Chong Shanley, Byun Roy, Jalaludin Bin B
Epidemiology, Health, People and Places Unit, Population Health, South Western Sydney Local Health District, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
Epidemiology, Health, People and Places Unit, Population Health, South Western Sydney Local Health District, NSW, Australia; Faculty of Dentistry, The University of Sydney, NSW, Australia.
Public Health Res Pract. 2015 Sep 30;25(4):e2541542. doi: 10.17061/phrp2541542.
Advances in geographic information systems (GIS) and increased availability of routinely collected data have the potential to contribute to public health and health services research. The aim of this feasibility study was to explore the use of GIS to measure access to general practices and its relationship to selected antenatal behaviours.
We obtained the Perinatal Data Collection, 2004-2008, for South Western Sydney Local Health District from the New South Wales Ministry of Health. Using a GIS, we generated circular and polygon-based 1 km and 2 km road network buffers from a maternal residential address and then calculated the number of general practices within those buffers (density measures). Distances to general practices from maternal residences were also calculated in the GIS as another measure of geographic access to general practices (proximity measures). We used generalised estimating equations logistic regression to examine associations between access to general practices, and smoking during pregnancy and late first antenatal visit.
The numbers of general practices within circular buffers were significantly greater than within polygon-based road network buffers. The average distance to the five closest general practices from a mother's residence was 2.3 km ± 3.0 km (median 1.4 km, range 0.05 km to 40.0 km). For two of the five measures of access, a higher number of general practices was associated with increased risk for late first antenatal visit. However, the associations were weak, with odds ratios very close to unity. Choice of metrics of geographic access to general practices did not alter the associations with smoking during pregnancy or late first antenatal visit.
GIS can be used to quantify measures of geographic access to health services for public health and health services research. Geographic access to general practices was generally not associated with smoking during pregnancy or late first antenatal visit. GIS and routinely collected health data can be used to answer novel questions in public health and health services research.
地理信息系统（GIS）的进展以及常规收集数据的可得性增加，有可能促进公共卫生和卫生服务研究。这项可行性研究的目的是探索使用GIS来衡量获得全科医疗服务的情况及其与选定的产前行为之间的关系。
我们从新南威尔士州卫生部获取了2004 - 2008年悉尼西南地方卫生区的围产期数据收集资料。利用GIS，我们从产妇居住地址生成基于圆形和多边形的1公里和2公里道路网络缓冲区，然后计算这些缓冲区内的全科医疗服务机构数量（密度指标）。在GIS中还计算了产妇住所到全科医疗服务机构的距离，作为获得全科医疗服务的地理可达性的另一指标（接近度指标）。我们使用广义估计方程逻辑回归来检验获得全科医疗服务与孕期吸烟以及首次产前检查延迟之间的关联。
圆形缓冲区内的全科医疗服务机构数量显著多于基于多边形的道路网络缓冲区内的数量。从母亲住所到最近的五家全科医疗服务机构的平均距离为2.3公里±3.0公里（中位数1.4公里，范围0.05公里至40.0公里）。对于五种可达性测量指标中的两种，全科医疗服务机构数量较多与首次产前检查延迟的风险增加相关。然而，这些关联较弱，比值比非常接近1。选择衡量获得全科医疗服务的地理可达性的指标并未改变与孕期吸烟或首次产前检查延迟之间的关联。
GIS可用于量化公共卫生和卫生服务研究中获得卫生服务的地理可达性指标。获得全科医疗服务的地理可达性通常与孕期吸烟或首次产前检查延迟无关。GIS和常规收集的健康数据可用于回答公共卫生和卫生服务研究中的新问题。
