Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
Int J Health Plann Manage. 2013 Jul-Sep;28(3):248-56. doi: 10.1002/hpm.2134. Epub 2012 Aug 31.
An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti.
We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care.
The highest annual surgical utilization rate was 184 operations/100,000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital (rs = -0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults (p < 0.01), and distance from residence to hospital was not significantly different between men and women (p = 0.25). Patients who received obstetric or gynecologic surgery originated 7.8% closer to the hospital than patients seeking other operations (p < 0.01), and patients who received emergent surgical care originated 24.8% closer to the hospital than patients who received elective surgery (p < 0.01).
Utilization of surgical services was low and inversely related to distance from residence to hospital in rural areas of central Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care.
以前已经描述过医疗保健利用与护理距离之间的反比关系。本研究的目的是评估海地中部紧急和基本外科护理的这种效果。
我们对海地 Cange 的Clinique Bon Sauveur的手术日志进行了回顾性研究，时间范围为 2008 年至 2010 年。我们使用地理信息系统绘制所有患者的家庭住址图。使用斯皮尔曼相关系数确定手术利用与距离之间的关系，并使用多元线性回归模型确定与旅行距离差异相关的特征。
最高年手术利用率为 184 例/每 10 万人。我们发现手术利用率与居住地到医院的距离之间存在显著的负相关关系(rs=-0.68，p=0.02)。从居住地到医院的中位数距离为 55.9 公里。儿科患者比成年人距离医院近 10.1%(p<0.01)，而且男性和女性之间的距离没有显著差异(p=0.25)。接受妇产科手术的患者比接受其他手术的患者距离医院近 7.8%(p<0.01)，接受紧急手术的患者比接受择期手术的患者距离医院近 24.8%(p<0.01)。
在海地中部农村地区，手术服务的利用率较低，与居住地到医院的距离呈反比。儿童和接受妇产科或紧急手术的患者距离医院更近，这些群体可能需要特别关注，以确保获得足够的手术护理。
