Brabyn Lars, Barnett Ross
Department of Geography, University of Waikato, Hamilton, New Zealand.
N Z Med J. 2004 Aug 6;117(1199):U996.
To use a geographical information system (GIS) approach to demonstrate the extent to which different areas in New Zealand vary in their geographical access to GPs, and to analyse the extent to which spatial access varies in relation to different population groups.
Three methods; population/GP ratios, least cost path analysis (LCPA), and an allocation method (which considered the capacity constraint of GPs) were used to demonstrate differences in geographic accessibility to GPs. Travel time, and distance to the closest GP, was calculated for every census enumeration district in New Zealand (n=38336)--thus enabling population-based accessibility statistics to be calculated and aggregated to the territorial local authority level. These calculations include the average travel time if everybody visited a GP once and the population more than 30 minutes from a GP. The composition of this population is analysed according to three criteria of need: the level of deprivation (NZDep2001), ethnicity (%Maori), and age (% <5 years, and %65 years and over).
There are significant regional variations in geographical accessibility in New Zealand, and these differences are dependent upon the method to calculate accessibility. Ratio measures give a different picture of GP access than the other two indicators, reflecting the fact that TAs with similar ratios often have wide variations in travel times as well as the size and proportion of the population living more than 30 minutes from the closest GP. TAs with larger numbers and a higher proportion of their populations living in such areas tend to be more deprived and have a higher proportion of Maori, especially in the North Island. There appears to be no significant trend by age.
Given the health and service consequences of poor access, the results suggest that more attention needs to be paid to extending the spatial information base in primary care, in order to achieve more effective planning of services for disadvantaged populations.
运用地理信息系统（GIS）方法，展示新西兰不同地区在获取全科医生服务的地理便利性方面的差异程度，并分析空间可达性因不同人群而产生的变化程度。
采用三种方法；人口/全科医生比例、最小成本路径分析（LCPA）以及一种分配方法（该方法考虑了全科医生的能力限制）来展示获取全科医生服务的地理可达性差异。计算了新西兰每个普查枚举区（n = 38336）到最近全科医生的出行时间和距离，从而能够计算基于人口的可达性统计数据，并汇总到地区地方当局层面。这些计算包括如果每个人都去看一次全科医生的平均出行时间以及距离全科医生超过30分钟路程的人口。根据三个需求标准分析了这部分人口的构成：贫困程度（NZDep2001）、种族（毛利人百分比）和年龄（<5岁百分比以及65岁及以上百分比）。
新西兰在地理可达性方面存在显著的区域差异，且这些差异取决于计算可达性的方法。比例指标所呈现的全科医生服务获取情况与其他两个指标不同，这反映出比例相似的地区管理局在出行时间以及距离最近全科医生超过30分钟路程的人口规模和比例方面往往存在很大差异。居住在这些地区的人口数量较多且比例较高的地区管理局往往更为贫困，毛利人比例也更高，尤其是在北岛。按年龄来看似乎没有明显趋势。
鉴于获取服务不便对健康和服务产生的影响，研究结果表明，需要更加关注扩展初级保健中的空间信息基础，以便为弱势群体更有效地规划服务。
