Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilians-Universität München (LMU), Munich, Germany.
BMJ Open. 2018 Oct 23;8(10):e021036. doi: 10.1136/bmjopen-2017-021036.
(1) To describe the accessibility of general practitioners (GPs) by the German population; (2) to determine factors on individual and area level, such as settlement structure and area deprivation, which are associated with the walking distance to a GP; and (3) to identify factors that may cause differences in the utilisation of any doctors.
Cross-sectional study using individual survey data from the representative German Socio-Economic Panel (SOEP) linked with area deprivation data from the German Index of Multiple Deprivation for 2010 (GIMD 2010) and official data for settlement structure (urban/rural areas) at district level. Logistic regression models were estimated to determine the relationship of individual and area factors with the distance to a GP. Negative binomial regressions were used to analyse the association with utilisation.
Germany.
n=20 601 respondents from the SOEP survey data 2009.
Walking distance to a GP.
Doctor visits.
Nearly 70% of the sample lives within a 20 min walk to a GP. People living in the most deprived areas have a 1.4-fold (95% CI 1.3 to 1.6) increased probability of a greater walking distance compared with the least deprived quintile, even after controlling for settlement structure and individual factors. In rural districts, people have a 3.1-fold (95% CI 2.8 to 3.4) higher probability of a greater walking distance compared with those in cities. Both area deprivation and rurality have a negative relationship with the utilisation of physicians, whereas the distance to a GP is not associated with the utilisation of physicians.
Walking distance to a GP depends on individual and area factors. In Germany, area deprivation is negatively correlated with the accessibility of GPs while controlling for settlement structure and individual factors. Both area factors are negatively associated with the utilisation of doctors. This knowledge could be used for future GP requirement plans.
(1)描述德国民众对全科医生的可及性；(2)确定个体和地区层面的因素，如居住结构和地区贫困程度，这些因素与到全科医生的步行距离有关；(3)确定可能导致任何医生利用差异的因素。
使用来自代表性德国社会经济面板 (SOEP) 的个人调查数据与 2010 年德国多重剥夺指数 (GIMD 2010) 的地区贫困数据以及区县级居住结构的官方数据进行链接的横断面研究。使用逻辑回归模型来确定个体和地区因素与到 GP 的距离的关系。使用负二项回归分析与利用的关联。
德国。
来自 SOEP 调查数据 2009 的 20601 名受访者。
到 GP 的步行距离。
医生就诊。
近 70%的样本在 20 分钟步行距离内可以找到 GP。与最贫困的五分位数相比，生活在最贫困地区的人到 GP 的步行距离增加的可能性增加了 1.4 倍（95%置信区间 1.3 至 1.6），即使在控制了居住结构和个体因素之后也是如此。在农村地区，与城市相比，人们到 GP 的步行距离增加的可能性要高出 3.1 倍（95%置信区间 2.8 至 3.4）。地区贫困和农村化都与医生的利用呈负相关，而到 GP 的距离与医生的利用无关。
到 GP 的步行距离取决于个体和地区因素。在德国，在控制居住结构和个体因素的情况下，地区贫困与全科医生的可及性呈负相关。两个地区因素都与医生的利用呈负相关。这些知识可用于未来的 GP 需求计划。
