An Improved Healthcare Accessibility Measure Considering the Temporal Dimension and Population Demand of Different Ages

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 Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility

Telemedicine has emerged as a transformative force in healthcare delivery, particularly in improving healthcare accessibility. This comprehensive review examines the impact of telemedicine on healthcare accessibility, exploring its ability to overcome geographical, financial, sociocultural, and infrastructural barriers to healthcare access. Through remote consultations, monitoring, and diagnosis facilitated by technology, telemedicine extends healthcare reach to remote and underserved areas while enhancing temporal accessibility with round-the-clock availability. By streamlining healthcare delivery systems, telemedicine reduces costs and promotes efficiency, ultimately fostering health equity and improving health outcomes. However, technological barriers, regulatory hurdles, and patient acceptance remain. To realize telemedicine's full potential, collaboration among stakeholders in the healthcare and technology sectors is imperative. Policymakers must enact supportive regulations, healthcare providers must integrate telemedicine into their practices, and technology companies must innovate to develop user-friendly platforms. Through concerted efforts, telemedicine can catalyze advancing healthcare accessibility and enhance the health and well-being of individuals worldwide.

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 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.

Experiences of migrant mothers attending vaccination services at primary healthcare facilities

Background

Migration to South Africa is currently dominated by women and children, for socio-economic and refugee reasons or to utilise the healthcare system for various services. Migrants and refugees are at risk of vaccine-preventable diseases, and many of their children have an incomplete or unknown immunisation status.

Aim

This study aimed to explore the experiences of migrant mothers in utilising child immunisation services in primary healthcare facilities.

Setting

Ten primary healthcare facilities that were providing immunisation services, located in the Buffalo City Metropolitan Municipality, Eastern Cape province, South Africa.

Methods

A qualitative research design, making use of in-depth interviews (IDIs) from 18 purposefully selected migrant women, was used for data collection. Thematic content analysis was used to analyse the recorded data of the experiences of study participants in their access to immunisation services.

Results

From the IDIs, four themes were identified: difficulty in communicating with the healthcare workers because of language barriers, access challenges, interpersonal barriers and interpersonal relationships were identified in this study, which influenced the utilisation of immunisation services by migrant mothers.

Conclusion

The findings of this study support and reinforce the duty of the South African government and healthcare facilities to work together to improve migrant women's access to immunisation services.

Contribution

A positive relationship between healthcare workers and migrant mothers while accessing immunisation services should contribute to reducing child mortality in South Africa and achieving Sustainable Development Goal 3 by the year 2030.

What, Where, and How to Collect Real-World Data and Generate Real-World Evidence to Support Drug Reimbursement Decision-Making in Asia: A reflection Into the Past and A Way Forward

BACKGROUND

Globally, there is increasing interest in the use of real-world data (RWD) and real-world evidence (RWE) to inform health technology assessment (HTA) and reimbursement decision-making. Using current practices and case studies shared by eleven health systems in Asia, a non-binding guidance that seeks to align practices for generating and using RWD/RWE for decision-making in Asia was developed by the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) Working Group, addressing a current gap and needs among HTA users and generators.

METHODS

The guidance document was developed over two face-to-face workshops, in addition to an online survey, a face-to-face interview and pragmatic search of literature. The specific focus was on what, where and how to collect RWD/ RWE.

RESULTS

All 11 REALISE member jurisdictions participated in the online survey and the first in-person workshop, 10 participated in the second in-person workshop, and 8 participated in the in-depth face-to-face interviews. The guidance document was iteratively reviewed by all working group members and the International Advisory Panel. There was substantial variation in: (a) sources and types of RWD being used in HTA, and (b) the relative importance and prioritization of RWE being used for policy-making. A list of national-level databases and other sources of RWD available in each country was compiled. A list of useful guidance on data collection, quality assurance and study design were also compiled.

CONCLUSION

The REALISE guidance document serves to align the collection of better quality RWD and generation of reliable RWE to ultimately inform HTA in Asia.

Spatial accessibility analysis of green space from a health-benefit perspective: Implications for healthy urban development

The spatial accessibility of urban park green space (UPGS) plays a crucial role in promoting the healthy development of cities and their residents. However, previous studies have overestimated the accessibility of UPGS and failed to adequately consider the impact of variegated parks on residents’ needs. To fill this gap in the research, we first propose an improved two-step floating catchment area (Huff-2SFCA) method that takes into consideration the trade-offs between supply, demand, and walking time to calculate the UPGS accessibility index for the built-up area of Mianyang, China. Next, we assess the spatial characteristics of UPGS accessibility from both partial and overall points of view and further explore the relationship between accessibility and population size. Our results show that (1) every street area has a different form of UPGS construction, and most of these spaces are of poor quality; (2) municipal-level parks are significantly more accessible than district-level parks, community-level parks, or neighborhood-level parks; (3) the overall distribution of accessibility is generally characterized by a decreasing trend along both sides of the river, with poor overall accessibility; and (4) 243 residential districts are located in high-demand–low-supply areas that need improving. This study can be employed to identify areas that are underserved by UPGS and can provide a basis for improving the accessibility of UPGS and promoting its health benefits.

Correlation between religion, spirituality and perception of healthcare services utilisation in Poland during COVID-19 pandemic

Background

The worldwide transmission of SARS CoV-2 caused the COVID-19 pandemic and had an impact on healthcare provision. The disruption of reliance on the health system during the COVID-19 pandemic posed a clear threat to public trust. Religiosity, like spirituality, is believed to have a positive influence on people's lives, enabling them to cope with illness, stress, and sudden life changes. In practice, although the terms religiosity and spirituality have similar meanings and are related, they are not identical concepts. The aim of this study is to compare the perceptions of the accessibility and quality of healthcare services provided before and during the COVID-19 pandemic in Poland by religious/spiritual people compared to those for whom religion and spirituality have little or no importance in their lives.

Methodology

This cross-sectional study was based on the authors' questionnaire, carried out during the third wave of the COVID-19 pandemic in Poland. Participants in the study were people living in various regions of Poland over 18 who were willing to complete the questionnaire voluntarily. The number of people sampled was two hundred and sixty-four. Convenience sampling method was used for this study. Statistical calculations were performed using Statistica 13 software from TIBCO and PQStat from PQStat Software and were based on the Kruskal-Wallis test, multiple regression model, the chi2 test of independence or the Mann-Whitney test. The result was considered statistically significant when p < α. The significance level was taken as α = 0.05.

Results

Two hundred and sixty-three respondents answered the questionnaire. Among them, 181 (69%) were women, and 82 (31%) were men. It was shown that religion is more important for women than for men and women who report a high role of religion in their lives rated the quality of healthcare services better before and during the COVID-19 pandemic. It was also concluded that religious people for whom religion played a major role and those who were helped by spiritual life rated accessibility and quality higher both before and during the pandemic.

Conclusions

Religious/spiritual people, through their more positive attitudes towards the world, were thought to rate access and quality of healthcare services better. Regardless of religious affiliation, the help of spiritual life during the pandemic or the importance of religion in life in all respondents, perception of healthcare services utilisation were decreased by the pandemic. This prompts thoughts on the implementation of spiritual assistance as a supportive measure to mitigate the effects of the pandemic.

Dynamic accessibility by car to tertiary care emergency services in Cali, Colombia, in 2020: cross-sectional equity analyses using travel time big data from a Google API

OBJECTIVES

To test a new approach to characterise accessibility to tertiary care emergency health services in urban Cali and assess the links between accessibility and sociodemographic factors relevant to health equity.

DESIGN

The impact of traffic congestion on accessibility to tertiary care emergency departments was studied with an equity perspective, using a web-based digital platform that integrated publicly available digital data, including sociodemographic characteristics of the population and places of residence with travel times.

SETTING AND PARTICIPANTS

Cali, Colombia (population 2.258 million in 2020) using geographic and sociodemographic data. The study used predicted travel times downloaded for a week in July 2020 and a week in November 2020.

PRIMARY AND SECONDARY OUTCOMES

The share of the population within a 15 min journey by car from the place of residence to the tertiary care emergency department with the shortest journey (ie, 15 min accessibility rate (15mAR)) at peak-traffic congestion hours. Sociodemographic characteristics were disaggregated for equity analyses. A time-series bivariate analysis explored accessibility rates versus housing stratification.

RESULTS

Traffic congestion sharply reduces accessibility to tertiary emergency care (eg, 15mAR was 36.8% during peak-traffic hours vs 84.4% during free-flow hours for the week of 6-12 July 2020). Traffic congestion sharply reduces accessibility to tertiary emergency care. The greatest impact fell on specific ethnic groups, people with less educational attainment and those living in low-income households or on the periphery of Cali (15mAR: 8.1% peak traffic vs 51% free-flow traffic). These populations face longer average travel times to health services than the average population.

CONCLUSIONS

These findings suggest that health services and land use planning should prioritise travel times over travel distance and integrate them into urban planning. Existing technology and data can reveal inequities by integrating sociodemographic data with accurate travel times to health services estimates, providing the basis for valuable indicators.

The Impact of Digital Transformation on Inpatient Care: A Mixed Design Study (Preprint)

BACKGROUND

In the context of the digital transformation of all areas of society, health care providers are also under pressure to change. New technologies and a change in patients' self-perception and health awareness require rethinking the provision of health care services. New technologies and the extensive use of data can change provision processes, optimize them, or replace them with new services. The inpatient sector, which accounts for a particularly large share of health care spending, plays a major role in this regard.

OBJECTIVE

This study examined the influences of current trends in digitization on inpatient service delivery.

METHODS

We conducted a scoping review. This was applied to identify the international trends in digital transformation as they relate to hospitals. Future trends were considered from different perspectives. Using the defined inclusion criteria, international peer-reviewed articles published between 2016 and 2021 were selected. The extracted core trends were then contextualized for the German hospital sector with 12 experts.

RESULTS

We included 44 articles in the literature analysis. From these, 8 core trends could be deduced. A heuristic impact model of the trends was derived from the data obtained and the experts' assessments. This model provides a development corridor for the interaction of the trends with regard to technological intensity and supply quality. Trend accelerators and barriers were identified.

CONCLUSIONS

The impact analysis showed the dependencies of a successful digital transformation in the hospital sector. Although data interoperability is of particular importance for technological intensity, the changed self-image of patients was shown to be decisive with regard to the quality of care. We show that hospitals must find their role in new digitally driven ecosystems, adapt their business models to customer expectations, and use up-to-date information and communications technologies.

Combining Temporal and Multi-Modal Approaches to Better Measure Accessibility to Banking Services

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.

Healthcare accessibility in preconflict Syria: a comparative spatial analysis

INTRODUCTION

There is scarce information about the allocation of health resources in Syria. Pre-existing inequalities were further intensified after the 2011 conflict which displaced over 50% of the population. This study provides an analysis of health inequalities in Syria focusing on spatial access to public hospitals and employs data from 2010, just prior to the outbreak of conflict. Establishing a preconflict snapshot of the health system could serve as a helpful baseline assessment for future studies to measure the impact of the conflict on the health system. Such information could also offer systematic data to guide postconflict reconstruction efforts.

METHODS

We compared two methods to quantify the inpatient bed access: provider to population ratio (PPR) and two-step floating catchment area (2SFCA) method. We compared PPR calculated at the governorate level with population weighted 2SFCA score calculated at a resolution of 2 km by 2 km. We then aggregated at the governorate level, tested multiple catchment sizes and calculated Gini coefficient for each governorate.

RESULTS

We found high inequality in access to public hospitals across and within governorates, especially in the north and eastern regions, where all governorates ranked in the lowest two quintiles using both PPR and 2SFCA. Relatively small governorates in the west and the south had higher spatial access and less inequality. Testing variability in catchment size showed that even at 125 km catchment, 65% of the country had accessibility below national average.

CONCLUSION

Methodologically, the use of 2SFCA provided more nuanced insights about hospital bed allocation than PPR. 2SFCA was able to account for the cross-boundary effect and road network quality. Realistic representation of health accessibility is possible in data-scarce settings such as Syria and could be adapted to assess health access inequalities in conflict and postconflict settings.

The effect of population distribution measures on evaluating spatial accessibility of primary health-care institutions: A case study from China

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.

COVID-19: A Comparative Study of Population Aggregation Patterns in the Central Urban Area of Tianjin, China

When a public health emergency occurs, a potential sanitation threat will directly change local residents' behavior patterns, especially in high-density urban areas. Their behavior pattern is typically transformed from demand-oriented to security-oriented. This is directly manifested as a differentiation in the population distribution. This study based on a typical area of high-density urban area in central Tianjin, China. We used Baidu heat map (BHM) data to calculate full-day and daytime/nighttime state population aggregation and employed a geographically weighted regression (GWR) model and Moran's I to analyze pre-epidemic/epidemic population aggregation patterns and pre-epidemic/epidemic population flow features. We found that during the COVID-19 epidemic, the population distribution of the study area tended to be homogenous clearly and the density decreased obviously. Compared with the pre-epidemic period: residents' demand for indoor activities increased (average correlation coefficient of the floor area ratio increased by 40.060%); traffic demand decreased (average correlation coefficient of the distance to a main road decreased by 272%); the intensity of the day-and-night population flow declined significantly (its extreme difference decreased by 53.608%); and the large-living-circle pattern of population distribution transformed to multiple small-living circles. This study identified different space utilization mechanisms during the pre-epidemic and epidemic periods. It conducted the minimum living security state of an epidemic-affected city to maintain the operation of a healthy city in the future.

An integrated analysis of spatial access to the three-tier healthcare delivery system in China: a case study of Hainan Island

BACKGROUND

Access to healthcare is critical for the implementation of Universal Health Coverage. With the development of healthcare insurance systems around the world, spatial impedance to healthcare institutions has attracted increasing attention. However, most spatial access methodologies have been developed in Western countries, whose healthcare systems are different from those in Low- and Middle-Income Countries (LMICs).

METHODS

Hainan Island was taken as an example to explore the utilization of modern spatial access techniques under China's specialized Three-Tier Health Care Delivery System. Healthcare institutions were first classified according to the three tiers. Then shortest travel time was calculated for each institution's tier, overlapped to identify eight types of multilevel healthcare access zones. Spatial access to doctors based on the Enhanced Two-Step Floating Catchment Area Method was also calculated.

RESULTS

On Hainan Island, about 90% of the population lived within a 60-min service range for Tier 3 (hospital) healthcare institutions, 80% lived within 30 min of Tier 2 (health centers), and 75% lived within 15 min of Tier 1 (clinics). Based on local policy, 76.36% of the population living in 48.52% of the area were able to receive timely services at all tiers of healthcare institutions. The weighted average access to doctors was 2.31 per thousand residents, but the regional disparity was large, with 64.66% being contributed by Tier 3 healthcare institutions.

CONCLUSION

Spatial access to healthcare institutions on Hainan Island was generally good according to travel time and general abundance of doctors, but inequity between regions and imbalance between different healthcare institution tiers exist. Primary healthcare institutions, especially in Tier 2, should be strengthened.

Spatial accessibility to colonoscopy and its role in predicting late-stage colorectal cancer

OBJECTIVE

To better determine the relationship between spatial access to colonoscopy and colorectal cancer (CRC) outcomes, our objective was to examine the agreement of the classic, enhanced, and variable two-step floating catchment area (2SFCA) methods in evaluating spatial access to colonoscopy and to compare the predictive validity of each method related to late-stage CRC. 2SFCA methods simultaneously consider supply/demand of services and impedance (ie, travel time).

DATA SOURCES

Colonoscopy provider locations were obtained from the South Carolina Ambulatory Surgery Database. ZIP code tabulation area (ZCTA) level population estimates and area-level poverty level were obtained from the American Community Survey. Rurality was determined by the United States Department of Agriculture's Rural-Urban Commuting Area codes. Individual-level CRC data were obtained from the South Carolina Central Cancer Registry.

STUDY DESIGN

Using the classic, enhanced, and variable 2SFCA methods, we calculated ZCTA-level spatial access to colonoscopy. We assessed agreement between the three methods by calculating Spearman's rank coefficients and weighted Kappas (Κ). Global and Local Moran's I were used to assess spatial clustering of accessibility scores across 2SFCA methods. We performed multilevel logistic regression analyses to examine the association between spatial accessibility to colonoscopy, area- and individual-level factors, and late-stage CRC.

PRINCIPAL FINDINGS

We found strong agreement (Weighted Κ = 0.82; 95% CI = 0.79-0.86) and identified similar clustering patterns with the classic and enhanced 2SFCA methods. There was negligible agreement among the classic/enhanced 2SFCA and the variable 2SFCA. Across all 2SFCA methods, regression models showed that spatial access to colonoscopy, rurality, and poverty level were not associated with greater odds of late-stage CRC, though Black race was associated with late-stage CRC across all models.

CONCLUSIONS

None of the 2SFCA methods showed an association with late-stage CRC. Future studies should explore which elements (spatial or nonspatial) of access to care have the greatest impact on CRC outcomes.

Spatial accessibility to healthcare facilities in coastal region of Bangladesh

Though equal and easy accessibility to healthcare facilities are a fundamental right, people of the coastal region often get poor accessibility to healthcare facilities. This research aimed to assess the spatial accessibility to healthcare facilities in the coastal region of Bangladesh. Patuakhali district was selected as the study area. Accessibility to three levels of healthcare facilities: Community Clinic (CC), Upazila Health Complex (UHC) and District Hospital (DH) was measured individually using Geographic Information System (GIS) adopting the simple distance measures. Finally, overall accessibility to healthcare facilities was measured by overlaying accessibility to all three levels of healthcare facilities according to their relative importance. The findings of this study showed that a significant portion (70%) of Patuakhali district had high accessibility to CC; whereas, almost 60% and 40% of the area had poor accessibility to UHC and DH, respectively. Furthermore, 40% and 28% of the area of Patuakhali district had low and high accessibility to overall healthcare facilities, respectively. Furthermore, accessibility to healthcare facilities was found very poor in rural areas, char areas, and seashore. Thereafter, it is recommended to provide an UHC in every upazila and a DH in the southern part of Galachipa upazila to ensure high spatial accessibility of healthcare facilities.

“Geografias” do acesso dos idosos aos cuidados de saúde primários na Área Metropolitana de Lisboa, Portugal - um território de diferenças

Resumo Vários autores têm refletido sobre a questão do acesso aos serviços de saúde, considerando a existência de várias dimensões, nas quais se inclui a disponibilidade e a acessibilidade. No contexto de envelhecimento que caracteriza as sociedades, a população idosa precisa de mais cuidados de saúde, e a acessibilidade a essas unidades assume importância acrescida. O objetivo do estudo é caracterizar o acesso da população idosa aos serviços de saúde, confrontando as possibilidades decorrentes da oferta de serviços com os padrões de procura. Do confronto entre oferta e procura resulta a possibilidade de identificar as dinâmicas intrarregionais e associá-las às diferentes condições socioeconômicas dos idosos, ao seu enquadramento familiar, modo de transporte e tipo de serviço. Esta abordagem considera duas fases metodológicas: o cálculo do potencial de cobertura populacional das unidades de cuidados primários, considerando a acessibilidade física recorrendo aos modos pedonal e rodoviário; e o confronto desses valores com a procura dos serviços, determinada a partir de inquéritos realizados aos residentes. Concluiu-se que, apesar dos equipamentos de saúde prestadores de cuidados primários terem sido programados como serviço de proximidade, a forma de prestação do serviço, as características socioeconômicas da população idosa e o modelo de urbanização apontam para diferenças relevantes no contexto da Área Metropolitana de Lisboa.

Spatial Accessibility to Primary Healthcare Services by Multimodal Means of Travel: Synthesis and Case Study in the City of Calgary

Universal access to primary healthcare facilities is a driving goal of healthcare organizations. Despite Canada's universal access to primary healthcare status, spatial accessibility to healthcare facilities is still an issue of concern due to the non-uniform distribution of primary healthcare facilities and population over space-leading to spatial inequity in the healthcare sector. Spatial inequity is further magnified when health-related accessibility studies are analyzed on the assumption of universal car access. To overcome car-centric studies of healthcare access, this study compares different travel modes-driving, public transit, and walking-to simulate the multi-modal access to primary healthcare services in the City of Calgary, Canada. Improving on floating catchment area methods, spatial accessibility was calculated based on the Spatial Access Ratio method, which takes into consideration the provider-to-population status of the region. The analysis revealed that, in the City of Calgary, spatial accessibility to the primary healthcare services is the highest for the people with an access to a car, and is significantly lower with multimodal (bus transit and train) means despite being a large urban centre. The social inequity issue raised from this analysis can be resolved by improving the city's pedestrian infrastructure, public transportation, and construction of new clinics in regions of low accessibility.