Kiani Behzad, Bagheri Nasser, Tara Ahmad, Hoseini Benyamin, Tabesh Hamed, Tara Mahmood
Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad.
Geospat Health. 2017 Nov 7;12(2):584. doi: 10.4081/gh.2017.584.
Poor access to haemodialysis facilities is associated with high mortality and morbidity rates. This study investigated factors affecting revealed access to the haemodialysis facilities considering patients living in rural and urban areas without any haemodialysis facility (Group A) and those living urban areas with haemodialysis facilities (Group B). This study is based on selfreported Actual Access Time (AAT) to referred haemodialysis facilities and other information regarding travel to haemodialysis facilities from patients. All significant variables on univariate analysis were entered into a univariate general linear model in order to identify factors associated with AAT. Both spatial (driving time and distance) and non-spatial factors (sex, income level, caregivers, transportation mode, education level, ethnicity and personal vehicle ownership) influenced the revealed access identified in Group A. The non-spatial factors for Group B patients were the same as for Group A, but no spatial factor was identified in Group B. It was found that accessibility is strongly underestimated when driving time is chosen as accessibility measure to haemodialysis facilities. Analysis of revealed access determinants provides policymakers with an appropriate decision base for making appropriate decisions and finding solutions to decrease the access time for patients under haemodialysis therapy. Driving time alone is not a good proxy for measuring access to haemodialysis facilities as there are many other potential obstacles, such as women's special travel problems, poor other transportation possibilities, ethnicity disparities, low education levels, low caregiver status and low-income.
血液透析设施可及性差与高死亡率和高发病率相关。本研究调查了影响血液透析设施实际可及性的因素，研究对象包括居住在没有任何血液透析设施的农村和城市地区的患者（A组）以及居住在有血液透析设施的城市地区的患者（B组）。本研究基于患者自我报告的前往指定血液透析设施的实际可及时间（AAT）以及其他有关前往血液透析设施行程的信息。单因素分析中所有显著变量都被纳入单因素一般线性模型，以确定与AAT相关的因素。空间因素（驾车时间和距离）和非空间因素（性别、收入水平、照顾者、交通方式、教育水平、种族和个人车辆拥有情况）均影响了A组患者的实际可及性。B组患者的非空间因素与A组相同，但未发现B组存在空间因素。研究发现，当选择驾车时间作为血液透析设施可及性的衡量指标时，可及性被严重低估。对实际可及性决定因素的分析为政策制定者提供了一个适当的决策基础，以便做出合适的决策并找到解决方案，以减少接受血液透析治疗患者的可及时间。仅驾车时间并不是衡量血液透析设施可及性的良好指标，因为还存在许多其他潜在障碍，如女性特殊的出行问题、其他交通方式不佳、种族差异、教育水平低、照顾者地位低和收入低等。
