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Beks H, Wood SM, Clark RA, Vincent VL. Spatial methods for measuring access to health care. Eur J Cardiovasc Nurs 2023; 22:832-840. [PMID: 37590972 DOI: 10.1093/eurjcn/zvad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
Access to health care is a universal human right and key indicator of health system performance. Spatial access encompasses geographic factors mediating with the accessibility and availability of health services. Equity of health service access is a global issue, which includes access to the specialized nursing workforce. Nursing research applying spatial methods is in its infancy. Given the use of spatial methods in health research is a rapidly developing field, it is timely to provide guidance to inspire greater application in cardiovascular research. Therefore, the objective of this methods paper is to provide an overview of spatial analysis methods to measure the accessibility and availability of health services, when to consider applying spatial methods, and steps to consider for application in cardiovascular nursing research.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
| | - Sarah M Wood
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
| | - Robyn A Clark
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Versace L Vincent
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
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2
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Dumedah G, Iddrisu S, Asare C, Adu-Prah S, English S. Inequities in spatial access to health services in Ghanaian cities. Health Policy Plan 2023; 38:1166-1180. [PMID: 37728231 DOI: 10.1093/heapol/czad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/12/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
Consideration of health equity is fundamental to enhancing the health of those who are economically/socially disadvantaged. A vital characteristic of health equity and therefore health disparity is the level of spatial access to health services and its distribution among populations. Adequate knowledge of health disparity is critical to enhancing the optimal allocation of resources, identification of underserved populations and improving the efficiency and performance of the health system. The provision of such insight for sub-Saharan African (SSA) cities is a challenge and is severely limited in the literature. Accordingly, this study examined the disparities in potential spatial access to health services for four selected urban areas in Ghana based on: (1) the number of physicians per population; (2) access score based on a weighted sum of access components; (3) travel time to health services and (4) the combined evaluation of linkages between travel distance, settlement area, population and economic status. The overall spatial access to health services is low across all selected cities varying between 3.02 and 1.78 physicians per 10 000 persons, whereas the access score is between 1.70 and 2.54. The current number of physicians needs to be increased by about five times to satisfy the World Health Organization's standard. The low spatial access is not equitable across and within the selected cities, where the economically disadvantaged populations were found to endure longer travel distances to access health services. Inequities were found to be embedded within the selected cities where economically poor populations are also disadvantaged in their physical access to healthcare. The health facilities in all cities have reasonable travel distances separating them but are inadequately resourced with physicians. Thus, increasing the physician numbers and related resources at spatially targeted existing facilities would considerably enhance spatial access to health services.
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Affiliation(s)
- Gift Dumedah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Seidu Iddrisu
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Christabel Asare
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Samuel Adu-Prah
- Department of Environmental and Geosciences, Sam Houston State University, Huntsville, TX 77341, USA
| | - Sinead English
- School of Biological Sciences, University of Bristol, Bristol BS8 1QU, UK
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Endalamaw A, Erku D, Khatri RB, Nigatu F, Wolka E, Zewdie A, Assefa Y. Successes, weaknesses, and recommendations to strengthen primary health care: a scoping review. Arch Public Health 2023; 81:100. [PMID: 37268966 DOI: 10.1186/s13690-023-01116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Primary health care (PHC) is a roadmap for achieving universal health coverage (UHC). There were several fragmented and inconclusive pieces of evidence needed to be synthesized. Hence, we synthesized evidence to fully understand the successes, weaknesses, effective strategies, and barriers of PHC. METHODS We followed the PRISMA extension for scoping reviews checklist. Qualitative, quantitative, or mixed-approach studies were included. The result synthesis is in a realistic approach with identifying which strategies and challenges existed at which country, in what context and why it happens. RESULTS A total of 10,556 articles were found. Of these, 134 articles were included for the final synthesis. Most studies (86 articles) were quantitative followed by qualitative (26 articles), and others (16 review and 6 mixed methods). Countries sought varying degrees of success and weakness. Strengths of PHC include less costly community health workers services, increased health care coverage and improved health outcomes. Declined continuity of care, less comprehensive in specialized care settings and ineffective reform were weaknesses in some countries. There were effective strategies: leadership, financial system, 'Diagonal investment', adequate health workforce, expanding PHC institutions, after-hour services, telephone appointment, contracting with non-governmental partners, a 'Scheduling Model', a strong referral system and measurement tools. On the other hand, high health care cost, client's bad perception of health care, inadequate health workers, language problem and lack of quality of circle were barriers. CONCLUSIONS There was heterogeneous progress towards PHC vision. A country with a higher UHC effective service coverage index does not reflect its effectiveness in all aspects of PHC. Continuing monitoring and evaluation of PHC system, subsidies to the poor, and training and recruiting an adequate health workforce will keep PHC progress on track. The results of this review can be used as a guide for future research in selecting exploratory and outcome parameters.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Daniel Erku
- School of Public Health, The University of Queensland, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
- Health Social Science and Development Research Institute, Kathmandu, Nepal
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Ab Hamid J, Juni MH, Abdul Manaf R, Syed Ismail SN, Lim PY. Spatial Accessibility of Primary Care in the Dual Public-Private Health System in Rural Areas, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3147. [PMID: 36833838 PMCID: PMC9959538 DOI: 10.3390/ijerph20043147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Jabrullah Ab Hamid
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, Shah Alam 40170, Selangor, Malaysia
| | - Muhamad Hanafiah Juni
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
| | - Rosliza Abdul Manaf
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
| | - Sharifah Norkhadijah Syed Ismail
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
- Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
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Liu Y, Su Y, Li X. Analyzing the Spatial Equity of Walking-Based Chronic Disease Pharmacies: A Case Study in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:278. [PMID: 36612596 PMCID: PMC9819594 DOI: 10.3390/ijerph20010278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Yue Liu
- School of Natural and Built Environment, Queen’s University Belfast, Belfast BT9 5AG, UK
| | - Yuwei Su
- School of Urban Design, Wuhan University, Wuhan 430072, China
| | - Xiaoyu Li
- Department of Landscape Architecture & Urban Planning, Texas A&M University, College Station, TX 77843, USA
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Munene A, Hall DC. Proximity of Water Wells to Public Water Testing Facilities in Alberta Using Drive Times. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221137437. [PMID: 36408333 PMCID: PMC9666857 DOI: 10.1177/11786302221137437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Approximately 10% of Albertans rely on well water for domestic purposes. The responsibility of water testing and stewardship is left to private well owners. Few well water owners conduct routine testing of their well water supplies. Drive times to public water testing facilities may be an important factor limiting a well owner's ability to conduct routine water testing. The objective of this study is to describe the proximity of water wells, using drive times, to public water testing facilities and describe the availability of facilities based on hours of operation. Using network analysis, we determined the proportion of a sample of wells within 3 estimated drive times of public water testing facilities. 5872 wells were included in the sample. One hundred and seven water testing facilities were mapped within the province. Of the 5872 wells mapped, 89% were located within 30 minutes of a water testing facility, 15% were located within 0 to 10 minutes of a water testing facility, 48% were located between 10 and 20 minutes of a water testing facility and 37% were located within 20 to 30 minutes of a water testing facility. Further analysis revealed that access to water testing facilities may be influenced by the hours of operation of the facilities.
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Affiliation(s)
- Abraham Munene
- Faculty of Nursing, University of
Alberta, Edmonton, AB, Canada
| | - David C. Hall
- Faculty of Veterinary Medicine,
University of Calgary, Calgary, AB, Canada
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Higgs G, Price A, Langford M. Investigating the impact of bank branch closures on access to financial services in the early stages of the COVID-19 pandemic. JOURNAL OF RURAL STUDIES 2022; 95:1-14. [PMID: 35945951 PMCID: PMC9353612 DOI: 10.1016/j.jrurstud.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/24/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
There is a longstanding policy interest in understanding the impacts of changes in access to public and private services in rural areas. To date much of the empirical analysis concerning changing patterns of accessibility has been predicated on assumptions regarding the mode of transport used to access such facilities. The availability of new and open sources of data, and the increasing sophistication of spatial analytical tools, has enabled alternative transportation modes to be included when investigating the impact of service changes. In this study a nationwide analysis of changes in public transport provision and bank closures has enabled the identification of those parts of Wales that were disproportionally impacted by the loss of financial services during the early years of the COVID-19 pandemic. Drawing on local scenarios which show the combined impact of such changes, the findings demonstrate how temporal variations in accessibility can be used to examine potential patterns of exclusion that arise from the loss of key services. We conclude by suggesting that any assessment of changes in accessibility needs a holistic approach that considers changes in the transport infrastructure alongside other facets of service provision to understand the full impact of such closures on rural communities.
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Affiliation(s)
- Gary Higgs
- GIS Research Centre, Wales Institute of Social and Economic Research and Data (WISERD), Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, CF37 1DL, UK
| | - Andrew Price
- GIS Research Centre, Wales Institute of Social and Economic Research and Data (WISERD), Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, CF37 1DL, UK
| | - Mitchel Langford
- GIS Research Centre, Wales Institute of Social and Economic Research and Data (WISERD), Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, CF37 1DL, UK
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Campillay-Campillay M, Calle-Carrasco A, Dubo P, Moraga-Rodríguez J, Coss-Mandiola J, Vanegas-López J, Rojas A, Carrasco R. Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12439. [PMID: 36231740 PMCID: PMC9564706 DOI: 10.3390/ijerph191912439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.
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Affiliation(s)
- Maggie Campillay-Campillay
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Ana Calle-Carrasco
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Pablo Dubo
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Jorge Moraga-Rodríguez
- Programa de Magíster en Metodología de Investigación Cualitativa para la Salud, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Juan Coss-Mandiola
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Jairo Vanegas-López
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Alejandra Rojas
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Raúl Carrasco
- Facultad de Ingeniería y Negocios, Univerdidad de Las Américas, Santiago 3981000, Chile
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Wang S, Widener M, Burchell AN, Grace D, Gesink D. Spatial Access to Sexual Health Clinics Measured Through a Novel Accessibility Score in Toronto, Canada. Sex Transm Dis 2022; 49:484-489. [PMID: 35470349 DOI: 10.1097/olq.0000000000001637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Understanding spatial access to sexual health services will provide the foundation for future resource planning and allocation. The purpose of this study was to evaluate the potential geographic access to sexual health services in Toronto, Canada, by developing a novel accessibility index to sexual health clinics. METHODS We created an accessibility index using the 2-step floating catchment area method to quantify neighborhood-level access to sexual health clinics. The index assumed mixed modes of urban travel through walking and public transit, as well as through driving, and was estimated at the census tract level. RESULTS Census tracts were grouped into quantiles by the estimated accessibility score. Census tracts with higher accessibility scores were characterized as those with greater residential instability and lower dependency and ethnic concentration. The downtown core area has all census tracts categorized as medium, high, or very high (average [SD] score, 1.320 [0.312]), whereas the noncore area has 56.98%, 302 of 530 census tracts categorized as medium, high, or very high (average [SD] score, -0.105 [0.960]). CONCLUSIONS We demonstrated the benefit of using statistical methods to quantify the geographical access to sexual health services and identified neighborhoods with high and low levels of access. Findings from this study present an overview of the level of spatial access to sexual health clinics in Toronto based on clinic locations in 2018 and can be further used to characterize neighborhoods with a lower level of access and inform policy and planning decisions in the city.
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Affiliation(s)
- Susan Wang
- From the Dalla Lana School of Public Health
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Combining Temporal and Multi-Modal Approaches to Better Measure Accessibility to Banking Services. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2022. [DOI: 10.3390/ijgi11060350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The UK, as elsewhere, has seen an accelerating trend of bank branch closures and reduced opening hours since the early 2000s. The reasons given by the banks are well rehearsed, but the impact assessments they provide to justify such programs and signpost alternatives have been widely criticized as being inadequate. This is particularly so for vulnerable customers dependent on financial services who may face difficulties in accessing remaining branches. There is a need whilst analyzing spatial patterns of access to also include temporal availability in relation to transport opportunities. Drawing on a case study of potential multi-modal accessibility to banks in Wales, we demonstrate how open-source tools can be used to examine patterns of access whilst considering the business operating hours of branches in relation to public transport schedules. The inclusion of public and private travel modes provides insights into access that are often overlooked by a consideration of service-side measures alone. Furthermore, findings from the types of tools developed in this study are illustrative of the additional information that could be included in holistic impact assessments, allowing the consequences of decisions being taken to close or reduce the operating hours of bank branches to be more clearly communicated to customers.
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Tao Z, Wang Q. Facility or Transport Inequality? Decomposing Healthcare Accessibility Inequality in Shenzhen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116897. [PMID: 35682478 PMCID: PMC9180880 DOI: 10.3390/ijerph19116897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 01/25/2023]
Abstract
Accessibility to healthcare services is crucial for residents’ wellbeing. Numerous studies have revealed significant spatial inequality in healthcare accessibility across various contexts. However, it still remains unclear whether the inequality is caused by the unbalanced spatial distribution of healthcare facilities or by unequal transport access to them. This study decomposes inequality in healthcare accessibility into facility- and transport-driven inequality by comparing scenarios of healthcare accessibility, which consider various combinations of multidimensional components of accessibility using different distance measures. Using a case study in Shenzhen, this study reveals that both facility distribution and transport access substantially contribute to spatial inequality in healthcare accessibility. Facility distribution accounts for 61.3% and 50.8% of the overall accessibility inequality for driving and transit modes, respectively. The remaining inequality is induced by imbalanced mobility provided by transport networks. Furthermore, the impact of transport component on healthcare accessibility is unevenly distributed. This study highlights that both facility- and transport-related countermeasures should be considered to improve the accessibility and equality of healthcare services. It provides transferable methods for quantitatively decomposing facility- and transport-driven inequality in accessibility to healthcare or other facilities.
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Affiliation(s)
- Zhuolin Tao
- Faculty of Geographical Science, Beijing Normal University, No. 19, Xinjiekouwai Ave., Haidian, Beijing 100875, China;
| | - Qi Wang
- Proficiency Skill Appraisal and Guidance Center of Natural Resources Ministry, Beijing 100830, China
- Correspondence:
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Abu Bakar MA, Samat N, Yaacob NS. Spatial accessibility to health care services among children with cerebral palsy in Johor, Peninsular Malaysia. GEOSPATIAL HEALTH 2021; 16. [PMID: 34672180 DOI: 10.4081/gh.2021.987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
| | - Narimah Samat
- School of Humanities, Universiti Sains Malaysia, Penang; Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Health Campus, Kelantan.
| | - Nik Soriani Yaacob
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Health Campus, Kelantan; Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan.
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Tan J, Wang X, Pan J. The effect of population distribution measures on evaluating spatial accessibility of primary health-care institutions: A case study from China. GEOSPATIAL HEALTH 2021; 16. [PMID: 33706500 DOI: 10.4081/gh.2021.936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
Improvement of the equality of geographical allocation of limited health-care resources requires an accurate evaluation of spatial accessibility of the facilities. The adoption of appropriate population distribution measures is one of the leading factors affecting such an evaluation. Using primary health-care institutions in Hainan, China as an example, this study aimed to explore the disparities embedded in spatial accessibility evaluations based on six common measures of population distribution, namely community/ village population (VillagePop), average population distribution (AveragePop), population distribution by night-time light intensity (NighttimelightPop) together with the public population databases LandScan, WorldPop and PoiPop for construction of the weights. The enhanced two-step floating catchment area method, two-way analysis of variance (ANOVA), Dunnett test, root mean square error and the mean absolute error were employed to assess and compare spatial accessibilities based on these different population distribution measures. The spatial accessibility of primary health-care institutions in Hainan was found to vary when plotted using the various population distribution measures mentioned. As indicated by the statistical outcomes of both ANOVA and the Dunnett test, using the spatial accessibility calculated by VillagePop as reference, those calculated by AveragePop and PoiPop were found to be significantly different. In addition, the spatial accessibilities calculated by AveragePop and PoiPop demonstrated higher error rates in the identification of underserved areas compared with the reference. Considering the limitations of public population databases, the adoption of night-time light data is highly recommended for estimating population distribution in the absence of high-resolution data.
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Affiliation(s)
- Jianxia Tan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu.
| | - Xiuli Wang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu.
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu.
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Farooqi AS, Detchou DK, Glauser G, Strouz K, McClintock SD, Malhotra NR. Gender is associated with long-term mortality after cerebellopontine angle tumor resection. Clin Neurol Neurosurg 2020; 201:106452. [PMID: 33422925 DOI: 10.1016/j.clineuro.2020.106452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Gender can contribute to adverse patient outcomes through social and biological factors. It is important to assess the effects of gender on long-term patient outcomes after care has already been accessed, in order to improve quality of care and mitigate healthcare disparities. PATIENTS AND METHODS 277 consecutive patients undergoing cerebellopontine angle tumor resection over a six-year period (June 09, 2013 - April 29, 2019) at a university health system were retrospectively evaluated. Outcomes included 90-day emergency department (ED) visit, readmission, reoperation and mortality following resection. Male and female patients in the whole population were analyzed by logistic regression. Thereafter, Coarsened Exact Matching was used to match female and male on important demographic factors, including history of prior surgery, median household income, and Charlson Comorbidity Index (CCI) score, among others. Regression was carried out in the matched population, with significance set at a p-value < 0.05. RESULTS In the matched population analysis, males were significantly more likely to experience mortality during the length of follow-up (p = 0.03) but not within 90-days of resection. There were no significant differences in 90-day mortality or reoperation during the length of follow-up in either the matched or pre-matched populations. No significant differences were found in any of the 90-day morbidity outcomes in either the matched or pre-matched populations. CONCLUSION Gender may predict long-term outcomes in patients following CPA tumor resection. It is possible that gender also contributes to outcome disparities in other neurosurgical procedures, which future studies should evaluate.
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Affiliation(s)
- Ali S Farooqi
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Donald K Detchou
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Krista Strouz
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, United States; West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA, United States
| | - Scott D McClintock
- West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA, United States
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
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Disparities in Geographical Access to Hospitals in Portugal. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2020. [DOI: 10.3390/ijgi9100567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
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Kang JY, Michels A, Lyu F, Wang S, Agbodo N, Freeman VL, Wang S. Rapidly measuring spatial accessibility of COVID-19 healthcare resources: a case study of Illinois, USA. Int J Health Geogr 2020; 19:36. [PMID: 32928236 PMCID: PMC7487451 DOI: 10.1186/s12942-020-00229-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/30/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.
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Affiliation(s)
- Jeon-Young Kang
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Alexander Michels
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Fangzheng Lyu
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Shaohua Wang
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nelson Agbodo
- Division of Health Data and Policy, Illinois Department of Public Health, Springfield, IL, USA
| | - Vincent L Freeman
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Shaowen Wang
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Versace VL, Coffee NT, Franzon J, Turner D, Lange J, Taylor D, Clark R. Comparison of general and cardiac care-specific indices of spatial access in Australia. PLoS One 2019; 14:e0219959. [PMID: 31344082 PMCID: PMC6657861 DOI: 10.1371/journal.pone.0219959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 07/05/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To identity differences between a general access index (Accessibility/ Remoteness Index of Australia; ARIA+) and a specific acute and aftercare cardiac services access index (Cardiac ARIA). Research design and methods Exploratory descriptive design. ARIA+ (2011) and Cardiac ARIA (2010) were compared using cross-tabulations (chi-square test for independence) and map visualisations. All Australian locations with ARIA+ and Cardiac ARIA values were included in the analysis (n = 20,223). The unit of analysis was Australian locations. Results Of the 20,223 locations, 2757 (14% of total) had the highest level of acute cardiac access coupled with the highest level of general access. There were 1029 locations with the poorest access (5% of total). Approximately two thirds of locations in Australia were classed as having the highest level of cardiac aftercare. Locations in Major Cities, Inner Regional Australia, and Outer Regional Australia accounted for approximately 98% of this category. There were significant associations between ARIA+ and Cardiac ARIA acute (χ2 = 25250.73, df = 28, p<0.001, Cramer’s V = 0.559, p<0.001) and Cardiac ARIA aftercare (χ2 = 17204.38, df = 16, Cramer’s V = 0.461, p<0.001). Conclusions Although there were significant associations between the indices, ARIA+ and Cardiac ARIA are not interchangeable. Systematic differences were apparent which can be attributed largely to the underlying specificity of the Cardiac ARIA (a time critical index that uses distance to the service of interest) compared to general accessibility quantified by the ARIA+ model (an index that uses distance to population centre). It is where the differences are located geographically that have a tangible impact upon the communities in these locations–i.e. peri-urban areas of the major capital cities, and around the more remote regional centres. There is a strong case for specific access models to be developed and updated to assist with efficient deployment of resources and targeted service provision. The reasoning behind the differences highlighted will be generalisable to any comparison between general and service-specific access models.
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Affiliation(s)
- Vincent Lawrence Versace
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
- National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- * E-mail:
| | - Neil T. Coffee
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Centre for Research and Action in Public Health (CeRAPH), University of Canberra, Canberra, ACT, Australia
| | - Julie Franzon
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Dorothy Turner
- Spatial Sciences Group, School of Biological Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jarrod Lange
- Hugo Centre for Migration and Population Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Danielle Taylor
- Basil Hetzel Institute for Translational Health Research, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robyn Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Jin M, Liu L, Tong D, Gong Y, Liu Y. Evaluating the Spatial Accessibility and Distribution Balance of Multi-Level Medical Service Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1150. [PMID: 30935065 PMCID: PMC6479551 DOI: 10.3390/ijerph16071150] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 11/16/2022]
Abstract
Public medical service facilities are among the most basic needs of the public and are directly related to residents' health. The balanced development of medical service facilities is of great significance. Public medical service facilities can be divided into different levels according to their medical equipment, service catchment, and medical quality, which is very important but has been ignored for a long time in accessibility evaluations. In this research, based on the hospital and population datasets of Shenzhen, we propose a hierarchical two-step floating catchment area (H2SFCA) method to evaluate the spatial accessibility of public medical resources considering the factors at different levels of medical resources. In the proposed method, the spatial accessibility of each level of public medical service facilities are evaluated using different distance attenuation functions according to the medical service's scope. In addition, a measurement is proposed to evaluate the equity of medical service facilities based on accessibility and population density distributions. To synthesize the general spatial accessibility and the distribution balance of public medical service facilities, we standardize the spatial accessibility of public medical service facilities at each level and then calculate the weighted sums of the accessibility of each level. The general spatial equity of public medical service facilities is also evaluated. The results show that the accessibility and distribution balance of medical resources performs dissimilarly at the three levels and can be discriminated within different regions of the city. The accessibility of citywide medical facilities in Shenzhen decreases from the city center to the suburban area in a radial pattern and the accessibility and distribution balance in the suburban areas needs improvement.
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Affiliation(s)
- Meihan Jin
- Laboratory for Urban Future, Peking University (Shenzhen), Shenzhen 518055, China.
- Shenzhen Key Laboratory of Urban Planning and Decision Making, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China.
- School of Architecture, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China.
| | - Lu Liu
- Shenzhen Key Laboratory of Urban Planning and Decision Making, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China.
- School of Architecture, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China.
| | - De Tong
- School of urban planning and design, Peking University Shenzhen Graduate School, Shenzhen 518055, China.
| | - Yongxi Gong
- Shenzhen Key Laboratory of Urban Planning and Decision Making, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China.
- School of Architecture, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China.
| | - Yu Liu
- Institute of Remote Sensing and Geographical Information Systems, School of Earth and Space Sciences, Peking University, Beijing 100871, China.
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