Distance, rurality and the need for care: access to health services in South West England.
Distance, rurality and the need for care: access to health services in South West England.
复制标题
DOI：
10.1186/1476-072x-3-21
复制
发表时间：
2004-09-29
影响因子：
4.9
通讯作者：
Barnett, Sarah
中科院分区：
文献类型：
--
作者：
Jordan, Hannah;Roderick, Paul;Barnett, Sarah
背景技术背景：本文探讨了英格兰西南部城市和农村地区卫生服务的地理可及性，比较了两种地理可及性的措施，并描述了最偏远的地区从hospital.Straight-line距离和驾驶时间到最近的全科诊所（GP）和急性医院（DGH）计算邮政编码和汇总到1991年人口普查病房。这两个措施之间的相关性被用来确定病房的直线距离是不是一个准确的预测驾驶时间。距离DGH超过25公里的病房被归类为“偏远”，其特征在于农村性、贫困、年龄结构和人口健康状况。结果：访问措施高度相关（r2>0.93）。最大的差异出现在西南部的沿海和农村地区。到GP的中位直线距离为1 km（IQR = 0.6-2 km），到DGHS的中位直线距离为12 km（IQR = 5-19 km）。在离医院最远的地区，早产和限制性长期疾病的发病率有所上升，但没有证据表明早产死亡率更高。国家统计局没有将远离DGH的一半选区归类为农村地区。在离医院最远的病房里，近四分之一的家庭没有汽车，在最偏远的地区，拥有两辆或两辆以上汽车的家庭比例也有所下降。结论：驾驶时间是一个更准确的衡量周边和农村地区的访问。获得保健服务，特别是全科医生的地理条件很好，但偏远对农村和城市地区都有影响：纯粹集中于农村地区的研究可能低估了获得保健的地理障碍。在1991年，仍有相当多的少数家庭没有汽车，很少有家庭拥有一辆以上的汽车，特别是在离医院很近或很远的地区。如果要准确反映没有自己交通工具的人的经历，就需要更好的地理准入措施，将公共和私人交通工具的可用性与距离和旅行时间结合起来。
BACKGROUND: This paper explores the geographical accessibility of health services in urban and rural areas of the South West of England, comparing two measures of geographical access and characterising the areas most remote from hospitals.Straight-line distance and drive-time to the nearest general practice (GP) and acute hospital (DGH) were calculated for postcodes and aggregated to 1991 Census wards. The correlation between the two measures was used to identify wards where straight-line distance was not an accurate predictor of drive-time. Wards over 25 km from a DGH were classified as 'remote', and characterised in terms of rurality, deprivation, age structure and health status of the population. RESULTS: The access measures were highly correlated (r2>0.93). The greatest differences were found in coastal and rural wards of the far South West. Median straight-line distance to GPs was 1 km (IQR = 0.6-2 km) and to DGHs, 12 km (IQR = 5-19 km). Deprivation and rates of premature limiting long term illness were raised in areas most distant from hospitals, but there was no evidence of higher premature mortality rates. Half of the wards remote from a DGH were not classed as rural by the Office for National Statistics. Almost a quarter of households in the wards furthest from hospitals had no car, and the proportion of households with access to two or more cars fell in the most remote areas. CONCLUSION: Drive-time is a more accurate measure of access for peripheral and rural areas. Geographical access to health services, especially GPs, is good, but remoteness affects both rural and urban areas: studies concentrating purely on rural areas may underestimate geographical barriers to accessing health care. A sizeable minority of households still had no car in 1991, and few had more than one car, particularly in areas very close to and very distant from hospitals. Better measures of geographical access, which integrate public and private transport availability with distance and travel time, are required if an accurate reflection of the experience those without their own transport is to be obtained.