Guagliardo Mark F
Center for Health Services and Community Research, Children's National Medical Center, Washington, DC, USA.
Int J Health Geogr. 2004 Feb 26;3(1):3. doi: 10.1186/1476-072X-3-3.
Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S.For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live. First, explicit definitions and conceptualizations of healthcare access have not been widely used to guide research. An additional barrier to progress has been an overwhelming concern about affordability of care, which has garnered the majority of attention and research resources. Also, the most popular measures of spatial accessibility to care - travel impedance to nearest provider and supply level within bordered areas - lose validity in congested urban areas. Better measures are needed. Fortunately, some advances are occurring on the methodological front. These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas.This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.
初级保健被认为是维护人群健康最重要的医疗保健形式，因为它相对成本较低，比专科和住院治疗更易于提供，并且如果分布合理，在大规模预防疾病进展方面最为有效。健康地理学领域的最新进展极大地增进了我们对卫生服务地理分布在人群健康维护中所起作用的理解。然而，这些知识大多是关于医院、专科服务以及农村地区的服务。对于初级保健的距离和供应对初级保健利用的影响，我们所知甚少，尤其是在美国。由于多种原因，在大多数人居住的城市地区，信息短缺问题尤为严重。首先，医疗保健可及性的明确定义和概念尚未广泛用于指导研究。取得进展的另一个障碍是对医疗保健可负担性的过度关注，这吸引了大部分关注和研究资源。此外，最常用的医疗保健空间可及性衡量指标——到最近医疗服务提供者的出行阻力以及划定区域内的供应水平——在拥堵的城市地区失去了有效性。我们需要更好的衡量指标。幸运的是，在方法学方面正在取得一些进展。这些进展可以增进我们对所有环境中各类医疗保健地理学的了解，包括城市地区的初级保健。本文解释了可及性的基本概念和衡量方法，提供了一些历史背景，概述了有关初级保健地理可及性的主要问题，描述了地理信息系统（GIS）和空间分析的最新发展，并给出了有前景的研究工作示例。
