Shah Tayyab Ikram, Bell Scott, Wilson Kathi
School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
PLoS One. 2016 Dec 20;11(12):e0168208. doi: 10.1371/journal.pone.0168208. eCollection 2016.
Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods.
This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population), was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms) used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons). An integrated geocoding approach was used to establish PHC locations.
The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs.
The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood level. In particular, the results show that the low access neighbourhoods tend to be clustered in the neighbourhoods at the urban periphery and immediately surrounding the downtown area.
城市环境会影响健康和福祉的诸多方面，获得医疗保健服务就是其中之一。在加拿大，城市地区获得初级卫生保健（PHC）是一个紧迫的研究和政策问题。加拿大大多数关于获得医疗保健服务的研究都集中在国家和省级层面；有必要将当前的认识推进到邻里等地方层面。
本研究使用三步浮动集水区（3SFCA）方法来考察家庭医生的空间可达性，以识别在地理上难以获得初级卫生保健服务的社区及其在加拿大14个城市地区的空间格局。使用3公里道路网络距离为各社区计算了一个初级卫生保健服务空间可达性指数，该指数代表可达性得分（每千人口的医生数）。本研究中使用的关于初级卫生保健提供者的信息（此定义不包括健康巴士或执业护士等移动服务或急诊室等分布较少的服务）是从公开可用且定期更新的来源（即省级医师和外科医生学院）收集的。采用综合地理编码方法来确定初级卫生保健机构的位置。
结果发现，产生城市层面可达性得分的三种方法，即简单比率法、邻里简单比率法和3SFCA法，彼此呈正相关。在城市地区内部和之间进行了比较分析，以考察初级卫生保健服务分布的差异。研究发现，在加拿大主要城市地区中，可达性得分较低的社区在满足高医疗需求人群方面存在进一步的劣势。
本研究结果表明，城市地区内部和之间在初级卫生保健服务的地理可达性方面存在很大差异。这项研究增进了我们对邻里层面医疗保健服务空间可达性的理解。特别是，结果表明，可达性低的社区往往集中在城市边缘和紧邻市中心的社区。
