takamiya S, Sato H, Morii Y, Ishikawa T, Ogasawara K. Optimal allocation of physicians improves accessibility and workload disparities in stroke care. Int J Equity Health 2023; 22:233. [PMID: 37936211 PMCID: PMC10631210 DOI: 10.1186/s12939-023-02036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Inequalities in access to stroke care and the workload of physicians have been a challenge in recent times. This may be resolved by allocating physicians suitable for the expected demand. Therefore, this study analyzes whether reallocation using an optimization model reduces disparities in spatial access to healthcare and excessive workload. METHODS This study targeted neuroendovascular specialists and primary stroke centers in Japan and employed an optimization model for reallocating neuroendovascular specialists to reduce the disparity in spatial accessibility to stroke treatment and workload for neuroendovascular specialists in Japan. A two-step floating catchment area method and an inverted two-step floating catchment area method were used to estimate the spatial accessibility and workload of neuroendovascular specialists as a potential crowdedness index. Quadratic programming has been proposed for the reallocation of neuroendovascular specialists. RESULTS The reallocation of neuroendovascular specialists reduced the disparity in spatial accessibility and the potential crowdedness index. The standard deviation (SD) of the demand-weighted spatial accessibility index improved from 125.625 to 97.625. Simultaneously, the weighted median spatial accessibility index increased from 2.811 to 3.929. Additionally, the SD of the potential crowdedness index for estimating workload disparity decreased from 10,040.36 to 5934.275 after optimization. The sensitivity analysis also showed a similar trend of reducing disparities. CONCLUSIONS The reallocation of neuroendovascular specialists reduced regional disparities in spatial accessibility to healthcare, potential crowdedness index, and disparities between facilities. Our findings contribute to planning health policies to realize equity throughout the healthcare system.
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Affiliation(s)
- Kazuki Ohashi
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
| | - Toshiya Osanai
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kyohei Bando
- Graduate School of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
| | - Kensuke Fujiwara
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Graduate School of Commerce, Otaru University of Commerce, 3-5-21, 047-8501, Otaru, Midori, Japan
| | - Takumi Tanikawa
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Faculty of Health Sciences, Hokkaido University of Science, 7-15-4-1, Maeda, Teine-ku, Sapporo, 006- 8585, Japan
| | - Yuji Tani
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Department of Medical Informatics and Hospital Management, Asahikawa Medical University, E2-1-1-1, 078-8510, Asahikawa, Midorigaoka, Japan
| | - Soichiro Takamiya
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-ku, Sapporo, 060-8638, Japan
- Department of Neurosurgery, Otaru General Hospital, 1-1-1, Wakamatsu, Otaru, 047-8550, Japan
| | - Hirotaka Sato
- Department of Neurosurgery, Asahikawa Medical University, E2-1-1-1, Midorigaoka, Asahikawa, 078- 8510, Japan
| | - Yasuhiro Morii
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6, Minami, Wako, Japan
| | - Tomoki Ishikawa
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Institute for Health Economics and Policy, 1-21-19, Toranomon, Minato-ku, 105-0001, Japan
| | - Katsuhiko Ogasawara
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan.
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Kim H, Park D, Seomun G, Kim H, Woosnam KM, Kim BJ. Health justice and economic segregation in climate risks: Tracing vulnerability and readiness progress. Health Place 2023; 84:103113. [PMID: 37717535 DOI: 10.1016/j.healthplace.2023.103113] [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: 05/09/2023] [Revised: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
Climate vulnerability can make urban space unhealthy and accentuate existing health (in)justice and (economic) segregation. Drawing on the vulnerability-readiness nexus and measuring health justice (i.e., health poverty, health distribution, and health access) and economic segregation (through indices), we strive to investigate the plausible pathways of the two constructs at the heat risks. Our work, focusing on metropolitan cities in South Korea, addresses the role of heat vulnerability and readiness nexus regarding health justice and economic segregation through correlational analysis and a time-trend comparative approach between 2011 and 2015 (as five year-long effects). Our results show that potential positive links exist between health poverty as a component of health justice and economic segregation. Moreover, climate readiness, as opposed to vulnerability, plays a crucial role in reducing economic segregation in the context of health justice and heat risks.
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Affiliation(s)
- Hyun Kim
- School of Public Administration, Chungnam National University, Daejeon, South Korea.
| | - Dujin Park
- Department of Sociology, Chungnam National University, Daejeon, South Korea.
| | - Gyu Seomun
- Department of Environmental Planning, Seoul National University, Seoul, South Korea.
| | - Hyewon Kim
- School of Public Administration, Chungnam National University, Daejeon, South Korea.
| | - Kyle Maurice Woosnam
- Warnell School of Forestry & Natural Resources, University of Georgia, Athens, GA 30602, USA; School of Tourism and Hospitality Management, University of Johannesburg, Auckland Park, South Africa.
| | - Bong Jik Kim
- Department of Otorhinolaryngology, Chungnam National University Sejong Hospital, College of Medicine, Chungnam National University, Daejeon, South Korea.
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18
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Fan L, Bonomi L. Hide Your Distance: Privacy Risks and Protection in Spatial Accessibility Analysis. PROCEEDINGS OF THE ... ACM SIGSPATIAL INTERNATIONAL CONFERENCE ON ADVANCES IN GEOGRAPHIC INFORMATION SYSTEMS : ACM GIS. ACM SIGSPATIAL INTERNATIONAL CONFERENCE ON ADVANCES IN GEOGRAPHIC INFORMATION SYSTEMS 2023; 2023:106. [PMID: 38152352 PMCID: PMC10751042 DOI: 10.1145/3589132.3625656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Measuring spatial accessibility to healthcare resources and facilities has long been an important problem in public health. For example, during disease outbreaks, sharing spatial accessibility data such as individual travel distances to health facilities is vital to policy making and designing effective interventions. However, sharing these data may raise privacy concerns, as information about individual data contributors (e.g., health status and residential address) may be disclosed. In this work, we investigate those unintended information leakage in spatial accessibility analysis. Specifically, we are interested in understanding whether sharing data for spatial accessibility computations may disclose individual participation (i.e., membership inference) and personal identifiable information (i.e., address inference). Furthermore, we propose two provably private algorithms that mitigate those privacy risks. The evaluation is conducted with real population and healthcare facilities data from Mecklenburg county, NC and Nashville, TN. Compared to state-of-the-art privacy practices, our methods effectively reduce the risks of membership and address disclosure, while providing useful data for spatial accessibility analysis.
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Affiliation(s)
- Liyue Fan
- University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Luca Bonomi
- Vanderbilt University Medical Center, Nashville, TN, USA
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19
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Ohashi K, Osanai T, Fujiwara K, Tanikawa T, Tani Y, Takamiya S, Sato H, Morii Y, Ogasawara K. Access to mechanical thrombectomy and ischemic stroke mortality in Japan: a spatial ecological study. Front Neurol 2023; 14:1209446. [PMID: 37731848 PMCID: PMC10507726 DOI: 10.3389/fneur.2023.1209446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Abstract
Background Advances in stroke treatment have greatly improved outcomes; however, disparities in access to treatment might increase. Achieving equitable access to stroke treatment is a health policy challenge, as rapid treatment is essential for positive outcomes. This ecological cross-sectional study aimed to determine the relationship between the disparities in spatial accessibility to mechanical thrombectomy (SAMT) and stroke mortality rates in Japan, hypothesizing that disparities in SAMT may increase the differences in stroke mortality between regions. Methods We used the average number of ischemic stroke (IS) deaths between 2020 and 2021 as the response variable; and SAMT, medical resources, and socioeconomic characteristics of each municipality as explanatory variables. A conditional autoregressive model was used to examine the association between the risk of stroke mortality and SAMT. The standardized mortality ratio (SMR) was mapped to understand the nationwide disparities in stroke mortality risk. Results The median number of IS deaths was 17.5 persons per year in the municipalities (2020 to 2021). The study also found that municipalities with low SAMT were located in the northern part of Japan. The non-spatial regression model results indicated that poor accessibility, a small proportion of bachelor's degrees or higher, and a high proportion of workers in secondary industries were related to high IS mortality. Three models were evaluated using spatial analysis; Model 1 with accessibility indicators alone, Model 2 with medical resources added to Model 1, and Model 3 with socioeconomic characteristics added to Model 2. In Models 1 and 2, the population-weighted spatial accessibility index (PWSAI) showed a significant negative relationship with stroke mortality. However, this was not evident in Model 3. Mapping using Model 3 showed that the high-risk areas were predominantly located in northern Japan, excluding Hokkaido. Conclusion Access to mechanical thrombectomy was estimated, and regional differences were observed. The relationship between accessibility and IS mortality is unknown; however, regardless of accessibility, municipalities with a high proportion of workers in secondary industries and a small proportion with bachelor's degrees or above are at risk of death from stroke.
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Affiliation(s)
- Kazuki Ohashi
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Toshiya Osanai
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kensuke Fujiwara
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Graduate School of Commerce, Otaru University of Commerce, Otaru, Japan
| | - Takumi Tanikawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan
| | - Yuji Tani
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Department of Medical Informatics and Hospital Management, Asahikawa Medical University, Asahikawa, Japan
| | - Soichiro Takamiya
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Neurosurgery, Otaru General Hospital, Otaru, Japan
| | - Hirotaka Sato
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yasuhiro Morii
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
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Desjardins MR, Desravines N, Fader AN, Wethington SL, Curriero FC. Geographic Disparities in Potential Accessibility to Gynecologic Oncologists in the United States From 2001 to 2020. Obstet Gynecol 2023; 142:688-697. [PMID: 37535956 DOI: 10.1097/aog.0000000000005284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/25/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To use a spatial modeling approach to capture potential disparities of gynecologic oncologist accessibility in the United States at the county level between 2001 and 2020. METHODS Physician registries identified the 2001-2020 gynecologic oncology workforce and were aggregated to each county. The at-risk cohort (women aged 18 years or older) was stratified by race and ethnicity and rurality demographics. We computed the distance from at-risk women to physicians. Relative access scores were computed by a spatial model for each contiguous county. Access scores were compared across urban or rural status and racial and ethnic groups. RESULTS Between 2001 and 2020, the gynecologic oncologist workforce increased. By 2020, there were 1,178 active physicians and 98.3% practiced in urban areas (37.3% of all counties). Geographic disparities were identified, with 1.09 physicians per 100,000 women in urban areas compared with 0.1 physicians per 100,000 women in rural areas. In total, 2,862 counties (57.4 million at-risk women) lacked an active physician. Additionally, there was no increase in rural physicians, with only 1.7% practicing in rural areas in 2016-2020 relative to 2.2% in 2001-2005 ( P =.35). Women in racial and ethnic minority populations, such as American Indian or Alaska Native and Hispanic women, exhibited the lowest level of access to physicians across all time periods. For example, 23.7% of American Indian or Alaska Native women did not have access to a physician within 100 miles between 2016 and 2020, which did not improve over time. Non-Hispanic Black women experienced an increase in relative accessibility, with a 26.2% increase by 2016-2020. However, Asian or Pacific Islander women exhibited significantly better access than non-Hispanic White, non-Hispanic Black, Hispanic, and American Indian or Alaska Native women across all time periods. CONCLUSION Although the U.S. gynecologic oncologist workforce increased steadily over 20 years, this has not translated into evidence of improved access for many women from rural and underrepresented areas. However, health care utilization and cancer outcomes may not be influenced only by distance and availability. Policies and pipeline programs are needed to address these inequities in gynecologic cancer care.
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Qiu N, Zhang T, Cheng J. Examining the impact of spatial accessibility to rehabilitation facilities on the degree of disability: A heterogeneity perspective. SSM Popul Health 2023; 23:101489. [PMID: 37588767 PMCID: PMC10425410 DOI: 10.1016/j.ssmph.2023.101489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
The positive effect of healthcare facilities on residents' health has been extensively studied. However, few studies have focused on the role of rehabilitation services as unique healthcare services for persons with disabilities. This study aimed to examine the relationship between the spatial accessibility of rehabilitation facilities and the degree of disability. To this end, an approach of measuring the spatial accessibility of rehabilitation facilities to persons with disabilities was proposed. This approach integrates multiple key elements including the characteristics of facilities (i.e., the capacity, frequency of use and service radius), characteristics of the mobility of persons with disabilities (i.e., the mode of travel, escort support, transportation fee and barrier-free environment requirements) and travel time obtained from a routing application programme interface. The accessibility of rehabilitation facilities was calculated at the neighbourhood level within the Central Urban Area of Tianjin Municipality. The ordinal logistic regression analysis revealed that higher accessibility to rehabilitation facilities generally corresponded to lower severity of disability. However, the impact varied depending on the type of disability. Increased accessibility was associated with greater severity of intellectual disability, whereas it was linked to reduced severity of visual, hearing, limb, mental and speech disabilities. It is suggested to incorporate disability diversity and the accessibility of rehabilitation facilities into spatial planning and governance.
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Affiliation(s)
- Ning Qiu
- School of Architecture and Urban Planning, Shandong Jianzhu University, China
| | | | - Jianquan Cheng
- Department of Natural Sciences, Manchester Metropolitan University, UK
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22
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Kou R, Mei K, Bi Y, Huang J, Yang S, Chen K, Li W. Equity and trends in general practitioners' allocation in China: based on ten years of data from 2012 to 2021. HUMAN RESOURCES FOR HEALTH 2023; 21:61. [PMID: 37533104 PMCID: PMC10394803 DOI: 10.1186/s12960-023-00841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND General practitioners (GP) are the gatekeepers of residents' health, 2021 is the 10th year of the establishment of the GP system in China. This study aims to assess the equity and trends of GP allocation in China from 2012 to 2021, summarize the efforts and progress of GPs in China during the decade, predict the development trend of GPs in mainland China in the next 5 years to provide a reference for regional health planning and rational allocation of GPs in China. METHODS Data from 2012 to 2021 on GPs in 22 provinces, 5 autonomous regions, and 4 municipalities directly under the central government in mainland China (excluding Hong Kong, Macao, and Taiwan) are collected by us. Gini coefficient, Lorenz curve and health resource agglomeration degree (HRAD) were used to analyze the equity of the allocation of GPs in China from different dimensions, a Grey prediction model was used to forecast the number of GPs in 2022-2026. RESULTS The number of GPs in mainland China increased from 109 794 to 434 868 from 2012 to 2021, with 3.08 GPs per 10 000 people in 2021. The Gini coefficient of GPs allocation by population in China decreased from 0.312 to 0.147 from 2012 to 2021, while the Gini coefficient of geographic dimension remained between 0.700 and 0.750. Compared with the degree of curvature of the Lorenz curve in the geographic dimension, the degree of curvature of the population and economic dimension were smaller. In 2021, the HRAD in the Eastern region was 4.618, the Central region was 1.493, with different degrees of imbalance among regions, the HRAD/PAD (population agglomeration degree) in the Eastern, Central and Western regions were 1.196, 0.880 and 0.821, respectively. GPs in the Eastern region is still concentrated, while the Central and Western regions were at a similar level, GPs were more scarce. The GM (1,1) model predicts that the number of GPs in mainland China will reach about 720 000 in 2026, the number of GPs per 10 000 people will reach 4.9. CONCLUSION After a decade of development, the number of GPs in China has increased significantly. It has reached the goal of the GP system when it was first established. However, the equity of the geographical dimension, both in terms of Gini coefficient and HRAD, has great differences between different regions. The average Gini coefficient at the geographic dimension is 0.723. The average HRAD index was 4.969 in the East and 0.293 in the West. The Western region has the problem of insufficient GP allocation in both population and geographical dimension. In the future, the number of GPs in China will continue to grow rapidly with the support of policies. The "2030" goal, proposed in 2018, is expected to be achieved by 2026. Due to certain factors (such as COVID-19), the actual situation may be different from the predicted results.
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Affiliation(s)
- Ruxin Kou
- School of Public Health, Weifang Medical University, Weifang, 261021, Shandong, China
| | - Kangni Mei
- School of Public Health, Weifang Medical University, Weifang, 261021, Shandong, China
| | - Yuqing Bi
- School of Public Health, Weifang Medical University, Weifang, 261021, Shandong, China
| | - Jingwen Huang
- School of Public Health, Weifang Medical University, Weifang, 261021, Shandong, China
| | - Shilan Yang
- School of Public Health, Weifang Medical University, Weifang, 261021, Shandong, China
| | - Kexuan Chen
- School of Public Health, Weifang Medical University, Weifang, 261021, Shandong, China
| | - Wei Li
- School of Public Health, Weifang Medical University, Weifang, 261021, Shandong, China.
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Liu L, Alford-Teaster J, Onega T, Wang F. Refining 2SVCA Method for Measuring Telehealth Accessibility of Primary Care Physicians in Baton Rouge, Louisiana. CITIES (LONDON, ENGLAND) 2023; 138:104364. [PMID: 37274944 PMCID: PMC10237453 DOI: 10.1016/j.cities.2023.104364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Equity in health care delivery is a longstanding concern of public health policy. Telehealth is considered an important way to level the playing field by broadening health services access and improving quality of care and health outcomes. This study refines the recently developed "2-Step Virtual Catchment Area (2SVCA) method" to assess the telehealth accessibility of primary care in the Baton Rouge Metropolitan Statistical Area, Louisiana. The result is compared to that of spatial accessibility via physical visits to care providers based on the popular 2-Step Floating Catchment Area (2SFCA) method. The study shows that both spatial and telehealth accessibilities decline from urban to low-density and then rural areas. Moreover, disproportionally higher percentages of African Americans are in areas with higher spatial accessibility scores; but such an advantage is not realized in telehealth accessibility. In the study area, absence of broadband availability is mainly a rural problem and leads to a lower average telehealth accessibility than physical accessibility in rural areas. On the other side, lack of broadband affordability is a challenge across the rural-urban continuum and is disproportionally associated with high concentrations of disadvantaged population groups such as households under the poverty level and Blacks.
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Affiliation(s)
- Lingbo Liu
- Department of Urban Planning, School of Urban Design, Wuhan University, Wuhan 430072, China
- Center for Geographic Analysis, Harvard University, Cambridge, MA 02138, USA
| | - Jennifer Alford-Teaster
- Norris Cotton Cancer Center, Lebanon, NH 03755, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah; Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
| | - Fahui Wang
- Graduate School and Department of Geography and Anthropology, Louisiana State University, LA 70803, USA
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24
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Park J, Michels A, Lyu F, Han SY, Wang S. Daily changes in spatial accessibility to ICU beds and their relationship with the case-fatality ratio of COVID-19 in the state of Texas, USA. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2023; 154:102929. [PMID: 36960405 PMCID: PMC10011039 DOI: 10.1016/j.apgeog.2023.102929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
During the COVID-19 pandemic, many patients could not receive timely healthcare services due to limited availability and access to healthcare resources and services. Previous studies found that access to intensive care unit (ICU) beds saves lives, but they overlooked the temporal dynamics in the availability of healthcare resources and COVID-19 cases. To fill this gap, our study investigated daily changes in ICU bed accessibility with an enhanced two-step floating catchment area (E2SFCA) method in the state of Texas. Along with the increased temporal granularity of measurements, we uncovered two phenomena: 1) aggravated spatial inequality of access during the pandemic, and 2) the retrospective relationship between insufficient ICU bed accessibility and the high case-fatality ratio of COVID-19 in rural areas. Our findings suggest that those locations should be supplemented with additional healthcare resources to save lives in future pandemic scenarios.
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Affiliation(s)
- Jinwoo Park
- Department of Geography and Geographic Information Science, University of Illinois Urbana- Champaign, Urbana, IL, USA
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana- Champaign, Urbana, IL, USA
| | - Alexander Michels
- Department of Geography and Geographic Information Science, University of Illinois Urbana- Champaign, Urbana, IL, USA
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana- Champaign, Urbana, IL, USA
| | - Fangzheng Lyu
- Department of Geography and Geographic Information Science, University of Illinois Urbana- Champaign, Urbana, IL, USA
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana- Champaign, Urbana, IL, USA
| | - Su Yeon Han
- Department of Geography and Environmental Studies, Texas State University, San Marcos, TX, USA
| | - Shaowen Wang
- Department of Geography and Geographic Information Science, University of Illinois Urbana- Champaign, Urbana, IL, USA
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana- Champaign, Urbana, IL, USA
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25
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Wang J, Kwan MP, Liu D, Peng X. Assessing the spatial distribution of and inequality in 15-minute PCR test site accessibility in Beijing and Guangzhou, China. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2023; 154:102925. [PMID: 36941950 PMCID: PMC10017274 DOI: 10.1016/j.apgeog.2023.102925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
China has been planning to construct SARS-CoV-2 antigen testing sites within a 15-min walk in most major cities to timely identify asymptomatic cases and stop the transmission of COVID-19. However, little is known about the spatial distribution of 15-min accessibility to PCR test sites. In this study, we analyze the spatial distribution of and inequality in 15-min accessibility to PCR test sites in two major Chinese cities (Beijing and Guangzhou) based on the cumulative-opportunity model. The results indicate that the current distribution of 15-min accessibility to PCR test sites is satisfactory when normal commuting is not disrupted. However, disruptions of normal commuting (e.g., due to work-from-home restrictions) can negatively influence 15-min accessibility to PCR test sites and increase its inequality. Our study provides policymakers with up-to-date knowledge about the spatial distribution of 15-min accessibility to PCR test sites, identifies the disadvantaged neighborhoods in terms of test site accessibility, and highlights the changes in accessibility and inequality because of travel disruptions.
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Affiliation(s)
- Jianying Wang
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Mei-Po Kwan
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Dong Liu
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- Institute of Future Cities, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Xia Peng
- Tourism College, Beijing Union University, Beijing, China
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26
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Fränti P, Mariescu-Istodor R, Akram A, Satokangas M, Reissell E. Can we optimize locations of hospitals by minimizing the number of patients at risk? BMC Health Serv Res 2023; 23:415. [PMID: 37120539 PMCID: PMC10148542 DOI: 10.1186/s12913-023-09375-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/06/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND To reduce risk of death in acute ST-segment elevation myocardial infraction (STEMI), patients must reach a percutaneous coronary intervention (PCI) within 120 min from the start of symptoms. Current hospital locations represent choices made long since and may not provide the best possibilities for optimal care of STEMI patients. Open questions are: (1) how the hospital locations could be better optimized to reduce the number of patients residing over 90 min from PCI capable hospitals, and (2) how this would affect other factors like average travel time. METHODS We formulated the research question as a facility optimization problem, which was solved by clustering method using road network and efficient travel time estimation based on overhead graph. The method was implemented as an interactive web tool and tested using nationwide health care register data collected during 2015-2018 in Finland. RESULTS The results show that the number of patients at risk for not receiving optimal care could theoretically be reduced significantly from 5 to 1%. However, this would be achieved at the cost of increasing average travel time from 35 to 49 min. By minimizing average travel time, the clustering would result in better locations leading to a slight decrease in travel time (34 min) with only 3% patients at risk. CONCLUSIONS The results showed that minimizing the number of patients at risk alone can significantly improve this single factor but, at the same time, increase the average burden of others. A more appropriate optimization should consider more factors. We also note that the hospitals serve also for other operators than STEMI patients. Although optimization of the entire health care system is a very complex optimization problems goal, it should be the aim of future research.
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Affiliation(s)
- Pasi Fränti
- School of Computing, University of Eastern Finland, P.O. Box 111, 80101, Joensuu, Finland.
| | | | - Awais Akram
- School of Computing, University of Eastern Finland, P.O. Box 111, 80101, Joensuu, Finland
| | - Markku Satokangas
- Finnish Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland
| | - Eeva Reissell
- Finnish Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland
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27
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Wei Z, Bai J, Feng R. Optimization referral rate design for hierarchical diagnosis and treatment system based on accessibility-utilization efficiency bi-objective collaboration: A case study of China. Soc Sci Med 2023; 322:115827. [PMID: 36893504 DOI: 10.1016/j.socscimed.2023.115827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 03/03/2023] [Indexed: 03/07/2023]
Abstract
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.
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Affiliation(s)
- Zhongyu Wei
- School of Geography and Tourism, Shaanxi Normal University, Xi'an, 710119, China
| | - Jianjun Bai
- School of Geography and Tourism, Shaanxi Normal University, Xi'an, 710119, China.
| | - Ruitao Feng
- School of Geography and Tourism, Shaanxi Normal University, Xi'an, 710119, China
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28
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Sui J, Zhang G, Lin T, Hamm NAS, Li C, Wu X, Hu K. Quantitative Evaluation of Spatial Accessibility of Various Urban Medical Services Based on Big Data of Outpatient Appointments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5050. [PMID: 36981964 PMCID: PMC10048955 DOI: 10.3390/ijerph20065050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Equity of urban medical services affects human health and well-being in cities and is important in building 'just' cities. We carried out a quantitative analysis of the spatial accessibility of medical services considering the diverse demands of people of different ages, using outpatient appointment big data and refining the two-step floating catchment area (2SFCA) method. We used the traditional 2SFCA method to evaluate the overall spatial accessibility of medical services of 504 communities in Xiamen city, considering the total population and the supply of medical resources. Approximately half the communities had good access to medical services. The communities with high accessibility were mainly on Xiamen Island, and those with low accessibility were further from the central city. The refined 2SFCA method showed a more diverse and complex spatial distribution of accessibility to medical services. Overall, 209 communities had high accessibility to internal medicine services, 133 to surgery services, 50 to gynecology and obstetrics services, and 18 to pediatric services. The traditional method may over-evaluate or under-evaluate the accessibility of different types of medical services for most communities compared with the refined evaluation method. Our study can provide more precise information on urban medical service spatial accessibility to support just city development and design.
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Affiliation(s)
- Jinling Sui
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Guoqin Zhang
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
| | - Tao Lin
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
- Xiamen Key Laboratory of Smart Management on the Urban Environment, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
| | - Nicholas A. S. Hamm
- School of Geographical Sciences, University of Nottingham, Ningbo 315100, China
| | - Chunlin Li
- CAS Key Laboratory of Forest Ecology and Management, Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang 110016, China
| | - Xian Wu
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
- Xiamen Key Laboratory of Smart Management on the Urban Environment, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
| | - Kaiqun Hu
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
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29
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Quartey T, Peprah C, Morgan AK. Determinants of national health insurance enrolment among people at risk of statelessness in the Awutu Senya East Municipality and Gomoa East District of Ghana. BMC Health Serv Res 2023; 23:153. [PMID: 36788530 PMCID: PMC9927045 DOI: 10.1186/s12913-022-08738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 10/25/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND This paper investigates the factors influencing the decision to enrol in Ghana's National Health Insurance Scheme (NHIS) among people at risk of statelessness, with emphasis on the individual's demographic and socioeconomic factors. METHODS: The study used data from a cross-sectional household survey undertaken in the Awutu Senya East Municipality and Gomoa East District of Ghana's Central Region between March 9 and June 26, 2021, on healthcare utilization culture among people at risk of statelessness. Descriptive statistics and binary logistic regression were used in analysing data from a sample of 384 people at risk of statelessness. RESULTS: The results reveal that about 51% of the at-risk population have ever enrolled while 48% of the respondents were enrolled on the NHIS at the time of the survey (active members). The majority of the enrolled members acquired their membership through self-payment of the enrolment fee. Additionally, respondents aged 26-35 had higher odds of enrolling, whiles those within 56-65 years had lower odds of enrolling in health insurance. Also, persons who are married and have a high school education or an equivalent qualification were more likely to enrol, while persons with no employment were less likely to enrol. CONCLUSION According to the paper, while the gap in coverage between rich and poor, married and single appears to have narrowed, these factors continue to determine NHIS coverage among people at risk of statelessness. The same is true for education. Efforts must be increased to ensure equal access to healthcare financing interventions for better access to health services.
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Affiliation(s)
- Theophilus Quartey
- grid.9829.a0000000109466120Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Peprah
- grid.9829.a0000000109466120Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Kwame Morgan
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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30
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Soukhov A, Páez A, Higgins CD, Mohamed M. Introducing spatial availability, a singly-constrained measure of competitive accessibility. PLoS One 2023; 18:e0278468. [PMID: 36662779 PMCID: PMC9858359 DOI: 10.1371/journal.pone.0278468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/16/2022] [Indexed: 01/21/2023] Open
Abstract
Accessibility indicators are widely used in transportation, urban and healthcare planning, among many other applications. These measures are weighted sums of reachable opportunities from a given origin, conditional on the cost of movement, and are estimates of the potential for spatial interaction. Over time, various proposals have been forwarded to improve their interpretability: one of those methodological additions have been the introduction of competition. In this paper we focus on competition, but first demonstrate how a widely used measure of accessibility with congestion fails to properly match the opportunity-seeking population. We then propose an alternative formulation of accessibility with competition, a measure we call spatial availability. This measure relies on proportional allocation balancing factors (friction of distance and population competition) that are equivalent to imposing a single constraint on conventional gravity-based accessibility. In other words, the proportional allocation of opportunities results in a spatially available opportunities value which is assigned to each origin that, when all origin values are summed, equals the total number of opportunities in the region. We also demonstrate how Two-Stage Floating Catchment Area (2SFCA) methods are equivalent to spatial availability and can be reconceptualized as singly-constrained accessibility. To illustrate the application of spatial availability and compare it to other relevant measures, we use data from the 2016 Transportation Tomorrow Survey of the Greater Golden Horseshoe area in southern Ontario, Canada. Spatial availability is an important contribution since it clarifies the interpretation of accessibility with competition and paves the way for future applications in equity analysis (e.g., spatial mismatch, opportunity benchmarking, policy intervention scenario analysis).
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Affiliation(s)
- Anastasia Soukhov
- School of Earth, Environment and Society, McMaster University, Hamilton, ON, Canada
| | - Antonio Páez
- School of Earth, Environment and Society, McMaster University, Hamilton, ON, Canada
| | - Christopher D. Higgins
- Department of Geography & Planning, University of Toronto Scarborough, Toronto, ON, Canada
| | - Moataz Mohamed
- Department of Civil Engineering, McMaster University, Hamilton, ON, Canada
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31
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Mavragani A, Dang Y, Vogel D, She B. The Effect of Offline Medical Resource Distribution on Online Physician-Patient Interaction: Empirical Study With Online and Offline Data. JMIR Form Res 2023; 7:e43533. [PMID: 36626204 PMCID: PMC9874990 DOI: 10.2196/43533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The relationship between online health communities (OHCs) and offline medical care is unclear because both provide physician-patient interaction services and channels. Taking advantage of information and communication technology, patients have been using OHCs widely. However, some physical medical resources (such as hospital beds and medical devices) cannot be replicated by information and communication technologies. Therefore, it is worth studying how offline medical resources affect physician-patient interactions in OHCs and how OHCs help to solve resource scarcity and the uneven distribution of traditional medical treatment. OBJECTIVE This study aimed to support the notion that physician-patient consultations in OHCs are influenced by the objective distribution of offline health care capital (accessibility and availability) and to provide suggestions for the allocation of medical resources in practice through the judicious use of offline and online channels. METHODS The empirical data in this study were collected from both online and offline channels. The offline data include 9 years (2006-2014) of medical resource statistics of 31 provincial administrative regions in mainland China. Moreover, data regarding the geolocation-based physician-patient interaction network in the OHC were also collected. The online data come from one of China's largest OHCs. We obtained 92,492 telephone consultation records of 6006 physicians using an automatic web crawler program. Social network analysis was used to visualize the descriptive statistics of the offline geolocation-based physician-patient interaction network in the OHC. A regression model with a squared variable was applied to analyze online and offline empirical data to further test our hypothesis. Two types of robustness tests were used to increase the reliability of the test results of the initial model. RESULTS The results of our social network analysis show that there is a uniform geographic distribution of patients who use OHCs, whereas the physician relies more on geographic advantage (eg, a higher medical resource capability). Moreover, the empirical results of the regression model support the notion that physician-patient telephone consultations are positively influenced by physicians' online contributions (βcontribution=.210; P<.001) and capital availability (βbed=.935; P=.07), and, interestingly, spatial accessibility has an inverted U-shaped effect (βdistance=.199; P<.001 and βdistance2=-.00449; P=.008). The results indicate that the use of OHCs, although constrained by offline medical resources, provides a channel for offline resources to flow from areas with high availability to those with low availability. CONCLUSIONS This study explores the relationship between online and offline channels by investigating online physician-patient interactions and offline medical resources. In particular, this study analyzes the impact of offline channels on online channels and verifies the possibility of OHC capital use shifting from a high-availability area to a low-availability area. In addition, it provides a theoretical and practical basis for understanding the interaction of online and offline channels of medical care.
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Affiliation(s)
| | - Yuanyuan Dang
- School of Business Administration, South China University of Technology, Guangzhou, China
| | - Doug Vogel
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Bofei She
- School of Business Administration, South China University of Technology, Guangzhou, China
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32
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Jörg R, Haldimann L. MHV3SFCA: A new measure to capture the spatial accessibility of health care systems. Health Place 2023; 79:102974. [PMID: 36708664 DOI: 10.1016/j.healthplace.2023.102974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/27/2023]
Abstract
Good accessibility of health care services is essential to meet the needs of the population and ensure adequate health care coverage. It usually refers to two spatial dimensions: availability (competition between populations for the same medical supply) and reachability (distance between population and medical supply). Traditional indicators of health care accessibility usually fail to consider both of these components simultaneously. Floating-Catchment-Area (FCA) methods were developed to address these shortcomings. This study reviews the existing FCA methods and proposes the Modified Huff-based Variable 3 Steps Floating Catchment Area (MHV3SFCA) method as a new approach. The MHV3SFCA method integrates the strengths of several existing FCA methods into a single method, such as supply competition through the Huff model, and the integration of variable effective catchment sizes. In addition, and as a novelty, the MHV3SFCA relies on the assumption of a constant overall population demand, independent of the distances between population units and supply sites. It also accounts for absolute difference in distances without overestimating distance effects. Based on the results of a simulation study the paper discusses the strengths of the MHV3SFCA method capturing spatial differences in access to health care services.
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Affiliation(s)
- Reto Jörg
- Swiss Health Observatory, Neuchâtel, Switzerland.
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33
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Arije O, Udoh E, Ijadunola K, Afolabi O, Aransiola J, Omoregie G, Tomori-Adeleye O, Ukeme-Edet O, Fajemisin O, Titus R, Onayade A. Combination prevention package of interventions for reducing vulnerability to HIV among adolescent girls and young women in Nigeria: An action research. PLoS One 2023; 18:e0279077. [PMID: 36652442 PMCID: PMC9847984 DOI: 10.1371/journal.pone.0279077] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 11/29/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW) in Nigeria are especially at risk of HIV in Nigeria. Their vulnerability to HIV is linked to multiple concurrent sexual relationships, transgenerational sex, and transactional sex, amongst other factors. These factors have sociocultural contexts that vary across a multi-cultural country like Nigeria. The aim of this study was to use an innovative collaborative approach to develop a minimum HIV prevention package for AGYW which is responsive to sociocultural settings and based on combination HIV prevention. METHODS We conducted action research to develop and implement actionable HIV prevention intervention models that address AGYW's vulnerabilities to HIV in three Nigerian States and the Federal Capital Territory (FCT) Abuja. The action research adopted the breakthrough series (BTS) collaborative, which accelerates improvement through mutual learning. The BTS implementation involved rapid Plan-Do-Study-Act (PDSA) cycles: an iterative process to plan and implement a basket of interventions. Problems or problematic situations, termed change topics, for which interventions could be carried out were identified in each study location. Using participatory approaches during a series of meetings called learning sessions, specific and innovative interventions, termed change ideas, were developed. These learning sessions were conducted with young women groups and other stakeholders. The change ideas were tested, studied, adapted, adopted, or discarded at each participating site. Exposure to and uptake of the implemented interventions was assessed in the study areas using a household survey with 4308 respondents, 53 focus group discussions, and 40 one-on-one interviews in intervention and control study sites. RESULTS Five categories of interventions were collaboratively developed, namely: Parental communication; Peer to peer interventions; Facilitator-led interventions; Non-traditional outlets for condoms, and Social media-based interventions. A good reach of the interventions was demonstrated as 77.5% of respondents reported exposure to at least one type of intervention. Nearly half of the respondents reported being exposed to the parental communication interventions, while 45.1% reported being exposed to the youth facilitator-driven interventions. Social media interventions had the lowest penetration. Also, there was between 15 to 20 positive percentage point difference between intervention and control for the uptake of HIV testing, and between 5 to 9 positive percentage point difference for uptake of male condoms. These differences were statistically significant at p<0.001. CONCLUSIONS Interventions developed through participatory approaches with young people and well-tailored to local realities can improve the acceptability and accessibility of programs that are able to reduce the risk of HIV infection among AGYW.
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Affiliation(s)
- Olujide Arije
- Institute of Public Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- * E-mail:
| | | | - Kayode Ijadunola
- Dept. of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusegun Afolabi
- Dept. of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Joshua Aransiola
- Dept. of Sociology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | | | | | - Rachel Titus
- Institute of Public Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adedeji Onayade
- Institute of Public Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- Dept. of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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34
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Wang F, Zeng Y, Liu L, Onega T. Disparities in spatial accessibility of primary care in Louisiana: From physical to virtual accessibility. Front Public Health 2023; 11:1154574. [PMID: 37143988 PMCID: PMC10151773 DOI: 10.3389/fpubh.2023.1154574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
Telehealth has been widely employed and has transformed how healthcare is delivered in the United States as a result of COVID-19 pandemic. While telehealth is utilized and encouraged to reduce the cost and travel burden for access to healthcare, there are debates on whether telehealth can promote equity in healthcare services by narrowing the gap among diverse groups. Using the Two-Step Floating Catchment Area (2SFCA) and Two-Step Virtual Catchment Area (2SVCA) methods, this study compares the disparities of physical and virtual access to primary care physicians (PCPs) in Louisiana. Both physical and virtual access to PCPs exhibit similar spatial patterns with higher scores concentrated in urban areas, followed by low-density and rural areas. However, the two accessibility measures diverge where broadband availability and affordability come to play an important role. Residents in rural areas experience additive disadvantage of even more limited telehealth accessibility than physical accessibility due to lack of broadband service provision. Areas with greater Black population proportions tend to have better physical accessibility, but such an advantage is eradicated for telehealth accessibility because of lower broadband subscription rates in these neighborhoods. Both physical and virtual accessibility scores decline in neighborhoods with higher Area Deprivation Index (ADI) values, and the disparity is further widened for in virtual accessibility compared to than physical accessibility. The study also examines how factors such as urbanicity, Black population proportion, and ADI interact in their effects on disparities of the two accessibility measures.
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Affiliation(s)
- Fahui Wang
- The Pinkie Gordon Lane Graduate School, Louisiana State University, Baton Rouge, LA, United States
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, United States
- *Correspondence: Fahui Wang,
| | - Yutian Zeng
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, United States
| | - Lingbo Liu
- Department of Urban Planning, School of Urban Design, Wuhan University, Wuhan, China
- Center for Geographic Analysis, Harvard University, Cambridge, MA, United States
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, Salt Lake City, UT, United States
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Zhou Z, Zhang X, Li M, Wang X. An SCM-G2SFCA Model for Studying Spatial Accessibility of Urban Parks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:714. [PMID: 36613037 PMCID: PMC9819648 DOI: 10.3390/ijerph20010714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
The urban park is the main leisure and entertainment place in residents' daily lives. The accessibility of parks is closely related to the physical and mental health of the residents. Although many scholars have conducted a great deal of research on the spatial accessibility of urban parks, they have rarely considered the supply competition among different parks and the impact of multiple travel modes on the spatial accessibility of parks. Therefore, based on Baidu map navigation data, in this paper, the park Baidu score is used to represent the competitive relationship among different parks, and the impact of multiple travel modes on the spatial accessibility of parks is considered. A supply competition and multiple travel modes Gaussian two-step floating catchment area (SCM-G2SFCA) model is established to evaluate the spatial accessibility of the parks in the Wuhou District, Chengdu, China. The results show that (1) compared with traditional methods, the SCM-G2SFCA model can obtain more accurate results using Baidu map navigation data. (2) There are obvious spatial differences in the accessibility distribution of the parks in the Wuhou District, Chengdu, with high accessibility in the south and low accessibility in the north. The Jinyang and Huaxing sub-districts in the southern suburbs have the highest park accessibility and can obtain more adequate park services. The Fangcaojie and Cujin sub-districts in the northern urban areas have the lowest park accessibility and are relatively lacking in park services. The research results of this study have important reference value for the rational planning of urban parks and the improvement of the spatial accessibility of urban parks in the Wuhou District of Chengdu and similar urban areas.
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Affiliation(s)
- Zexu Zhou
- School of Geomatics and Urban Spatial Information, Beijing University of Civil Engineering and Architecture, Beijing 102616, China
- Key Laboratory for Urban Spatial Informatics of Ministry of Natural Resources, Beijing 102616, China
| | - Xuedong Zhang
- School of Geomatics and Urban Spatial Information, Beijing University of Civil Engineering and Architecture, Beijing 102616, China
- Key Laboratory for Urban Spatial Informatics of Ministry of Natural Resources, Beijing 102616, China
| | - Mengwei Li
- School of Geomatics and Urban Spatial Information, Beijing University of Civil Engineering and Architecture, Beijing 102616, China
- Key Laboratory for Urban Spatial Informatics of Ministry of Natural Resources, Beijing 102616, China
| | - Xuedi Wang
- School of Geomatics and Urban Spatial Information, Beijing University of Civil Engineering and Architecture, Beijing 102616, China
- Key Laboratory for Urban Spatial Informatics of Ministry of Natural Resources, Beijing 102616, China
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Dai T, Guo K, Zhao J, Lu W. Impact of the presence of private hospitals on the spatial equality of healthcare accessibility in Beijing, China. GEOSPATIAL HEALTH 2022; 17. [PMID: 36468587 DOI: 10.4081/gh.2022.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
Providing equal geographical access to hospitals, either in the public or private healthcare sector, is vital and will benefit public health in general. Against the background of the partial privatization of the healthcare sector, the impact of private hospitals on equal healthcare access has been a highly neglected issue. We have applied an assessment methodology to study this situation by comparing the status quo scenario with one without private hospitals, based on accessibility analysis and spatial equality measurements. The case study of Beijing, China revealed a double-sided impact. With the presence of private hospitals, the Gini coefficient of spatial accessibility in urban districts was reduced from 0.03391 to 0.03211, while it increased from 0.1734 to 0.1914 in suburban districts. Thus, private hospitals improved spatial equality in urban districts in Beijing but jeopardized it in suburban districts. These research findings should enlighten policymakers to promote healthcare equality but would also need to be repeated in some other big cities.
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Affiliation(s)
- Teqi Dai
- Faculty of Geographical Science, Beijing Normal University, Beijing.
| | - Kaifei Guo
- Faculty of Geographical Science, Beijing Normal University, Beijing.
| | - Juanjuan Zhao
- College of Resource Environment and Tourism, Capital Normal University, Beijing.
| | - Wenqing Lu
- Faculty of Geographical Science, Beijing Normal University, Beijing.
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Le KH, La TXP, Tykkyläinen M. Service quality and accessibility of healthcare facilities: digital healthcare potential in Ho Chi Minh City. BMC Health Serv Res 2022; 22:1374. [PMCID: PMC9675284 DOI: 10.1186/s12913-022-08758-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Effective delivery of health services requires adequate quality in healthcare facilities and easy accessibility to health services physically or virtually. The purpose of this study was to reveal how the quality of healthcare facilities varies across the different parts of Ho Chi Minh City and how well residents (N = 9 million) can reach healthcare facilities. By demarcating the deficiently served areas of low accessibility, the study shows where urban planning and digital healthcare could improve accessibility to health services and the quality of services efficiently. Methods The analysis utilised geocoded information on hospitals, clinics, roads and population and the data of the quality scores of healthcare facilities. Quality scores were analysed by hot spot analysis and inverse distance weighting. Accessibility and formation of travel time-based service areas by travel time distances were calculated using road network, driving speed and population data. Results The results unveiled a centripetal spatial pattern of healthcare facilities and a similar pattern in their quality. Outside the travel time of 30 min for hospitals and 15 min for clinics, the deficiently served areas have a population of 1.1 to 1.2 million. Based on the results and the evidence of digital healthcare, this paper highlights how to develop and plan spatially effective service provision. Especially, it gives grounds to discuss how cost-effective digital healthcare could be applied to improve the accessibility and quality of health services in an urban structure of extensively varying accessibility to health services. Conclusions The results bring up the need and the means for improving the quality of health services and their cost-efficient availability by location optimisation, road improvements and implementing digital healthcare provided by hospitals and clinics in the city. At the same, this study provides a multidisciplinary approach for planning more equal and efficient health service provision geographically.
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Affiliation(s)
- Khanh Hung Le
- Faculty of Urban Studies (FUS), University of Social Sciences and Humanities, Vietnam National University Ho Chi Minh City (VNU-HCM), Room A309, 10 - 12 Dinh Tien Hoang Street, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| | - Thi Xuan Phuong La
- HCMC Institute for Development Studies, 28 Le Quy Don Street, Vo Thi Sau Ward, District 3, Ho Chi Minh City, Vietnam
| | - Markku Tykkyläinen
- grid.9668.10000 0001 0726 2490Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland
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Kuo FY, Wen TH. Assessing the spatial variability of raising public risk awareness for the intervention performance of COVID-19 voluntary screening: A spatial simulation approach. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2022; 148:102804. [PMID: 36267149 PMCID: PMC9567310 DOI: 10.1016/j.apgeog.2022.102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
The rapid spread of a (re)emerging pandemic (e.g., COVID-19) is usually attributed to the invisible transmission caused by asymptomatic cases. Health authorities rely on large-scale voluntary screening to identify and isolate invisible spreaders as well as symptomatic people as early as possible to control disease spread. Raising public awareness is beneficial for improving the effectiveness of epidemic prevention because it could increase the usage and demand for testing kits. However, the effectiveness of testing could be influenced by the spatial demand for medical resources in different periods. Spatial demand could also be triggered by public awareness in areas with two geographical factors, including spatial proximity to resources and attractiveness of human mobility. Therefore, it is necessary to explore the spatial variations in raising public awareness on the effectiveness of COVID-19 screening. We implemented spatial simulation models to integrate various levels of public awareness and pandemic dynamics in time and space. Moreover, we also assessed the effects of the spatial proximity of testing kits and the ease of human mobility on COVID-19 testing at various levels of public awareness. Our results indicated that high public awareness promotes high willingness to be tested. This causes the demand to not be fully satisfied at the peak times during a pandemic, yet the shortage of tests does not significantly increase pandemic severity. We also found that when public awareness is low, concentrating on unattractive areas (such as residential or urban fringe areas) could promote a higher benefit of testing. On the other hand, when awareness is high, the factor of distances to testing stations is more important for promoting the benefit of testing; allocating additional testing resources in areas distant from stations could have a higher benefit of testing. This study aims to provide insights for health authorities into the allocation of testing resources against disease outbreaks with respect to various levels of public awareness.
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Affiliation(s)
- Fei-Ying Kuo
- Department of Geography, National Taiwan University, Taiwan
| | - Tzai-Hung Wen
- Department of Geography, National Taiwan University, Taiwan
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Cuervo LG, Martínez-Herrera E, Cuervo D, Jaramillo C. Improving equity using dynamic geographic accessibility data for urban health services planning. GACETA SANITARIA 2022; 36:497-499. [PMID: 35697568 DOI: 10.1016/j.gaceta.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Luis Gabriel Cuervo
- Biomedical Research Methodology and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Eliana Martínez-Herrera
- Faculty at the National School of Public Health, Universidad de Antioquia, Medellín, Colombia; Research Group on Inequalities in Health, Environment and Employment Conditions (GREDS-EMCONET); Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Ciro Jaramillo
- School of Civil Engineering and Geomatics, Universidad del Valle, Cali, Colombia
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Chen J, Wang C, Zhang Y, Li D. Measuring spatial accessibility and supply-demand deviation of urban green space: A mobile phone signaling data perspective. Front Public Health 2022; 10:1029551. [PMID: 36339177 PMCID: PMC9634643 DOI: 10.3389/fpubh.2022.1029551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/06/2022] [Indexed: 01/29/2023] Open
Abstract
The reasonable distribution of urban green space (UGS) is a topic that urban researchers have been exploring for a long time. Solving the imbalance between the supply and demand of UGS plays an important role in improving the health level of a city. This study examines the central urban area of Hefei as an example. We developed a modified Gaussian two-step floating catchment area method and used the path planning model of Gaode Map to evaluate the accessibility of UGS under different transportation modes and different time thresholds while integrating mobile phone signaling data. Additionally, a fine-scale analysis of the actual supply and demand relationship of UGS was conducted by integrating the accessibility evaluation results with the recreational situation of UGS to analyze the deviation of supply and demand to further discuss the spatial distribution equilibrium of UGS. The main conclusions are as follows. (1) The spatial distribution of UGSs in the central urban area of Hefei is uneven. Different time thresholds and different transportation modes have a significant impact on the UGS accessibility evaluation results. (2) With the increase in the time threshold or travel distance, the number of grids above the moderate accessibility level generally increases. The spatial distribution of the grids with moderate, high and highest accessibility level present different patterns of contiguous, clusters, and spots distribution. (3) After combining these results with the actual recreational situation of UGS, we found that the overall demand in the central urban area exceeds the supply at the 15-min threshold, while the overall supply exceeds the demand at the 30-min threshold. The grids with balanced supply and demand or more supply than demand have comprehensive parks with a moderate population density and strong road connectivity in the neighborhood. This study strengthens the data granularity and improves the accuracy of accessibility evaluation by integrating mobile phone signaling data with the path planning model of Gaode Map. Also, we evaluate the accessibility with multi-transport modes and different time thresholds, which can bring more practical guidance for optimizing the distribution of UGS.
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An informatics-driven intelligent system to improve healthcare accessibility for vulnerable populations. J Biomed Inform 2022; 134:104196. [PMID: 36075484 DOI: 10.1016/j.jbi.2022.104196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022]
Abstract
Broad disparities persist in access to healthcare and health outcomes in the United States, especially among vulnerable populations. An important step towards improving their healthcare access is to ensure "having access", or "accessibility". Drawing together the Behavioral Model of Health Services Use, social determinants of health (SDOH), and spatial healthcare accessibility literature, the research attempts to create an integrative accessibility measure to support the improvement of "having access" for vulnerable populations. A Vulnerable Population Healthcare Accessibility Framework (VPHAF) is proposed to systematically integrate vulnerable population characteristics, health behavior, customer satisfaction, and other SDOH factors to measure healthcare accessibility using advanced analytics. The qualitative and quantitative evaluation of VPHAF demonstrates that it enhances the existing spatial accessibility methods. An intelligent spatial decision support system (SDSS) instantiates the framework to support the decision making in improving healthcare accessibility for vulnerable populations in a regional healthcare plan. The system was evaluated by decision makers from a real-world organization as a useful tool with high usability. The intelligent SDSS enables the collection of SDOH data from multiple sources and uses analytics to measure healthcare accessibility focusing on characteristics of vulnerable populations. Policymakers and health plan providers can use the system to increase awareness of social risks and advocate for better policy decisions in creating equitable healthcare access and reducing health disparity.
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Cuervo LG, Martinez-Herrera E, Osorio L, Hatcher-Roberts J, Cuervo D, Bula MO, Pinilla LF, Piquero F, Jaramillo C. Dynamic accessibility by car to tertiary care emergency services in Cali, Colombia, in 2020: cross-sectional equity analyses using travel time big data from a Google API. BMJ Open 2022; 12:e062178. [PMID: 36581989 PMCID: PMC9438204 DOI: 10.1136/bmjopen-2022-062178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To test a new approach to characterise accessibility to tertiary care emergency health services in urban Cali and assess the links between accessibility and sociodemographic factors relevant to health equity. DESIGN The impact of traffic congestion on accessibility to tertiary care emergency departments was studied with an equity perspective, using a web-based digital platform that integrated publicly available digital data, including sociodemographic characteristics of the population and places of residence with travel times. SETTING AND PARTICIPANTS Cali, Colombia (population 2.258 million in 2020) using geographic and sociodemographic data. The study used predicted travel times downloaded for a week in July 2020 and a week in November 2020. PRIMARY AND SECONDARY OUTCOMES The share of the population within a 15 min journey by car from the place of residence to the tertiary care emergency department with the shortest journey (ie, 15 min accessibility rate (15mAR)) at peak-traffic congestion hours. Sociodemographic characteristics were disaggregated for equity analyses. A time-series bivariate analysis explored accessibility rates versus housing stratification. RESULTS Traffic congestion sharply reduces accessibility to tertiary emergency care (eg, 15mAR was 36.8% during peak-traffic hours vs 84.4% during free-flow hours for the week of 6-12 July 2020). Traffic congestion sharply reduces accessibility to tertiary emergency care. The greatest impact fell on specific ethnic groups, people with less educational attainment and those living in low-income households or on the periphery of Cali (15mAR: 8.1% peak traffic vs 51% free-flow traffic). These populations face longer average travel times to health services than the average population. CONCLUSIONS These findings suggest that health services and land use planning should prioritise travel times over travel distance and integrate them into urban planning. Existing technology and data can reveal inequities by integrating sociodemographic data with accurate travel times to health services estimates, providing the basis for valuable indicators.
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Affiliation(s)
- Luis Gabriel Cuervo
- Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universitat Autònoma de Barcelona, Washington, Cataluña, Spain
| | - Eliana Martinez-Herrera
- Epidemiology Research Group, National School of Public Health, Universidad de Antioquia, Medellín, Colombia
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain
| | - Lyda Osorio
- Escuela de Salud Pública, Facultad de Salud, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Janet Hatcher-Roberts
- WHO Collaborating Centre for Knowledge Translation, Technology Assessment for Health Equity, Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada
- School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | | | - Ciro Jaramillo
- School of Civil and Geomatic Engineering, Universidad del Valle, Cali, Valle del Cauca, Colombia
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Chen Y, Wu J. The Effect of the Referral System on the Accessibility of Healthcare Services: A Case Study of the Wuhan Metropolitan Development Zone. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10441. [PMID: 36012076 PMCID: PMC9408004 DOI: 10.3390/ijerph191610441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
The geographical accessibility of public healthcare institutions is the key factor affecting the equity of healthcare services. Based on the hierarchical medical system and referral system in China, we analyzed the referral accessibility of hospitals in the Wuhan Metropolitan Development Zone. Before the implementation of the referral system, only 7.91% of the total communities met the accessibility standard for secondary and tertiary hospitals, which meant that there was significant inequality in high-level healthcare. Moreover, 5.4% of the total communities did not meet the accessibility standard for primary hospitals, which meant that there were insufficient primary hospitals. After the implementation of the referral system, the proportions of communities meeting the accessibility standards for the first-stage referral, second-stage referral and cross-level referral were 92.6%, 99.9% and 98.3%, respectively. The results show that the referral system has improved the accessibility of healthcare, but it has not completely solved healthcare inequality. The first-stage referral accessibility of healthcare services in the northern, western and eastern groups does not meet the accessibility standard, which is due to the inefficient layout of secondary hospitals. The Wuhan government should construct secondary hospitals in these groups and primary hospitals in the central urban area and the southeastern, southern, western and eastern groups.
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Hong I, Wilson B, Gross T, Conley J, Powers T. Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia. APPLIED SPATIAL ANALYSIS AND POLICY 2022; 16:141-161. [PMID: 35967757 PMCID: PMC9363866 DOI: 10.1007/s12061-022-09472-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Existing measures of health care access were inadequate for guiding policy decisions in West Virginia, as they identified the entire state as having limited access. To address this, we compiled a comprehensive database of primary health care providers and facilities in the state, developed a modified E2SFCA tool to measure spatial access in the context of West Virginia's rural and mountainous nature, and integrated this with an index of socio-economic barriers to access. The integrated index revealed that the rural areas, especially in the southern part of the state, have especially limited access to primary health care. 1. Introduction. An emerging public health issue which has been exacerbated by the COVID-19 pandemic, is that of healthcare deserts, which are places where basic affordable health care is not accessible for residents. This problem has become worse in rural areas as rural hospitals close. In these areas, including West Virginia, scattered populations suffer from limited access to primary healthcare services. Uneven geographic and socio-economic barriers to accessing primary health care are major contributing factors to these health disparities. West Virginia's unique rural and mountainous settlement patterns, aging population, and economic crisis over the past two decades have resulted in unequal access to the primary healthcare services for its residents. The rural nature of the state makes it difficult to maintain medical facilities accessible to much of the population, especially as rural hospitals have been closing, such as the one in Williamson, WV (Jarvie, 2020). The mountainous terrain slows down travel across winding roads, lengthening travel times to the nearest hospital, while an aging population has increased health care needs. Lastly, an economic crisis and higher poverty rate makes West Virginians less able to pay for health care. As a result, West Virginians are confronting a health crisis. According to a recent report by the West Virginia Health Statistics Center (2019), West Virginians rank first in the country for heart attacks, have the second-highest obesity rate and prevalence of mental health problems in the country, along with the fourth-highest rate of diabetes and fifth-highest rate of cancer. An issue faced by West Virginia's policymakers is the limitations of tools for identifying and assessing healthcare deserts, as they are poorly suited for the unique challenges in West Virginia. Academic research has not analyzed comprehensive primary healthcare accessibility in WV, although previous studies have focused on Appalachia (e.g., Behringer & Friedell 2006; Smith & Holloman, 2011; Elnicki et al., 1995; Donohoe et al., 2015, 2016a, 2016b), and others focus on access to more specialized services (Valvi et al., 2019; Donohoe, 2016a). Existing approaches to identify the healthcare deprived areas, such as Health Professional Shortage Areas (HPSA), are not suitable for guiding West Virginia policies, because every one of the 55 counties within the state has several HPSAs, which makes prioritizing resources difficult. The lack of easily accessible, comprehensive, and up-to-date physician and healthcare facility database creates additional difficulties. Physician license datasets were found to often include inconsistent, misleading, and out-of-date information. The last limitation of the HPSA designation is that it is based on zip code areas and census tracts, which are not ideal as zip code areas lack spatial context and much covariate data, while rural census tracts are too large to capture spatial variation of access. In this context, the WV HealthLink project was begun with joint effort with WV Rural Health Initiative (RHI) to fill gaps in research and support decision making for primary healthcare access in West Virginia. The goals of the projects are: (1) to help West Virginia's three medical schools provide specialized professional training in rural healthcare; (2) to address health disparities by investing in clinical projects in underserved areas; and (3) to retain health professionals in WV. In 2018, to support these goals, HealthLink was invited by the RHI's leadership to analyze disparities in primary health care access in West Virginia and develop tools for rural healthcare decision-making. These goals also create a comprehensive and up-to-date physician and facility database, new analysis tools, and new visualization tools for decision support. The goals of this paper are to assess the spatial and social accessibility of primary health care in West Virginia, and to understand spatial and social determinants that shape this access. To achieve these goals, this paper completes the following objectives: (1) define primary healthcare and access; (2) build an extensive and up-to-date primary healthcare database; (3) develop an assessment framework for WV; and (4) visualize the results for policy makers and practitioners. The structure of this paper is as follows. First, we describe three methodological problems encountered as we define primary health care access. Second, we present the methods used to resolve these problems, and conclude by presenting our modified enhanced two-step floating catchment area (E2FCA hereafter) approach and its results for WV. Our foci in this modification were improving the accuracy of the analysis regarding measuring distance, considering distance decay effect, and more precisely representing the location of supply and demand.
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Affiliation(s)
| | - Bradley Wilson
- Department of Geology and Geography, West Virginia University, 98 Beechurst Ave Morgantown, 26505 WV Morgantown, USA
| | - Thomson Gross
- Center for Resilient Communities, West Virginia University, West Virginia Morgantown, USA
| | - Jamison Conley
- Department of Geology and Geography, West Virginia University, 98 Beechurst Ave Morgantown, 26505 WV Morgantown, USA
| | - Theodore Powers
- Department of Anthropology, University of Iowa, Iowa Iowa City, USA
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Cromley G, Lin J. Examining the impact of COVID-19 vaccination rates on differential access to critical care. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2022; 145:102751. [PMID: 35757493 PMCID: PMC9212364 DOI: 10.1016/j.apgeog.2022.102751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/20/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
The measurement of potential access to health care has focused primarily on what might be called "place-based" access or the differential access among geographic locations rather than between different populations. The vaccination program to inoculate the population against the effects of the COVID-19 virus has created two different at-risk populations. This research examines the impact of COVID-19 vaccination rates on access to critical care for persons fully-vaccinated versus those not fully-vaccinated. In this situation, additional tools are necessary to understand: 1) if there is a significant difference in accessibility between different populations, 2) the magnitude of this difference and how it is distributed across accessibility levels, and 3) how the differences between groups are distributed across the state. A study of access to intensive care unit (ICU) beds by these two populations for the state of Illinois found that although there was a statistically significant difference in access, the magnitude of differences was small. A more important difference was being located in the Chicago Area of the state. The not-fully vaccinated in the Chicago Area had higher than expected spatial access due to the lower need for ICU beds by a higher percentage of fully vaccinated people.
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Affiliation(s)
- Gordon Cromley
- Spatial Literacy Center, Dickinson College, Carlisle, PA, USA
| | - Jie Lin
- School of Earth Sciences, Zhejiang University, Hangzhou, Zhejiang, China
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Improving the Spatial Accessibility of Community-Level Healthcare Service toward the ‘15-Minute City’ Goal in China. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2022. [DOI: 10.3390/ijgi11080436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The recent global COVID-19 pandemic serves as another reminder that people in different urban neighborhoods need equal access to basic medical services. This study aims to improve the spatial accessibility of healthcare services toward the ‘15-minute city’ goal. Methods: We chose Zhengzhou, China, as a case study. To improve spatial accessibility, two optimization models of optimal supply-demand allocation (OSD) and the capacitated p-medina problem (CPMP) were used. Spatial accessibility in this study is defined as the walking time from the communities to healthcare centers. Results: For the current status of healthcare services at the community level, the mean travel time is 18.3 min, and 39.6% of residents can access healthcare services within a 15-minute travel time. Population coverage within a 15-minute walking time is significantly lower than the national target of 80%. After redefining the service areas through OSD allocation, the mean travel time was reduced to 16.5 min, and 45.1% of the population could reach services. Furthermore, the 60 newly proposed healthcare centers selected by the CPMP model could potentially increase by 35.0% additional population coverage. The average travel time was reduced to 10 min. Conclusions: Both the redefinition of the service areas and the opening of new service centers are effective ways to improve the spatial accessibility of healthcare services. Two methods of this study have implications for urban planning practices towards the 15-minute city.
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Spatial evaluation of animal health care accessibility and veterinary shortage in France. Sci Rep 2022; 12:13022. [PMID: 35906375 PMCID: PMC9338267 DOI: 10.1038/s41598-022-15600-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
The decrease in the supply of veterinary healthcare in France adversely affects health of food-producing animals. In a One Health perspective, the health of people, animals and their shared environment are interconnected, and adequate supply of veterinary healthcare is required to ensure public health. Prevention of outbreaks and zoonotic diseases that may impact public health mobilizes a set of public policies, including strengthening veterinary workforce. These policies should be informed by quantification of animal health care accessibility, yet this has not been well characterized. The objective was to quantify the accessibility to veterinary healthcare for cattle, swine, and poultry sectors in France. A Two-Step Floating Catchment Area (2SFCA) approach was used to measure the level of accessibility to veterinary clinics. In the cattle sector, the 2SFCA score indicated relatively high accessibility in the north and south of France, but insufficient accessibility elsewhere. In the swine sector, there was high accessibility in the north east and in north of France, medium accessibility in the south west, and insufficient accessibility elsewhere. Finally, in the poultry sector, all regions had insufficient accessibility. Sensitivity analysis examining the effects of a change in spatial accessibility according to various travel time showed that the optimal threshold to compute 2SFCA score in cattle, swine and poultry sectors were respectively, 45, 60 and 60 min. According to a definition of “underserved area” derived from an official decree and the optimal thresholds to compute 2SFCA, the cattle, swine and poultry sector have on average 75.3, 89.9 and 98.3% underserved area, respectively. We provided evidence that the supply of animal health care was not sufficient and we proposed recommendations on how to assess animal health care accessibility, enabling modelling and visualization of the effects of potential public policies aimed at reducing veterinary shortages.
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An Assessment of the Accessibility of Multiple Public Service Facilities and Its Correlation with Housing Prices Using an Improved 2SFCA Method—A Case Study of Jinan City, China. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2022. [DOI: 10.3390/ijgi11070414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The spatial distribution and accessibility of urban public service facilities affect socioeconomic factors in the lives of residents, especially housing prices. Given that most previous studies focus on the accessibility of a certain, single type of facility and its impact on housing prices, this research uses improved two-step floating catchment area (2SFCA) methods by considering the differences in the service capacity of different types of public service facilities in real life to evaluate their accessibility to residential communities in Jinan city based on 3117 facilities covering 11 different kinds of facilitates. Then, we assess the spatial distribution of the impact of the accessibility of different public service facilities on housing prices in Jinan city through a local indicator of a spatial association (LISA) cluster diagram generated based on the bivariate local Moran’s index. Our objectives are to assess the accessibility of multiple public service facilities using an improved 2SFCA method and to explore the spatial correlations between the accessibility of public service facilities and housing prices. The results show that the housing prices in Jinan are clustered and that the areas with high housing prices are mainly concentrated in the Lixia District and the center of the downtown area. The accessibility of medical, shopping, educational and bus stop facilities in the Lixia District is better than that in other districts. The accessibility of shopping, medical and tourist attraction facilities has the most significant impact on housing prices, and the number of communities in which the accessibility of these public service facilities and housing prices form a positive correlation cluster accounts for 50.5%, 47.9% and 45.8% of all communities, respectively. On the other hand, educational accessibility and bus stop accessibility have nothing to do with housing prices, and the number of communities in which the accessibility of these public service facilities forms a not-significant cluster with housing prices accounting for 51.1% and 56.5% of the total, respectively. In this study, the combined 2SFCA method is used to improve the method for evaluating the accessibility of a variety of public service facilities, and its applicability is verified by practical application. By analyzing the spatial correlation between accessibility and housing prices, we expand our understanding of accessibility and show that it plays a central role in housing prices, which will help to improve the spatial pattern of urban public places in the future, provide support for decision makers and provide a reference for the government and real estate developers.
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Park J, Goldberg DW. An Examination of the Stochastic Distribution of Spatial Accessibility to Intensive Care Unit Beds during the COVID-19 Pandemic: A Case Study of the Greater Houston Area of Texas. GEOGRAPHICAL ANALYSIS 2022; 55:GEAN12340. [PMID: 35941845 PMCID: PMC9350384 DOI: 10.1111/gean.12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 05/10/2023]
Abstract
Sufficient and reliable health care access is necessary for people to be able to maintain good health. Hence, investigating the uncertainty embedded in the temporal changes of inputs would be beneficial for understanding their impact on spatial accessibility. However, previous studies are limited to implementing only the uncertainty of mobility, while health care resource availability is a significant concern during the coronavirus disease (COVID-19) pandemic. Our study examined the stochastic distribution of spatial accessibility under the uncertainties underlying the availability of intensive care unit (ICU) beds and ease of mobility in the Greater Houston area of Texas. Based on the randomized supply and mobility from their historical changes, we employed Monte Carlo simulation to measure ICU bed accessibility with an enhanced two-step floating catchment area (E2SFCA) method. We then conducted hierarchical clustering to classify regions of adequate (sufficient and reliable) accessibility and inadequate (insufficient and unreliable) accessibility. Lastly, we investigated the relationship between the accessibility measures and the case fatality ratio of COVID-19. As result, locations of sufficient access also had reliable accessibility; downtown and outer counties, respectively, had adequate and inadequate accessibility. We also raised the possibility that inadequate health care accessibility may cause higher COVID-19 fatality ratios.
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Affiliation(s)
- Jinwoo Park
- Department of GeographyTexas A&M UniversityCollege StationTexasUSA
| | - Daniel W. Goldberg
- Department of GeographyTexas A&M UniversityCollege StationTexasUSA
- Department of Computer Science & EngineeringTexas A&M UniversityCollege StationTexasUSA
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Tao Z, Wang Q. Facility or Transport Inequality? Decomposing Healthcare Accessibility Inequality in Shenzhen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116897. [PMID: 35682478 PMCID: PMC9180880 DOI: 10.3390/ijerph19116897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 01/25/2023]
Abstract
Accessibility to healthcare services is crucial for residents’ wellbeing. Numerous studies have revealed significant spatial inequality in healthcare accessibility across various contexts. However, it still remains unclear whether the inequality is caused by the unbalanced spatial distribution of healthcare facilities or by unequal transport access to them. This study decomposes inequality in healthcare accessibility into facility- and transport-driven inequality by comparing scenarios of healthcare accessibility, which consider various combinations of multidimensional components of accessibility using different distance measures. Using a case study in Shenzhen, this study reveals that both facility distribution and transport access substantially contribute to spatial inequality in healthcare accessibility. Facility distribution accounts for 61.3% and 50.8% of the overall accessibility inequality for driving and transit modes, respectively. The remaining inequality is induced by imbalanced mobility provided by transport networks. Furthermore, the impact of transport component on healthcare accessibility is unevenly distributed. This study highlights that both facility- and transport-related countermeasures should be considered to improve the accessibility and equality of healthcare services. It provides transferable methods for quantitatively decomposing facility- and transport-driven inequality in accessibility to healthcare or other facilities.
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Affiliation(s)
- Zhuolin Tao
- Faculty of Geographical Science, Beijing Normal University, No. 19, Xinjiekouwai Ave., Haidian, Beijing 100875, China;
| | - Qi Wang
- Proficiency Skill Appraisal and Guidance Center of Natural Resources Ministry, Beijing 100830, China
- Correspondence:
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