Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements

Patterns and determinants of health care utilization among people with Parkinson's disease: A population-based analysis in Ontario, Canada

In Ontario, despite the increasing prevalence of Parkinson's disease (PD), barriers to access-to-care for people with Parkinson's disease (PwP) and their caregivers are not well understood. The objective of this study is to examine spatial patterns of health care utilization among PwP and identify factors associated with PD-related health care utilization of individuals in Ontario. We employed a retrospective, population-based study design involving administrative health data to identify PwP as of March 31, 2018 (N = 35,482) using a previously validated case definition. An enhanced 2-step floating catchment area method was used to measure spatial accessibility to PD care and a descriptive spatial analysis was conducted to describe health service utilization by geographic area and specialty type. Negative binomial regression models were then conducted to identify associated geographic, socioeconomic, comorbidity and demographic factors. There was marked spatial variability in PD-related service utilization, with neurology and all provider visits being significantly higher in urban areas (CMF>1.20; p<0.05) and family physician visits being significantly higher (CMF >1.20; p<0.05) in more rural areas and remote areas. More frequent visits to family physicians were associated with living in rural areas, while less frequent visitation was associated with living in areas of low spatial accessibility with high ethnic concentration. Visits to neurologists were positively associated with living in areas of high spatial accessibility and with high ethnic concentration. Visits to all providers were also positively associated with areas of high spatial accessibility. For all outcomes, less frequent visits were found in women, older people, and those living in more deprived areas as years living with PD increased. This study demonstrates the importance of geographic, socioeconomic and individual factors in determining PwP's likelihood of accessing care and type of care provided. Our results can be expected to inform the development of policies and patient care models aimed at improving accessibility among diverse populations of PwP.

Future Possible Changes in Medically Underserved Areas in Japan: A Geographic Information System-Based Simulation Study

BACKGROUND

A decrease in populations could affect healthcare access and systems, particularly in medically underserved areas (MUAs) where depopulation is becoming more prevalent. This study aimed to simulate the future population and land areas of MUAs in Japan.

METHODS

This study covered 380,948 1 km meshes, 87,942 clinics, and 8354 hospitals throughout Japan as of 2020. The areas outside a 4 km radius of medical institutions were considered as MUAs, based on the measure of areas in the current Japanese Medical Care Act. Based on the population estimate for a 1 km mesh, the population of mesh numbers of MUAs was predicted for every 10 years from 2020 to 2050 using geographic information system analysis. If the population within a 4 km radius from a medical institution fell below 1000, the institution was operationally assumed to be closed.

RESULTS

The number of MUAs was predicted to decrease from 964,310 (0.77% of the total Japanese population) in 2020 to 763,410 (0.75%) by 2050. By 2050, 48,105 meshes (13% of the total meshes in Japan) were predicted to be new MUAs, indicating a 31% increase in MUAs from 2020 to 2050. By 2050, 1601 medical institutions were tentatively estimated to be in close proximity.

CONCLUSIONS

In Japan, the population of MUAs will decrease, while the land area of MUAs will increase. Such changes may reform rural healthcare policy and systems.

Enhancing Health Care Accessibility and Equity Through a Geoprocessing Toolbox for Spatial Accessibility Analysis: Development and Case Study

BACKGROUND

Access to health care services is a critical determinant of population health and well-being. Measuring spatial accessibility to health services is essential for understanding health care distribution and addressing potential inequities.

OBJECTIVE

In this study, we developed a geoprocessing toolbox including Python script tools for the ArcGIS Pro environment to measure the spatial accessibility of health services using both classic and enhanced versions of the 2-step floating catchment area method.

METHODS

Each of our tools incorporated both distance buffers and travel time catchments to calculate accessibility scores based on users' choices. Additionally, we developed a separate tool to create travel time catchments that is compatible with both locally available network data sets and ArcGIS Online data sources. We conducted a case study focusing on the accessibility of hemodialysis services in the state of Tennessee using the 4 versions of the accessibility tools. Notably, the calculation of the target population considered age as a significant nonspatial factor influencing hemodialysis service accessibility. Weighted populations were calculated using end-stage renal disease incidence rates in different age groups.

RESULTS

The implemented tools are made accessible through ArcGIS Online for free use by the research community. The case study revealed disparities in the accessibility of hemodialysis services, with urban areas demonstrating higher scores compared to rural and suburban regions.

CONCLUSIONS

These geoprocessing tools can serve as valuable decision-support resources for health care providers, organizations, and policy makers to improve equitable access to health care services. This comprehensive approach to measuring spatial accessibility can empower health care stakeholders to address health care distribution challenges effectively.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A catchment and location-allocation analysis of mammography access in Delaware, US: implications for disparities in geographic access to breast cancer screening

BACKGROUND

Despite a 40% reduction in breast cancer mortality over the last 30 years, not all groups have benefited equally from these gains. A consistent link between later stage of diagnosis and disparities in breast cancer mortality has been observed by race, socioeconomic status, and rurality. Therefore, ensuring equitable geographic access to screening mammography represents an important priority for reducing breast cancer disparities. Access to breast cancer screening was evaluated in Delaware, a state that experiences an elevated burden from breast cancer but is otherwise representative of the US in terms of race and urban-rural characteristics. We first conducted a catchment analysis of mammography facilities. Finding evidence of disparities by race and rurality, we next conducted a location-allocation analysis to identify candidate locations for the establishment of new mammography facilities to optimize equitable access.

METHODS

A catchment analysis using the ArcGIS Pro Service Area analytic tool characterized the geographic distribution of mammography sites and Breast Imaging Centers of Excellence (BICOEs). Poisson regression analyses identified census tract-level correlates of access. Next, the ArcGIS Pro Location-Allocation analytic tool identified candidate locations for the placement of additional mammography sites in Delaware according to several sets of breast cancer screening guidelines.

RESULTS

The catchment analysis showed that for each standard deviation increase in the number of Black women in a census tract, there were 68% (95% CI 38-85%) fewer mammography units and 89% (95% CI 60-98%) fewer BICOEs. The more rural counties in the state accounted for 41% of the population but only 22% of the BICOEs. The results of the location-allocation analysis depended on which set of screening guidelines were adopted, which included increasing mammography sites in communities with a greater proportion of younger Black women and in rural areas.

CONCLUSIONS

The results of this study illustrate how catchment and location-allocation analytic tools can be leveraged to guide the equitable selection of new mammography facility locations as part of a larger strategy to close breast cancer disparities.

Hide Your Distance: Privacy Risks and Protection in Spatial Accessibility Analysis

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.

An assessment of the spatial distribution of bulk billing-only GP services in Australia in relation to area-based socio-economic status

BACKGROUND

The accessibility to affordable primary healthcare services contributes to population health and health equity. A key aspect to accessibility is the geographical distribution of primary healthcare services. Limited studies have assessed the nationwide spatial distribution of bulk billing-only medical practices or 'no-fee' services. The aim of this study was to provide a nationwide approximation of bulk billing-only services and evaluate the socio-demographic status and population characteristics in relation to the distribution of bulk billing-only GP services.

METHODS

The methodology in this study used Geographic Information System (GIS) technology to map the locations of all bulk bulking-only medical practices collected in mid-2020 and linked this with population data. The population data and practice locations were analysed at the level of Statistical Areas Level 2 (SA2) regions and used the most recent Census data.

RESULTS

The study sample included (n =2095) bulk billing-only medical practice locations. The nationwide average Population-to-Practice (PtP) ratio was 1 practice to 8529 people for regions with access to bulk billing-only practice, and 57.4% of the Australian population lives within an SA2 that has access to at least one bulk billing-only medical practices. No significant associations were identified between practice distribution and area socio-economic status.

CONCLUSION

The study identified areas with low access to affordable GP services, with many SA2 regions having no access to bulk billing-only practices. Findings also indicate that there was no association between area socio-economic status and the distribution of bulk billing-only services.

Correlating Access to Primary Medical Care and Veterinary Care Providers: A Novel Application of Spatial Gravity Modelling

Increasingly, health professionals are recognizing the need for a more holistic, or One Health, approach to wellness. Companion animals share the lives and homes of many Americans, and yet little research exists on the intersection of disparities of access to veterinary care and access to human health care. This research aims to fill that gap by exploring the use of a spatial model that identifies the relationship of supply and demand while also considering reductions as a function of travel time to a care facility. Four counties in Alabama were analyzed at the census tract level to determine the supply of primary care physicians and veterinary care providers. This research provides a unique application of the Enhanced Two-Step Floating Catchment Area model by independently examining access to each type of care and then comparing both access supply values at the census level. Results indicated a statistically significant positive relationship between access to both types of care, implying areas with lower access to primary care have concomitantly low access to veterinary care. Implications for practice include the introduction of this methodological approach, identification of future parameter specification research to improve the approach, and identification of an area of significant concern in the One Health framework. Further, the results can inform solution strategies such as offering integrated care interventions for both humans and their companion animal household members with direct use for policymakers aimed at increasing equitable access to health care across the One Health spectrum.

A comparative study for accessing primary healthcare between planning assessment and actual utilization for older adults: a case from Dalian City, China

Introduction

As China has rapidly evolved into an aging society, the Chinese government has developed a community-oriented primary healthcare system to vigorously expedite the transfer of primary health care (PHC) from higher-level hospitals to community health centers (CHCs). However, current planning standards for CHCs have not considered the heterogeneity of older adults in supply-demand services, such that the areas with severe aging may comprise of underestimated levels of accessibility.

Methods

This study focuses on the gap in PHC access between planning assessment and actual utilization for older adults. We conducted an empirical study in the city area of Dalian based on the check-in and survey data from CHCs during the COVID-19 pandemic. A comparison model was built to calculate matching probability using a modified Gaussian Two-Step Floating Catchment Area (G2SFCA) method.

Results

As indicated by the results, the communities in the primary healthcare shortage area (PHCSA) increased 6.8% by considering the heterogeneity of older adults; these communities with underserved PHC were ignored by the current planning assessment. Based on the comparison of actual and theoretical accessibility for older adults, we found that the average matching probability was about 76.6%, which means approximately a quarter of older adults have been misestimated the accessibility of PHC.

Discussion

Further analysis for the older adults with mismatched accessibility showed two causes of the gap, one is the lack of connection between the spatial distribution of facilities and the allocation of service supply, and the other is the subjective cross-catchment visit to CHCs for older adults.

Study protocol for a multi-level cross-sectional study on the equitable reach and implementation of coordinated specialty care for early psychosis

BACKGROUND

Approximately 115,000 young adults will experience their first episode of psychosis (FEP) each year in the USA. Coordinated specialty care (CSC) for early psychosis is an evidence-based early intervention model that has demonstrated effectiveness by improving quality of life and reducing psychiatric symptoms for many individuals. Over the last decade, there has significant increase in the implementation of CSC programs throughout the USA. However, prior research has revealed difficulties among individuals and their family members accessing CSC. Research has also shown that CSC programs often report the limited reach of their program to underserved populations and communities (e.g., ethnoracial minorities, rural and low socioeconomic neighborhoods). Dissemination and implementation research focused on the equitable reach and implementation of CSC is needed to address disparities at the individual level.

METHODS

The proposed study will create a novel integrative multi-level geospatial database of CSC programs implemented throughout the USA that will include program-level data (e.g., geocoded location, capacity, setting, role availability), provider-level data (race, ethnicity, professional credentials), and neighborhood-level census data (e.g., residential segregation, ethnic density, area deprivation, rural-urban continua, public transit time). This database will be used to characterize variations in CSC programs by geographical location and examine the overall reach CSC programs to specific communities. The quantitative data will be combined with qualitative data from state administrators, providers, and service users that will inform the development of dissemination tools, such as an interactive dashboard, that can aid decision making.

DISCUSSION

Findings from this study will highlight the impact of outer contextual determinants on implementation and reach of mental health services, and will serve to inform the future implementation of CSC programs with a primary focus on equity.

Evaluation of accessibility and equity to hospitals by public transport: evidence from six largest cities of Ohio

INTRODUCTION

In the United States, health care has long been viewed as a 'right,' and residents of the state of Ohio are no exception. The Ohio Department of Health ensures that this right exists for all residents of Ohio. Socio-spatial characteristics, however, can have an impact on access to health care, particularly among vulnerable groups. This article seeks to measure the spatial accessibility to healthcare services by public transport in the six largest cities of Ohio based on population and to compare the accessibility of healthcare to vulnerable demographic groups. To the authors' knowledge, this is the first study to analyze the accessibility and equity of hospitals by public transit across different cities in Ohio, allowing the identification of common patterns, difficulties, and knowledge gaps.

METHODOLOGY

Using a two-step floating catchment area technique, the spatial accessibility to general medical and surgical hospitals through public transportation was estimated, considering both service-to-population ratios and travel time to these health services. The average accessibility of all census tracts and the average accessibility of the 20% of most susceptible census tracts were determined for each city. Using Spearman's rank correlation coefficient between accessibility and vulnerability, an indicator was then devised to evaluate vertical equity.

FINDINGS

Within cities (except Cleveland), people of vulnerable census tracts have less access to hospitals via public transportation. These cities (Columbus, Cincinnati, Toledo, Akron, and Dayton) fail in terms of vertical equity and average accessibility. According to this, vulnerable census tracts in these cities have the lowest accessibility levels.

CONCLUSION

This study emphasizes the issues connected with the suburbanization of poverty in Ohio's large cities and the need to provide adequate public transportation to reach hospitals on the periphery. In addition, this study shed light on the need for additional empirical research to inform the implementation of guidelines for healthcare accessibility in Ohio. Researchers, planners, and policymakers who want to make healthcare more accessible for everyone should take note of the findings in this study.

Measuring Geographic Access to Transgender Hormone Therapy in Texas: A Three-step Floating Catchment Area Analysis

While the extant literature has established that transgender people face significant barriers to accessing healthcare, no studies to date have offered an explicitly spatial analysis of their access to trans-specific care. This study aims to fill that gap by providing a spatial analysis of access to gender-affirming hormone therapy (GAHT) using Texas as a case study. We used the three-step floating catchment area method, which relies on census tract-level population data and location data for healthcare facilities to quantify spatial access to healthcare within a specific drive-time window, in our case 120 min. For our tract-level population estimates we adapt estimates of the rates of transgender identification from a recent data source, the Household Pulse Survey, and use these in tandem with a spatial database of GAHT providers of the lead author's creation. We then compare results of the 3SFCA with data on urbanicity and rurality, as well as which areas are deemed medically underserved. Finally, we conduct a hot-spot analysis that identifies specific areas where health services could be planned in ways that could improve both access to GAHT for trans people and access to primary care for the general population. Ultimately, we conclude that our results illustrate that patterns of access to trans-specific medical care, like GAHT, do not neatly follow patterns of access to primary care for the general population and that therefore trans communities' access to healthcare warrants specific, further investigation.

Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis

BACKGROUND

Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil.

METHODS

We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96.

RESULTS

We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas.

CONCLUSION

Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.

Geographic proximity to immunization providers and vaccine series completion among children ages 0-24 months

OBJECTIVES

In the U.S., vaccination coverage is lower in rural versus urban areas. Spatial accessibility to immunization services has been a suspected risk factor for undervaccination in rural children. Our objective was to identify whether geographic factors, including driving distance to immunization providers, were associated with completion of recommended childhood vaccinations.

METHODS

We analyzed records from Montana's immunization information system for children born 2015-2017. Using geolocated address data, we calculated distance in road miles from children's residences to the nearest immunization provider. A multivariable log-linked binomial mixed model was used to identify factors associated with completion of the combined 7-vaccine series by age 24 months.

RESULTS

Among 26,085 children, 16,503 (63.3%) completed the combined 7-vaccine series by age 24 months. Distance to the nearest immunization provider ranged from 0 to 81.0 miles (median = 1.7; IQR = 3.2), with the majority (92.1%) of children living within 10 miles of a provider. Long distances (>10 miles) to providers had modest associations with not completing the combined 7-vaccine series (adjusted prevalence ratio [aPR]: 0.97, 95% confidence interval [CI]: 0.96-0.99). After adjustment for other factors, children living in rural areas (measured by rural-urban commuting area) were significantly less likely to have completed the combined 7-vaccine series than children in metropolitan areas (aPR: 0.88, 95% CI: 0.85-0.92).

CONCLUSIONS

Long travel distances do not appear to be a major barrier to childhood vaccination in Montana. Other challenges, including limited resources for clinic-based strategies to promote timely vaccination and parental vaccine hesitancy, may have greater influence on rural childhood vaccination.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Quantitative Evaluation of Spatial Accessibility of Various Urban Medical Services Based on Big Data of Outpatient Appointments

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.

Spatial Accessibility of Primary Care in the Dual Public-Private Health System in Rural Areas, Malaysia

Disparities in access to health services in rural areas represent a global health issue. Various external factors contribute to these disparities and each root requires specific remedial action to alleviate the issue. This study elucidates an approach to assessing the spatial accessibility of primary care, considering Malaysia's dual public-private system specifically in rural areas, and identifies its associated ecological factors. Spatial accessibility was calculated using the Enhance 2-Step Floating Catchment Area (E2SFCA) method, modified as per local context. Data were secondary sourced from Population and Housing Census data and administrative datasets pertaining to health facilities and road network. The spatial pattern of the E2SFCA scores were depicted using Hot spot Analysis. Hierarchical multiple linear regression and geographical weight regression were performed to identify factors that affect E2SFCA scores. Hot spot areas revolved near the urban agglomeration, largely contributed by the private sector. Distance to urban areas, road density, population density dependency ratios and ethnic composition were among the associated factors. Accurate conceptualization and comprehensive assessment of accessibility are crucial for evidence-based decision making by the policymakers and health authorities in identifying areas that need attention for a more specific and localized planning and development.

Greater spatial access to care is associated with lower mortality for emergency general surgery

BACKGROUND

Emergency general surgery (EGS) diseases are time-sensitive conditions that require urgent surgical evaluation, yet the effect of geographic access to care on outcomes remains unclear. We examined the association of spatial access with outcomes for common EGS conditions.

METHODS

A retrospective analysis of twelve 2014 State Inpatient Databases, identifying adults admitted with eight EGS conditions, was performed. We assessed spatial access using the spatial access ratio (SPAR)-an advanced spatial model that accounts for travel distance, hospital capacity, and population demand, normalized against the national mean. Multivariable regression models adjusting for patient and hospital factors were used to evaluate the association between SPAR with (a) in-hospital mortality and (b) major morbidity.

RESULTS

A total of 877,928 admissions, of which 104,332 (2.4%) were in the lowest-access category (SPAR, 0) and 578,947 (66%) were in the high-access category (SPAR, ≥1), were analyzed. Low-access patients were more likely to be White, male, and treated in nonteaching hospitals. Low-access patients also had higher incidence of complex EGS disease (low access, 31% vs. high access, 12%; p < 0.001) and in-hospital mortality (4.4% vs. 2.5%, p < 0.05). When adjusted for confounding factors, including presence of advanced hospital resources, increasing spatial access was protective against in-hospital mortality (adjusted odds ratio, 0.95; 95% confidence interval, 0.94-0.97; p < 0.001). Spatial access was not significantly associated with major morbidity.

CONCLUSION

This is the first study to demonstrate that geospatial access to surgical care is associated with incidence of complex EGS disease and that increasing spatial access to care is independently associated with lower in-hospital mortality. These results support the consideration of spatial access in the development of regional health systems for EGS care.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level III.

The Contributions of Population Distribution, Healthcare Resourcing, and Transportation Infrastructure to Spatial Accessibility of Health Care

Population demand, healthcare resourcing, and transportation linkage are considered as major determinants of spatial access to health care. Temporal changes of the 3 determinants would result in gain or loss of spatial access to health care. As a remarkable milestone achieved by Targeted Poverty Reduction Project launched in China, the significant improvements in spatial access to health care served as an ideal context for investigating the relative contributions of these 3 determinants to the changes in spatial access to health care in a rural county. A national level poverty-stricken county, Chishui county from Guizhou province, China, was chosen as our study area. The enhanced two-step floating catchment area model and the chain substitution method were employed for analysis. The relative contributions of the 3 determinants demonstrated variations with villages. The relative contributions of healthcare resourcing were positive in all villages as indicated by sharp increases in healthcare resources. Population changes and transportation infrastructure expansion had both negative and positive effects on spatial access to health care for different villages. Decisionmakers should take into account the duration of travel time spent between where people live, where transport hubs are located, and where healthcare services are delivered in the process of formulating policies toward rural healthcare planning. For villages with poorly-established infrastructure, the optimization of population distribution and healthcare resourcing should be considered as the priority. A stronger marginal effect would be induced by transportation infrastructure expansion with increased spatial accessibility. This study provides empirical evidences to inform healthcare planning in low- and middle-income countries.

Assessing Spatial Accessibility of Community Hospitals for the Elderly in Beijing, China

Accessibility of health services signifies the quality and equitability of universal health provision. The hierarchical medical system recently implemented in China offers the policy instruments to improve medical services to the elderly in an aging society. As the critical primary care gateway, accessibility to community hospitals has significant impacts on people's health. However, current research has paid little attention to spatial accessibility within walking distance of community hospitals, especially for the elderly. This study selected four districts with different urbanization levels in the rapidly developing Beijing metropolis. The spatial interaction model was applied to measure the accessibility of community hospitals for the elderly at the community level. An attractiveness index was computed based on key hospital traits. The results showed that: (1) community hospitals could cover 82.66% of elderly residents, and 77.63% of the communities were within walking distance. The served elderly proportion was relatively high in central urban areas and low in the suburbs. (2) The attractiveness indices of hospitals varied notably between districts, with higher values in more urbanized areas. (3) The spatial accessibility for the elderly of hospitals differed significantly between the four districts, with a descending gradient from central to suburban and rural areas, as indicated by the Gini coefficients and Lorenz curves. (4) The accessibility index was strongly related to the served elderly population and the hospital-residence distance. The findings provide policy directions to the government, including providing more primary-care resources to suburban and rural areas, building new community hospitals in identified provision gaps, upgrading some clinics to hospitals in rural areas, and planning hospitals according to the projected trend of the elderly population in terms of quantity and distribution. The considerable provision disparity between core urban, suburban and rural areas can be addressed by refined spatial health planning informed by research.

MHV3SFCA: A new measure to capture the spatial accessibility of health care systems

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.

Investigating where adolescents engage in moderate to vigorous physical activity and sedentary behaviour: An exploratory study

BACKGROUND

There is a persistent lack of understanding on the influence of the environment on behaviour and health. While the environment is considered an important modifiable determinant of health behaviour, past research assessing environments often relies on static, researcher-defined buffers of arbitrary distance. This likely leads to misrepresentation of true environmental exposures. This exploratory study aims to compare researcher-defined and self-drawn buffers in reflecting the spaces and time adolescents engage in physical activity (PA) and sedentary behaviour. It also investigates if adolescent's access the PA facility and greenspace nearest their home or school for PA, as well as examine how much time adolescents spent in PA at any PA facilities and greenspaces.

METHODS

Adolescents (aged 14-18 years; n = 34) were recruited from schools in West Yorkshire, England. Seven consecutive days of global positioning system (GPS) and accelerometer data were collected at 15 second intervals. Using ArcGIS, we compared 30 different researcher-defined buffers including: radial, network and ellipse buffers at 400m, 800m, 1000m, 1600m and 3000m and participant-defined self-drawn neighbourhoods to objectively measured PA and sedentary space and PA time. Location of PA was also compared to Points of Interest data to determine if adolescents use the nearest PA facility or greenspace to their home or school and to examine how much PA was undertaken within these locations.

RESULTS

Our exploratory findings show the inadequacy of researcher-defined buffer size in assessing MVPA space or sedentary space. Furthermore, less than 35% of adolescents used the greenspaces or PA facilities nearest to their home or school. Approximately 50% of time spent in PA did not occur within the home, school, PA facility, or greenspace environments.

CONCLUSION

Our exploratory findings help to begin to quantify the inadequacy of researcher-defined, and self-drawn buffers in capturing adolescent MVPA and sedentary space, as well as time spent in PA. Adolescents often do not use PA facilities and greenspaces nearest their home and school and a large proportion of PA is achieved outside PA facilities and greenspaces. Further research with larger samples are needed to confirm the findings of this exploratory study.

Evaluating spatial accessibility of cultural urban land use by using improved 2SFCA method in Xi'an, China

With rapid urbanization, contradictions between rapid economic development and a lack of spiritual culture become increasingly complicated. Accessibility is a useful spatial quantitative index to evaluate the spiritual and cultural construction of the city. Amongst various accessibility methods, the two-step floating catchment area (2SFCA) method is suitable for evaluating cultural urban land use (CULU) based on its advantage of flexibility and rationality. This study selects Xi'an as the representative ancient city. Based on comparing accessibility results between different travel modes (walk, bus, subway, and total), and analyzing through statistics, Z-score, and comparison of classification, comparison of a particular area, we obtain the characteristics of CULU accessibility in Xi'an. Firstly, for different travel modes, the distribution of CULU accessibility value in Xi'an is imbalanced, and the accessibility value of bus and subway is closely related to public transport resources. Secondly, CULU in Xi'an has apparent features of being dense in the center, sparse in the suburbs, and lack edge, which correspond to the development of the city. Finally, about 60% accessibility value is contributed by historical CULU, which reflects the typical characteristics of Xi'an as an ancient city with rich historical resources. This study profoundly analyses the attributes of CULU in Xi'an and provides essential data for decision-makers. Furthermore, it gives a significant exploration for building a CULU evaluation system in the future.

Impact of the presence of private hospitals on the spatial equality of healthcare accessibility in Beijing, China

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.

Impact of traffic congestion on spatial access to healthcare services in Nairobi

Background

Geographic accessibility is an important determinant of healthcare utilization and is critical for achievement of universal health coverage. Despite the high disease burden and severe traffic congestion in many African cities, few studies have assessed how traffic congestion impacts geographical access to healthcare facilities and to health professionals in these settings. In this study, we assessed the impact of traffic congestion on access to healthcare facilities, and to the healthcare professionals across the healthcare facilities.

Methods

Using data on health facilities obtained from the Ministry of Health in Kenya, we mapped 944 primary, 94 secondary and four tertiary healthcare facilities in Nairobi County. We then used traffic probe data to identify areas within a 15-, 30- and 45-min drive from each health facility during peak and off-peak hours and calculated the proportion of the population with access to healthcare in the County. We employed a 2-step floating catchment area model to calculate the ratio of healthcare and healthcare professionals to population during these times.

Results

During peak hours, <70% of Nairobi's 4.1 million population was within a 30-min drive from a health facility. This increased to >75% during off-peak hours. In 45 min, the majority of the population had an accessibility index of one health facility accessible to more than 100 people (<0.01) for primary health care facilities, one to 10,000 people for secondary facilities, and two health facilities per 100,000 people for tertiary health facilities. Of people with access to health facilities, a sub-optimal ratio of <4.45 healthcare professionals per 1,000 people was observed in facilities offering primary and secondary healthcare during peak and off-peak hours.

Conclusion

Our study shows access to healthcare being negatively impacted by traffic congestion, highlighting the need for multisectoral collaborations between urban planners, health sector and policymakers to optimize health access for the city residents. Additionally, growing availability of traffic probe data in African cities should enable similar analysis and understanding of healthcare access for city residents in other countries on the continent.

Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches

Suggestions of the existence of so-called 'social care deserts' in England in the years leading up to the COVID-19 pandemic drew attention to the potential impact of geographical inequalities on the availability of residential, nursing and domiciliary care. To date, much of this analysis has been conducted at spatially aggregated scales such as that of local authorities or postcode sector. Hidden within such aggregate-level analysis however are geographical differences in the local provision of care services. In this paper, we draw attention to geographical modelling techniques that can be used to examine local trends in the supply of social care services in relation to potential demand. These spatial models can be used to examine variations in the number of facilities (or choice) within reasonable drive times/distances. Drawing on a national database of residential and nursing care beds in Wales for March 2020, we illustrate the potential of such techniques to provide an insight into current patterns in access to care homes, and to monitor future changes in the fall-out from the effects of the COVID-19 pandemic on the care home sector. The concentration of care home sites in metropolitan areas and in the heavily populated post-industrial valleys in the south-east is identified, but significant demand present in these areas ameliorates scores towards mid-range ratios. We conclude by suggesting that the types of techniques used in this study enable disparities in provision within localised areas to be better explored, thereby helping planners and policy makers to address potential inequalities in provision.

Women's Access to Kidney Transplantation in France: A Mixed Methods Research Protocol

Kidney transplantation is the best renal replacement therapy (medically and economically) for eligible patients with end-stage kidney disease. Studies in some French regions and in other countries suggest a lower access to the kidney transplant waiting listing and also to kidney transplantation, once waitlisted, for women. Using a mixed methods approach, this study aims to precisely understand these potential sex disparities and their causes. The quantitative study will explore the geographic disparities, compare the determinants of access to the waiting list and to kidney transplantation, and compare the reasons and duration of inactive status on the waiting list in women and men at different scales (national, regional, departmental, and census-block). The qualitative study will allow describing and comparing women's and men's views about their disease and transplantation, as well as nephrologists' practices relative to the French national guidelines on waiting list registration. This type of study is important in the current societal context in which the reduction of sex/gender-based inequalities is a major social expectation.

Disparities in Spatial Access to Emergency Surgical Services in the US

Importance

Hospitals with emergency surgical services provide essential care for a wide range of time-sensitive diseases. Commonly used measures of spatial access, such as distance or travel time, have been shown to underestimate disparities compared with more comprehensive metrics.

Objective

To examine population-level differences in spatial access to hospitals with emergency surgical capability across the US using enhanced 2-step floating catchment (E2SFCA) methods.

Design, Setting, and Participants

A cross-sectional study using the 2015 American Community Survey data. National census block group (CBG) data on community characteristics were paired with geographic coordinates of hospitals with emergency departments and inpatient surgical services, and hospitals with advanced clinical resources were identified. Spatial access was measured using the spatial access ratio (SPAR), an E2SFCA method that captures distance to hospital, population demand, and hospital capacity. Small area analyses were conducted to assess both the population with low access to care and community characteristics associated with low spatial access. Data analysis occurred from February 2021 to July 2022.

Main Outcomes and Measures

Low spatial access was defined by SPAR greater than 1.0 SD below the national mean (SPAR <0.3).

Results

In the 217 663 CBGs (median [IQR] age for CBGs, 39.7 [33.7-46.3] years), there were 3853 hospitals with emergency surgical capabilities and 1066 (27.7%) with advanced clinical resources. Of 320 million residents, 30.8 million (9.6%) experienced low access to any hospital with emergency surgical services, and 82.6 million (25.8%) to advanced-resource centers. Insurance status was associated with low access to care across all settings (public insurance: adjusted rate ratio [aRR], 1.21; 95% CI, 1.12-1.25; uninsured aRR, 1.58; 95% CI, 1.52-1.64). In micropolitan and rural areas, high-share (>75th percentile) Hispanic and other (Asian; American Indian, Alaska Native, or Pacific Islander; and 2 or more racial and ethnic minority groups) communities were also associated with low access. Similar patterns were seen in access to advanced-resource hospitals, but with more pronounced racial and ethnic disparities.

Conclusions and Relevance

In this cross-sectional study of access to surgical care, nearly 1 in 10 US residents experienced low spatial access to any hospital with emergency surgical services, and 1 in 4 had low access to hospitals with advanced clinical resources. Communities with high rates of uninsured or publicly insured residents and racial and ethnic minority communities in micropolitan and rural areas experienced the greatest risk of limited access to emergency surgical care. These findings support the use of E2SFCA models in identifying areas with low spatial access to surgical care and in guiding health system development.

Urban Spatial Accessibility of Primary Care and Hypertension Control and Awareness on Chicago's South Side: A Study From the COMPASS Cohort

BACKGROUND

Understanding the relationship between hypertension and spatial accessibility of primary care can inform interventions to improve hypertension control and awareness, especially among disadvantaged populations. This study aims to investigate the association between spatial accessibility of primary care and hypertension control and awareness.

METHODS

Participant data from the COMPASS (Chicago Multiethnic Prevention and Surveillance Study) between 2013 and 2019 were analyzed. All participants were geocoded. Locations of primary care providers in Chicago were obtained from MAPSCorps. A score was generated for spatial accessibility of primary care using an enhanced 2-step floating catchment area method. A higher score indicates greater accessibility. Measured hypertension was defined as systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg. Logistic regression was used to estimate odds ratio and 95% CI for hypertension status in relation to accessibility score quartiles.

RESULTS

Five thousand ninety-six participants (mean age, 53.4±10.8) were included. The study population was predominantly non-Hispanic black (84.0%), over 53% reported an annual household income <$15 000, and 37.3% were obese. Measured hypertension prevalence was 78.7% in this population, among which 37.7% were uncontrolled and 41.0% were unaware. A higher accessibility score was associated with lower measured hypertension prevalence. In fully adjusted models, compared with the first (lowest) quartile of accessibility score, the odds ratio strengthened from 0.82 (95% CI, 0.67-1.01) for the second quartile to 0.75 (95% CI, 0.62-0.91) for the third quartile, and further to 0.73 (95% CI, 0.60-0.89) for the fourth (highest) quartile. The increasing trend had a P<0.01. Similar associations were observed for both uncontrolled and unaware hypertensions. When stratified by neighborhood socioeconomic status, a higher accessibility score was associated with lower rates of unaware hypertension in both disadvantaged and nondisadvantaged neighborhoods.

CONCLUSIONS

Better spatial accessibility of primary care is associated with improved hypertension awareness and control.

Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act

BACKGROUND

The 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30 min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans.

OBJECTIVE

Assess the extent to which the 2018 MISSION Act facilitates spatial access to primary care for Veterans living in rural versus urban Oregon.

DESIGN

We identified locations of all VA and non-VA primary care clinics in Oregon then calculated 30-min drive-time catchment areas from census tract centroids to the nearest clinics. We compared measures of spatial access to primary care for Veterans in rural, micropolitan, and urban areas.

PARTICIPANTS

American Community Survey data representing Oregon adults.

MAIN MEASURES

Two measures of spatial access focusing on the number of clinics (supply), and an access index based on the two-step floating catchment area method (2SFCA) which accounts for number of clinics (supply) and population size (demand).

KEY RESULTS

Compared to only 13.0% of rural Veterans, 83.6% of urban Veterans lived within 30 min' drive time of VA primary care. Given the MISSION Act's eligibility criteria, 81.6% of rural Veterans and ~ 97% of urban and micropolitan Veterans had spatial access to primary care. When accounting for both supply and demand, rural areas had significantly higher access scores (p < 0.05) compared to urban areas.

CONCLUSIONS

Using MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.

Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia

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.

The role of geographic information system and global positioning system in dementia care and research: a scoping review

Background

Geographic Information System (GIS) and Global Positioning System (GPS), vital tools for supporting public health research, provide a framework to collect, analyze and visualize the interaction between different levels of the health care system. The extent to which GIS and GPS applications have been used in dementia care and research is not yet investigated. This scoping review aims to elaborate on the role and types of GIS and GPS applications in dementia care and research.

Methods

A scoping review was conducted based on Arksey and O’Malley’s framework. All published articles in peer-reviewed journals were searched in PubMed, Scopus, and Web of Science, subject to involving at least one GIS/GPS approach focused on dementia. Eligible studies were reviewed, grouped, and synthesized to identify GIS and GPS applications. The PRISMA standard was used to report the study.

Results

Ninety-two studies met our inclusion criteria, and their data were extracted. Six types of GIS/GPS applications had been reported in dementia literature including mapping and surveillance (n = 59), data preparation (n = 26), dementia care provision (n = 18), basic research (n = 18), contextual and risk factor analysis (n = 4), and planning (n = 1). Thematic mapping and GPS were most frequently used techniques in the dementia field.

Conclusions

Even though the applications of GIS/GPS methodologies in dementia care and research are growing, there is limited research on GIS/GPS utilization in dementia care, risk factor analysis, and dementia policy planning. GIS and GPS are space-based systems, so they have a strong capacity for developing innovative research based on spatial analysis in the area of dementia. The existing research has been summarized in this review which could help researchers to know the GIS/GPS capabilities in dementia research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12942-022-00308-1.

Rural–Urban Disparities in Realized Spatial Access to General Practitioners, Orthopedic Surgeons, and Physiotherapists among People with Osteoarthritis in Alberta, Canada

Rural Canadians have high health care needs due to high prevalence of osteoarthritis (OA) but lack access to care. Examining realized access to three types of providers (general practitioners (GPs), orthopedic surgeons (Ortho), and physiotherapists (PTs)) simultaneously helps identify gaps in access to needed OA care, inform accessibility assessment, and support health care resource allocation. Travel time from a patient’s postal code to the physician’s postal code was calculated using origin–destination network analysis. We applied descriptive statistics to summarize differences in travel time, hotspot analysis to explore geospatial patterns, and distance decay function to examine the travel pattern of health care utilization by urbanicity. The median travel time in Alberta was 11.6 min (IQR = 4.3–25.7) to GPs, 28.9 (IQR = 14.8–65.0) to Ortho, and 33.7 (IQR = 23.1–47.3) to PTs. We observed significant rural–urban disparities in realized access to GPs (2.9 and IQR = 0.0–92.1 in rural remote areas vs. 12.6 and IQR = 6.4–21.0 in metropolitan areas), Ortho (233.3 and IQR = 171.3–363.7 in rural remote areas vs. 21.3 and IQR = 14.0–29.3 in metropolitan areas), and PTs (62.4 and IQR = 0.0–232.1 in rural remote areas vs. 32.1 and IQR = 25.2–39.9 in metropolitan areas). We identified hotspots of realized access to all three types of providers in rural remote areas, where patients with OA tend to travel longer for health care. This study may provide insight on the choice of catchment size and the distance decay pattern of health care utilization for further studies on spatial accessibility.

The Spatial Distribution and Optimization of Medical and Health Land from the Perspective of Public Service Equalization: A Case Study of Urumqi City

From the two aspects of land quantity and spatial distribution, this article studies the existing problems and ideas for optimizing the supply of medical and health (M&H) land for municipal units to promote an equal supply of urban public services. Method: The existing problems were explored with the help of the kernel density, the spatial gravity model and the buffer zone analysis method, and the key optimization areas of M&H land under the trends of population flow were explored by constructing a suitability evaluation system for the natural, social and ecological elements. Results: The total amount of M&H land in the study area was lower than the standard. The characteristics of land supply that support hospitals and primary medical care are different, which makes it difficult for the population in different regions to obtain services from the two types of medical facilities. The supply of both types of land has room for improvement. Conclusion: The effect of public M&H supply is greatly affected by the factors of land supply, which directly causes the problem of uneven medical services in different regions. The land-use layout should be scientifically planned according to the characteristics of different regions.

Construction and validation of a spatial database of providers of transgender hormone therapy in the US

What little data on transgender healthcare is available often focuses on transgender people's negative experiences in accessing healthcare. However, no research has been conducted that illustrates where gender-affirming hormone therapy, one part of transgender-specific medical care, is available. Without these data, large scale research to discern patterns of availability of and access to gender-affirming medical care is nearly impossible. Community-based organizations, and even trans individuals themselves have constructed repositories and databases of healthcare providers to inform other care seekers where they can access transition-related care providers, but their data are often incomplete, and usually formatted to be user-facing rather than streamlined for research purposes. To fill this gap, this article outlines the methodology for the construction of a spatial database of providers of gender-affirming hormone therapy for transgender people in the US, which is available on GitHub, created from existing community-based resources and the accompanying verification process. The completeness of the database is tested via comparison to data from the US Transgender Survey in which respondents reported travel distance to access transgender-specific care providers. The database accounted for all but 7.5% of respondents who may have accessed unknown facilities based on self-reported travel distance. Results indicate that existing methodologies for database construction regarding healthcare providers are difficult to apply when working with transgender-specific medical care and that tests for replicability and validation often take for granted the wide availability of relevant data and information. While the database unto itself can only demonstrate where care is available, it will enable future research into why these geographic patterns in care availability exist. Finally, the methodology can be replicated to produce databases for other kinds of specialized or politicized medical care such as abortion, gender-affirming surgery, or HIV treatment.

Assessment of primary healthcare accessibility and inequality in north-eastern Kazakhstan

Out of the many aspects of health care, the concept of physical accessibility is a priority that not only encompasses availability of health care resources, but also requires that they are easily accessible for all. To assess this factor as expressed in terms of the number of available physicians in the north-eastern part of Kazakhstan, we used the enhanced two-step float catchment area in a geographic information system approach. The Gini index and the Lorentz curve were used to evaluate the economic inequality within this region. Based on the data obtained, we developed models to increase the availability of health care considering allocation of additional primary health care resources. A low to zero index was found to be typical for most rural settlements, which currently make up less than 15% of the total population. We also identified a correlation between the index of accessibility and that of inequality, which indicates that areas with high accessibility show a more equitable distribution of resources. The developed location/ allocation models of additional primary health care resources can be useful in implementing government initiatives to improve the availability of primary health care in rural areas.

An Equity Evaluation on Accessibility of Primary Healthcare Facilities by Using V2SFCA Method: Taking Fukuoka City, Japan, as a Case Study

The primary healthcare facilities are among the most basic needs of the residents, huge in quantity and widespread. Their distributions are directly related to people’s health, which affects the sustainable development of cities. The accessibility calculation of primary level healthcare facilities and the equity evaluation of accessibility from the perspective of medical service category and urban population is very important for the decision-making of layout and configuration but has been ignored for a long time. This study took the primary healthcare facilities of Fukuoka city in Japan as research objects; it first used the variable two-step floating catchment area (V2SFCA) method to calculate the healthcare catchment areas (HCAs) of medical service providers and the population catchment area (PCAs) of medical demand locations, and then obtained the accessibility to primary healthcare facilities. Finally, the spatial disparities of accessibility were evaluated from three aspects: overall space distribution by using Global and Local Moran’s I, service quality, and the population to be served. The results showed that HCAs were from 500 m to 6400 m, PCAs ranged from 500 m to 3000 m, the use of variable catchments can improve the accuracy of accessibility assessment results; the accessibility of primary healthcare facilities was clustered and had significant spatial differences, which were high in urban center and low in suburban area; the obvious differences in the accessibility distribution characteristics of clinics in differential diagnosis and treatment departments led to different degrees of unsaturation in the types of medical services obtained by residents; although the elderly’s demand for basic medical care was many times higher than that of other age groups, the accessibility in high-demand areas was generally low, and the situation in severely high-demand areas was more serious. This work puts forward a multi-dimensional realistic evaluation system for equality accessibility of primary healthcare facilities, providing the data support for the medical resources and facilities’ allocation and the intensive land use.

Identifying the vulnerable regions of emergency medical services based on the three-stage of accessibility: a case study in Xi'an, China

Background

Emergency department crowding is an obstacle in the process of obtaining emergency care services, which will lead to the increase of time cost. Most studies focused on the direct access to emergency medical resources, and few studies took the crowding of hospital emergency department as an evaluation index to reflect the convenience of obtaining emergency medical resources. It is a significance for the identification of areas with insufficient access to emergency service resources with this method.

Methods

This paper utilizes the improved potential model and the inverted Two-Step Floating Catchment Area method, combined with network map API service data to evaluate response time, delivery time and waiting time (for emergency department crowding) spent in different residential areas of Xi’an City in the process of emergency. Meanwhile, the vulnerable regions of gaining emergency medical resources are identified through the comprehensive analysis of the three stages of emergency.

Results

The studies show that the residents in built-up area are more convenient to get ambulance service and arrive at care hospitals than those in suburban areas, but they may face greater hospital crowdedness. Although suburban residents are faced with low hospital crowdedness, they spend more time on getting ambulances and going to care hospitals. The accessibility of emergency medical resources varies greatly among residents in different regions, with 5.38% of the residents were identified in the high-risk area distributing in suburban residential areas in the south of the city center, 21.92% in the medium risk area in the southern mountainous areas and the periphery of the core suburban areas of the city, and 46.11% in the low-risk area which are mainly distributed in built-up areas in gaining emergency medical services.

Conclusions

Obviously, getting an ambulance and arriving at the nearest hospital quickly shows that it is conducive to access to emergency resources. However, the impact of hospital emergency crowding can not be ignored, especially in the area surrounded by high-grade hospitals in the central area of the city. In considering the spatial layout of emergency stations and emergency hospitals, the dislocation distribution of hospitals at different levels should be reasonably adjusted to balance the equity of residents in obtaining emergency medical resources.

Using GIS to Understand the Influence of Hurricane Harvey on Spatial Access to Primary Care

Hurricanes can have a significant impact on the functioning and capacity of healthcare systems. However, little work has been done to understand the extent to which hurricanes influence local residents' spatial access to healthcare. Our study evaluates the change in spatial access to primary care physicians (PCPs) between 2016 and 2018 (i.e., before and after Hurricane Harvey) in Harris County, Texas. We used an enhanced 2-step floating catchment area (E2SFCA) method to measure spatial access to PCPs at the census tract level. The results show that, despite an increased supply of PCPs across the county, most census tracts, especially those in the northern and eastern fringe areas, experienced decreased access during this period as measured by the spatial access ratio (SPAR). We explain this decline in SPAR by the shift in the spatial distribution of PCPs to the central areas of Harris County from the fringe areas after Harvey. We also examined the socio-demographic impact in the SPAR change and found little variation in change among different socio-demographic groups. Therefore, public health professionals and disaster managers may use our spatial access measure to highlight the geographic disparities in healthcare systems. In addition, we recommend considering other social and institutional dimensions of access, such as users' needs, preferences, resource capacity, mobility options, and quality of healthcare services, in building a resilient and inclusive post-hurricane healthcare system.

Access to the COVID-19 services during the pandemic - a scoping review

Appropriate accessibility to coronavirus disease 2019 (COVID-19) services is essential in the efficient management of the pandemic. Different geospatial methods and approaches have been used to measure accessibility to COVID-19 health-related services. This scoping review aimed to summarize and synthesize the geospatial studies conducted to measure accessibility to COVID-19 healthcare services. Web of Science, Scopus, and PubMed were searched to find relevant studies. From 1113 retrieved unique citations, 26 articles were selected to be reviewed. Most of the studies were conducted in the USA and floating catchment area methods were mostly used to measure the spatial accessibility to COVID-19 services including vaccination centres, Intensive Care Unit beds, hospitals and test sites. More attention is needed to measure the accessibility of COVID-19 services to different types of users especially with combining different non-spatial factors which could lead to better allocation of resources especially in populations with limited resources.

Supply-demand matching of medical services at a city level under the background of hierarchical diagnosis and treatment - based on Didi Chuxing Data in Haikou, China

BACKGROUND

Implementation of the Healthy China Strategy and the hierarchical diagnosis and treatment system has injected new vitality into medical services. Given the insufficient supply of medical services and increasing demand for medical treatment, exploring the supply-demand pattern of medical services has become an urgent theoretical and practical problem to be solved. The equity of healthcare facilities has received widespread attention, but due to limited data, there is little research on the supply-demand pattern of medical services. This study focuses on evaluating the supply-demand matching pattern of medical services at different levels in Haikou City with big geographic data and promoting the realization of a balance between medical supply and demand.

METHODS

This study utilizes spatial data of medical institutions, Didi Chuxing Data, and population density data. Firstly, use the two-step floating catchment area method and GIS spatial analysis to explore characteristics of the supply-demand patterns of medical services at different levels in Haikou. Secondly, we mine residents' demand for medical treatment based on Didi Chuxing Data. Then combined with population density data, divide supply-demand matching of medical institutions into four types. Finally, propose optimization strategies for the problems.

RESULTS

The accessibility pattern of high-level medical institutions in Haikou presents high in the north and low in the south. The accessibility pattern of low-level medical institutions is the opposite. High-level medical institutions have a strong demand for medical treatment, which is less hampered by distance. The healthcare demand of low-level medical institutions is small, and they mainly are medium- and short-distance medical travel. The types of medical services at different levels are mainly "low supply - low demand" and "high supply - low demand" types.

CONCLUSIONS

Medical services at different levels in Haikou are mainly in supply-demand imbalance. Therefore, we put forward optimization strategies to promote the equity of primary medical services, such as propelling the establishment and improvement of the hierarchical diagnosis and treatment system, building a new model of medical and health service supply, and strengthening balanced coverage of primary medical institutions. The mining of big geographic data is beneficial to alleviate the mismatch between medical supply and demand, although the data and methods need to be improved.

Trap of weights: The reuse of weights in the floating catchment area (FCA) methods to measuring accessibility

Background: Geographic weights are vital in the floating catchment area (FCA) method of accessibility measurements due to their simulation of spatial barriers in various ways. When modelling population demand, geographical weights with different distance decay coefficients can reflect diverse distance tolerances in facility utilization and could lead to erratic accessibility results. Quantifying accessibility as the sum of weighted supply-demand ratios can alleviate the distance decay coefficient's influence and generate stable geographic patterns. However, the effects of weighted ratios on different FCA models and resources have not been investigated. Methods: To identify impacts of weighted ratios on various FCA variants, this study contrasted the accessibility calculated from the sum of ratios (access) and the sum of weighted ratios (access ratios) within three prevalent FCA models: enhanced two-step FCA (E2SFCA), modified two-step FCA (M2SFCA), and three-step FCA (3SFCA). In addition, the accessibilities of various resources evaluate the stability of the weighted ratios' effect. This study therefore examined the accessibilities to primary schools, job opportunities, and major hospitals in Shanghai. Shanghai is a case study that provides lessons on using big data to measure accessibility in metropolitan areas. Results: Geographic weights can not only mitigate the impact of the distance decay coefficients, but can also eliminate model features, which reduces the performance of the M2SFCA's supply decay and the 3SFCA's population demand adjustment in accessibility results. Moreover, weighted ratios tend to overestimate accessibility in marginal communities that lie within fewer catchments, regardless of the resource type. This tendency can lead to an epistemological trap that creates an inaccurate and counter-intuitive perception of resource distribution in a given area. Conclusions: The results identify a gap between the methodological logic and the empirical perception in accessibility measurements. This study concludes that the use of geographic weights needs to be cautious and epistemologically consistent.

The Promotional Effect of Health Education on the Medical Service Utilization of Migrants: Evidence From China

There were 376 million migrants in China by 2020, who made significant contributions to urban development. However, they used limited medical services and had lower self-reported health status than inflow city residents. Based on this, this study uses the cross-sectional data of the 2017 China Migrants Dynamic Survey (CMDS) to construct a multiple linear regression model to empirically study the role of health education in improving medical services utilization for migrants. It finds that compared to migrants without health education, the probability of the medical service utilization for migrants with health education has increased significantly, and counseling is more effective than other methods for health education. This promotion effect of health education has been established after a series of robustness tests. Furthermore, this study finds that the closer the migrants are to medical service resources, the greater the effect of health education on medical services utilization for migrants. The heterogeneity test shows that the effect of health education on medical services utilization for migrants is greater among the non-elderly and those with lower education levels. From the perspective of health education, the findings in this study provide empirical evidence to support the government in formulating policies to improve the utilization of medical services for migrants and reduce health inequality.

Household Income and Older Adult Population Predict Number of Integrative Medicine Providers Around US Hospitals: An Environmental Scan Study

Background

Integrative medicine (IM) is a growing subspecialty among the American healthcare system, but little is known about geographical and sociodemographic variability in access to services.

Objective

To better understand access to IM healthcare services, we aim to: 1.) document the number of IM providers within the hospital service area (HSA) of various hospitals across the United States (US) and, 2.) explore the relationship between age, income, and race as predictors of the number of IM providers.

Methods

We conducted an environmental scan to document the number of IM providers including naturopathic, acupuncture, chiropractic, and massage therapy providers within the HSA of 16 US hospitals using state and national search databases. We examined predictors of the number of providers per HSA using population and demographic data from the U.S. Census Bureau. Search database quality was evaluated using the Center for Disease Control and Prevention Clear Communication Index.

Results

The number of IM providers varied from 11.6 – 67.4 providers/100,000 persons. Massage therapists were the most prevalent (n = 13.8/100,000), followed by chiropractors (n = 5.2/100,000), acupuncturists (n = 4.6/100,000), and naturopathic physicians (n = .5/100,000). Higher average household income and population >65 years old were associated with more IM providers within an HSA (Rate Ratio (RR) 4.22, 95% CI 1.49-12.01; and 1.14, 1.05 - 1.24, respectively). In addition, the quality of publicly available search databases varied widely among US states (4.84 - 8.00/10), but less so among IM provider types (6.21 - 7.57/10).

Conclusions

The high variability in number of IM providers and search database quality among various HSAs across the US warrants further investigation into factors influencing access to services. Our findings regarding income and older adult population raise concern for inequitable access to care, but are also promising when considering the increasing demand for healthcare services among the older adult population.

Evaluating the accessibility to healthcare facilities under the Chinese hierarchical diagnosis and treatment system

An accurate assessment of current healthcare resource allocations is essential to address existing inequities in the hierarchical diagnosis and treatment system introduced in China. The data come from statistical reports of local governments and the developer platform of Amap, a Chinese mobile map. The data were analysed using the hierarchical two-step floating catchment area method. By spatial accessibility analysis, the distribution of accessibility to hierarchical healthcare facilities in Zhongshan City, Guangdong Province was found to be uneven, with clustered high accessibility in the central, north-western and southern parts of the city. To enhance the capacity of healthcare services, the government should allocate healthcare resources rationally to better associate with population densities.

Pharmacy deserts and patients with breast cancer receipt of influenza vaccines

BACKGROUND

Yearly influenza vaccination is strongly recommended at age 65 and reimbursed by Medicare without copays or deductibles at pharmacies and clinical settings. Uptake is low among patients with a high risk for influenza complications and good access to specialist care, such as recent cancer survivors. We hypothesized that more accessible pharmacies could be associated with higher immunization uptake in such patients.

OBJECTIVES

To determine whether pharmacy access is associated with influenza vaccination in subjects recently diagnosed with breast cancer, and whether this association differs by additional risk factors for influenza complications.

METHODS

We examined a cohort of patients with stage 0-III breast cancer diagnosed 2011-2015 from the Surveillance, Epidemiology, and End Results-Medicare cancer registry. All retail pharmacies in the United States were identified, and pharmacy access was measured by assessing supply and demand in each census tract using a 2-stage floating catchment area approach that accounted for pharmacy driving distances recommended by the Centers for Medicare and Medicaid Services. We examined the association of pharmacy access with influenza vaccination after breast cancer diagnosis in regression models.

RESULTS

More than 11% of 45,722 patients with breast cancer lived in census tracts where no pharmacies were within recommended driving distances from the population-weighted tract center. Vaccination in the year after diagnosis was less likely for patients in these very low-access tracts (adjusted odds ratio 0.92 [95% CI 0.86-0.96]), black (0.55 [0.51-0.60]) and Hispanic (0.76 [0.70-0.83]) women, and Medicaid recipients (0.74 [0.69-0.79]). Vaccination was inversely associated with per capita income in the subject's census tract, but there was no difference in the pharmacy effect by race, ethnicity, or census tract income.

CONCLUSION

Very low pharmacy access is associated with modest reductions in vaccination that could be useful for policy and planning regarding vaccinator resources and outreach.

Spatial accessibility to health care services among children with cerebral palsy in Johor, Peninsular Malaysia

Cerebral palsy (CP) is one of the most common causes of disability in childhood, leading to functional limitations and poor nutritional status. Families with CP children face challenges in providing proper care. Thus, accessibility of CP patients to health facilities is important to ensure that they can maintain regular visits to health facilities for proper treatment and care. The current study aimed to map the spatial distribution of CP in Johor, Malaysia and measure the accessibility of CP patients to nearby hospitals, health clinics and community-based rehabilitation centres. The study is based on CP cases in 2017 obtained from the Department of Social Welfare, Malaysia and analysed using the average nearest neighbour, buffer analysis and Kernel Density Estimation. Results indicate that there is generally good access to health care services for many of the CP children in Johor, but for 25% of those living more than 10 km away from the health clinics or community-based rehabilitation centres, regular visits can be a problem. This information should be used for targeted intervention and planning for health care strategies. Furthermore, information on hospital accessibility of CP children would allow for planning of proper and regular treatment for these patients. The study has shown that it is possible to improve the understanding of the distribution of CP cases by integrating spatial analysis using geographical information systems without relying on official information about the density of populations.

Incorporating broadband durability in measuring geographic access to health care in the era of telehealth: A case example of the 2-step virtual catchment area (2SVCA) Method

The COVID-19 (coronavirus disease 2019) pandemic has expanded telehealth utilization in unprecedented ways and has important implications for measuring geographic access to healthcare services. Established measures of geographic access to care have focused on the spatial impedance of patients in seeking health care that pertains to specific transportation modes and do not account for the underlying broadband network that supports telemedicine and e-health. To be able to measure the impact of telehealth on healthcare access, we created a pilot augmentation of existing methods to incorporate measures of broadband accessibility to measure geographic access to telehealth. A reliable measure of telehealth accessibility is important to enable policy analysts to assess whether the increasing prevalence of telehealth may help alleviate the disparities in healthcare access in rural areas and for disadvantaged populations, or exacerbate the existing gaps as they experience "double burdens."

Measuring hospital spatial accessibility using the enhanced two-step floating catchment area method to assess the impact of spatial accessibility to hospital and non-hospital care on the length of hospital stay

Background

Optimal healthcare access improves the health status and decreases health inequalities. Many studies demonstrated the importance of spatial access to healthcare facilities in health outcomes, particularly using the enhanced two-step floating catchment area (E2SFCA) method. The study objectives were to build a hospital facility access indicator at a fine geographic scale, and then to assess the impact of spatial accessibility to inpatient hospital and non-hospital care services on the length of hospital stay (LOS).

Methods

Data concerning older adults (≥75 years) living in the Nord administrative region of France were used. Hospital spatial accessibility was computed with the E2SFCA method, and the LOS score was calculated from the French national hospital activity and patient discharge database. The relationship between LOS and spatial accessibility to inpatient hospital care and to three non-hospital care types (general practitioners, physiotherapists, and home-visiting nurses) was analyzed with linear regression models.

Results

The mean number (standard deviation) of beds per 10,000 inhabitants was 19.0 (10.69) in Medical, Surgical and Obstetrics (MCO) facilities and 5.58 (2.19) in Postoperative and Rehabilitation Care (SSR) facilities, highlighting important variations within the region. Accessibility to hospital services was higher in large urban areas, despite the dense population and higher demand. In 2014, the mean LOS scores were 0.26 for MCO and 0.85 for SSR, but their geographical repartition was non-homogeneous. The linear regression analysis revealed a strong negative and significant association between LOS and non-hospital care accessibility.

Conclusions

This is the first study to measure spatial accessibility to inpatient hospital care in France using the E2SFCA method, and to investigate the relationship between healthcare utilization (LOS score) and spatial accessibility to inpatient hospital care facilities and three types of non-hospital care services. Our findings might help to make decisions about deploying additional beds and to identify the best locations for non-hospital care services. They might also contribute to improve access, and to ensure the best coordination and sustainability of inpatient and outpatient services, in order to better cover the population’s healthcare needs. International studies using multiple consensual indicators of healthcare outcomes and accessibility and sophisticated modeling methods are needed.