Geographical Accessibility of Community Health Assist System General Practitioners for the Elderly Population in Singapore: A Case Study on the Elderly Living in Housing Development Board Flats

Navigating Aged Care Services with GIS: Trends, Developments, and Future Directions

BACKGROUND

With the growing challenge of an aging population, emerging technologies are increasingly being integrated into the production, organization, and delivery of aged care services. Geographic Information System (GIS), a computer-based tool for spatial information analysis and processing, has made significant strides in the allocation of care recources and service delivery for older adults, a notably vulnerable group. Despite its growing importance, cross-disciplinary literature reviews on this theme are scare. This scoping review was conducted to encapsulate the advancements and discern the future trajectory of GIS applications in aged care services.

METHODS

A comprehensive search across nine databases yielded 5941 articles. Adhering to specific inclusion and exclusion criteria, 61 articles were selected for a detailed analysis.

RESULTS

The 61 articles span from 2003 to 2022, with a notable increase in publications since 2018, comprising 41 articles (67% of the total) published between 2018-2022. Developed countries contributed 66% of the papers, with 45% focusing on accessibility issues. In the domain of aged care services, GIS has been predominantly utilized for model construction, mapping, and site selection, with a growing emphasis on addressing the unique needs of different subgroups of older adults.

CONCLUSION

The past two decades have seen substantial growth in the application of GIS in aged care services, reflecting its increasing importance in this field. This scoping review not only charts the historical development of GIS applications in aged care services but also underscores the need for innovative research approaches. Future directions should emphasize the integration of GIS with diverse methodologies to address the heterogeneous needs of older adults and improve the overall delivery of aged care services. Such advancements in GIS applications have the potential to significantly enhance the efficiency, accessibility, and quality of care for the aging population.

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.

Analyzing the Spatial Equity of Walking-Based Chronic Disease Pharmacies: A Case Study in Wuhan, China

Chronic diseases place a substantial financial burden on both the patient and the state. As chronic diseases become increasingly prevalent with urbanization and aging, primary chronic disease pharmacies should be planned to ensure that patients receive an equitable distribution of resources. Here, the spatial equity of chronic disease pharmacies is investigated. In this study, planning radiuses and Web mapping are used to assess the walkability and accessibility of planned chronic disease pharmacies; Lorenz curves are used to evaluate the match between the service area of the pharmacies and population; location quotients are used to identify the spatial differences of the allocation of chronic disease pharmacies based on residents. Results show that chronic disease pharmacies have a planned service coverage of 38.09%, an overlap rate of 58.34%, and actual service coverage of 28.05% in Wuhan. Specifically, chronic disease pharmacies are spatially dispersed inconsistently with the population, especially the elderly. The allocation of chronic disease pharmacies is directly related to the standard of patients' livelihood. Despite this, urban development does not adequately address this group's equity in access to medication. Based on a case study in Wuhan, China, this study aims to fill this gap by investigating the spatial equity of chronic disease medication purchases.

Housing and health in vulnerable social groups: an overview and bibliometric analysis

Previous studies have confirmed that poor living conditions can lead to a wide range of health problems. However, in the context of the COVID-19 pandemic, vulnerable groups in unstable housing are more susceptible to disease. This study aims to systematically examine the housing and health problems of vulnerable groups using a bibliometric approach to explore how housing causes health problems, types of health illnesses, and coping strategies. It is found that the poor housing mechanism, persistent inequalities, and poor housing environments have a significant impact on the health of vulnerable groups. Therefore, the government must make concerted efforts across all sectors to ensure that the housing and health care needs of vulnerable groups are improved, and that housing security standards and related policies are improved; targeted safety plans are formulated with community as the carrier, taking into account the characteristics of vulnerable groups; and new information technology is widely used to provide medical convenience for vulnerable groups. It is hoped that the research in this paper can arouse social attention to the health of vulnerable groups and improve their health from the perspective of housing, so as to point out the direction for solving the housing health problems of vulnerable groups in the future.

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.

Circular Economy: a Comparison Between the Case of Singapore and France

Nowadays, due to the continuous developments in economies, various dilemmas are emerging, including energy demand, waste management, and greenhouse gas emissions (GHE). A promising approach to address these issues is a transition toward a circular economy (CE), and one of its successful approaches is the waste-to-energy (WTE). By exploiting WTE, there will be less demand for raw materials and resources. In this study, two developed countries, including France and Singapore, are evaluated based on their CE transition using the WTE method. Both countries are developing rapidly in terms of a successful CE. Reducing landfills as the major problem in Singapore is one of the most vital plans in their CE project. The planned target in Singapore is reducing landfill by 30% by 2030. Furthermore, Singapore aims for reaching a 70% recycling rate by 2050. On the other hand, the CE in France includes more comprehensive laws in four different sectors, such as production, consumption, waste management, and mobilizing actors. It is planned that by 2025, the recycling rate in France will reach 100%. A roadmap toward building a CE cannot be succeeded unless some practical strategies are developed for overcoming the encountered obstacles. The roadmap of both countries shows a specific milestone to reach a better CE, cleaner environment, and less use of natural resources. Most of the Singapore sustainable plans are planned to be caught by 2030, while France is trying to complete them by 2025. It should be noted that due to the current pandemic situation caused by COVID-19, there are some issues in implementing the obligations and plans thoroughly.

Disparities in Healthcare Services and Spatial Assessments of Mobile Health Clinics in the Border Regions of Thailand

Reducing the disparities in healthcare access is one of the important goals in healthcare services and is significant for national health. However, measuring the complexity of access in truly underserved areas is the critical step in designing and implementing healthcare policy to improve those services and to provide additional support. Even though there are methods and tools for modeling healthcare accessibility, the context of data is challenging to interpret at the local level for targeted program implementation due to its complexity. Therefore, the purpose of this study is to develop a concise and context-specific methodology for assessing disparities for a remote province in Thailand to assist in the development and expansion of the efficient use of additional mobile health clinics. We applied the geographic information system (GIS) methodology with the travel time-based approach to visualize and analyze the concealed information of spatial data in the finer analysis resolution of the study area, which was located in the border region of the country, Ubon Ratchathani, to identify the regional differences in healthcare allocation. Our results highlight the significantly inadequate level of accessibility to healthcare services in the regions. We found that over 253,000 of the population lived more than half an hour away from a hospital. Moreover, the relationships of the vulnerable residents and underserved regions across the province are underlined in the study and substantially discussed in terms of expansion of mobile health delivery to embrace the barrier of travel duration to reach healthcare facilities. Accordingly, this research study addresses regional disparities and provides valuable references for governmental authorities and health planners in healthcare strategy design and intervention to minimize the inequalities in healthcare services.

Primary Care Networks and Starfield's 4Cs: A Case for Enhanced Chronic Disease Management

The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN's face in chronic disease management. The objective of this study is to map features of PCN to Starfield's "4Cs" framework. The "4Cs" of primary care-comprehensiveness, first contact access, coordination and continuity-offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN's empowering features that fulfil the "4Cs". On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the "4Cs". However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.

Disparities in Geographical Access to Hospitals in Portugal

Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for implementing policies to improve the access to those services. The aim of this paper is to assess whether inequalities in terms of access to a hospital in Portugal have improved over the last 20 years. A population-weighted driving time was applied using the census tract population, the roads network, the reference hospitals’ catchment area and the municipality boundaries. The results show that municipalities are 25 min away from the hospital—3 min less than in 1991—and that there is an association with premature mortality, elderly population and population density. However, disparities between municipalities are still huge. Municipalities with higher rates of older populations, isolated communities or those located closer to the border with Spain face harder challenges and require greater attention from local administration. Since municipalities now have responsibilities for health, it is important they implement interventions at the local level to tackle disparities impacting access to healthcare.

Identifying optimal indicators and purposes of population segmentation through engagement of key stakeholders: a qualitative study

BACKGROUND

Various population segmentation tools have been developed to inform the design of interventions that improve population health. However, there has been little consensus on the core indicators and purposes of population segmentation. The existing frameworks were further limited by their applicability in different practice settings involving stakeholders at all levels. The aim of this study was to generate a comprehensive set of indicators and purposes of population segmentation based on the experience and perspectives of key stakeholders involved in population health.

METHODS

We conducted in-depth semi-structured interviews using purposive sampling with key stakeholders (e.g. government officials, healthcare professionals, social service providers, researchers) involved in population health at three distinct levels (micro, meso, macro) in Singapore. The interviews were audio-recorded and transcribed verbatim. Thematic content analysis was undertaken using NVivo 12.

RESULTS

A total of 25 interviews were conducted. Eight core indicators (demographic characteristics, economic characteristics, behavioural characteristics, disease state, functional status, organisation of care, psychosocial factors and service needs of patients) and 21 sub-indicators were identified. Age and financial status were commonly stated as important indicators that could potentially be used for population segmentation across three levels of participants. Six intended purposes for population segmentation included improving health outcomes, planning for resource allocation, optimising healthcare utilisation, enhancing psychosocial and behavioural outcomes, strengthening preventive efforts and driving policy changes. There was consensus that planning for resource allocation and improving health outcomes were considered two of the most important purposes for population segmentation.

CONCLUSIONS

Our findings shed light on the need for a more person-centric population segmentation framework that incorporates upstream and holistic indicators to be able to measure population health outcomes and to plan for appropriate resource allocation. Core elements of the framework may apply to other healthcare settings and systems responsible for improving population health.

TRIAL REGISTRATION

The study was approved by the SingHealth Institutional Review Board (CIRB Reference number: 2017/2597).