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全面覆盖?按城市化程度和社会剥夺程度对英格兰全科医疗和社区药房服务可及性进行的区域层面分析。

Access all areas? An area-level analysis of accessibility to general practice and community pharmacy services in England by urbanity and social deprivation.

作者信息

Todd Adam, Copeland Alison, Husband Andy, Kasim Adetayo, Bambra Clare

机构信息

Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, UK Centre of Health and Inequalities Research (CIHR), Durham University, Durham, UK.

Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, UK.

出版信息

BMJ Open. 2015 May 8;5(5):e007328. doi: 10.1136/bmjopen-2014-007328.

Abstract

OBJECTIVES

(1) To determine the percentage of the population in England that has access to a general practitioner (GP) premises within a 20 min walk (the accessibility); (2) explore the relationship between the walking distance to a GP premises and urbanity and social deprivation and (3) compare accessibility of a GP premises to that of a community pharmacy--and how this may vary by urbanity and social deprivation.

DESIGN

This area-level analysis spatial study used postcodes for all GP premises and community pharmacies in England. Each postcode was assigned to a population lookup table and Lower Super Output Area (LSOA). The LSOA was then matched to urbanity (urban, town and fringe, or village, hamlet and isolated dwellings) and deprivation decile (using the Index of Multiple Deprivation score 2010).

PRIMARY OUTCOME MEASURE

Living within a 20 min walk of a GP premises.

RESULTS

Overall, 84.8% of the population is estimated to live within a 20 min walk of a GP premises: 81.2% in the most affluent areas, 98.2% in the most deprived areas, 94.2% in urban and 19.4% in rural areas. This is consistently lower when compared with the population living within a 20 min walk of a community pharmacy.

CONCLUSIONS

Our study shows that the vast majority of the population live within a 20 min walk of a GP premises, with higher proportions in the most deprived areas--a positive primary care law. However, more people live within a 20 min walk of a community pharmacy compared with a GP premises, and this potentially has implications for the commissioning of future services from these healthcare providers in England.

摘要

目标

(1)确定在英格兰能够在20分钟步行路程内到达全科医生(GP)诊疗场所的人口比例(可达性);(2)探究到GP诊疗场所的步行距离与城市化程度和社会剥夺之间的关系;(3)比较GP诊疗场所与社区药房的可达性,以及这两者如何因城市化程度和社会剥夺而有所不同。

设计

这项区域层面的空间分析研究使用了英格兰所有GP诊疗场所和社区药房的邮政编码。每个邮政编码都被分配到一个人口查找表和下一级超级输出区(LSOA)。然后将LSOA与城市化程度(城市、城镇边缘或村庄、小村落及独立住宅)和剥夺十分位数(使用2010年多重剥夺指数得分)进行匹配。

主要观察指标

居住在距离GP诊疗场所20分钟步行路程内。

结果

总体而言,估计84.8%的人口居住在距离GP诊疗场所20分钟步行路程内:最富裕地区为81.2%,最贫困地区为98.2%,城市地区为94.2%,农村地区为19.4%。与居住在距离社区药房20分钟步行路程内的人口相比,这一比例始终较低。

结论

我们的研究表明,绝大多数人口居住在距离GP诊疗场所20分钟步行路程内,在最贫困地区这一比例更高——这是一项积极的初级保健规律。然而,与距离GP诊疗场所20分钟步行路程内的人口相比,更多人居住在距离社区药房20分钟步行路程内,这可能对英格兰这些医疗服务提供者未来服务的委托产生影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e08/4431167/e59d8e5bdcc2/bmjopen2014007328f01.jpg

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