Lin Swu-Jane, Crawford Stephanie Y, Warren Salmon J
Department of Pharmacy Administration, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL 60612, USA.
Soc Sci Med. 2005 Apr;60(8):1881-91. doi: 10.1016/j.socscimed.2004.08.025.
The area configuration of healthcare resources, such as the number of hospitals per hundred thousand population, has often been used in healthcare planning and policy making to estimate the global access (potential access) of health services to a local population. However, the actual utilization of the "available" healthcare resources (revealed access) is usually much more limited. The objectives of this study were to examine the availability of healthcare resources by measuring the potential access and the revealed access for outpatients who need to access pharmacies to fill prescriptions of Schedule II (CII) opioids for pain management, and to explore the difference between rural and urban residents in these two types of access. About 191,700 prescriptions for CII opioids dispensed in 1997 in the state of Michigan, USA were analyzed. Revealed accessibility was measured by the distance between the paired zip codes of the pharmacy and the patient listed on each prescription. Potential accessibility was measured by the distance from a patient's zip code to that of the nearest community pharmacy that could dispense the opioid prescriptions. The analyses on revealed access showed that 50% of the CII prescriptions were dispensed by pharmacies located within a 5-mile radius of patients' residences, 75% of prescriptions were dispensed within about a 10-mile radius, and 90% were within 20 miles. If patients were free to access the nearest pharmacy for dispensing (a hypothetical situation under potential access), the median, 75th percentile, and 90th percentile distances could reduce to 2, 3, and 5 miles, respectively. Similar differences between revealed and potential access were observed in both rural and urban areas and for every major opioid drug group. We conclude that policymakers should recognize the discrepancy between potential and revealed accessibility and move beyond only considering area configuration of healthcare resources to evaluating and improving access to care.
医疗资源的区域配置，比如每十万人口的医院数量，常常被用于医疗规划和政策制定中，以估计当地居民获得医疗服务的总体可及性（潜在可及性）。然而，“可用”医疗资源的实际利用率（实际可及性）通常要低得多。本研究的目的是通过测量需要前往药房开具用于疼痛管理的II类阿片类药物处方的门诊患者的潜在可及性和实际可及性，来检验医疗资源的可及性，并探讨农村和城市居民在这两种可及性类型上的差异。对1997年美国密歇根州发放的约19.17万份II类阿片类药物处方进行了分析。实际可及性通过药房与每份处方上列出的患者配对邮政编码之间的距离来衡量。潜在可及性通过患者邮政编码与能够开具阿片类药物处方的最近社区药房的邮政编码之间的距离来衡量。对实际可及性的分析表明，50%的II类处方由位于患者住所半径5英里范围内的药房发放，75%的处方在约10英里半径内发放，90%在20英里内发放。如果患者可以自由前往最近的药房取药（潜在可及性下的假设情况），中位数、第75百分位数和第90百分位数距离可分别降至2英里、3英里和5英里。在农村和城市地区以及每个主要阿片类药物组中，实际可及性和潜在可及性之间都观察到了类似的差异。我们得出结论，政策制定者应认识到潜在可及性与实际可及性之间的差异，不应仅考虑医疗资源的区域配置，而应进一步评估和改善医疗服务的可及性。
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