Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia.
National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria, Australia.
PLoS One. 2019 Jul 25;14(7):e0219959. doi: 10.1371/journal.pone.0219959. eCollection 2019.
To identity differences between a general access index (Accessibility/ Remoteness Index of Australia; ARIA+) and a specific acute and aftercare cardiac services access index (Cardiac ARIA).
Exploratory descriptive design. ARIA+ (2011) and Cardiac ARIA (2010) were compared using cross-tabulations (chi-square test for independence) and map visualisations. All Australian locations with ARIA+ and Cardiac ARIA values were included in the analysis (n = 20,223). The unit of analysis was Australian locations.
Of the 20,223 locations, 2757 (14% of total) had the highest level of acute cardiac access coupled with the highest level of general access. There were 1029 locations with the poorest access (5% of total). Approximately two thirds of locations in Australia were classed as having the highest level of cardiac aftercare. Locations in Major Cities, Inner Regional Australia, and Outer Regional Australia accounted for approximately 98% of this category. There were significant associations between ARIA+ and Cardiac ARIA acute (χ2 = 25250.73, df = 28, p<0.001, Cramer's V = 0.559, p<0.001) and Cardiac ARIA aftercare (χ2 = 17204.38, df = 16, Cramer's V = 0.461, p<0.001).
Although there were significant associations between the indices, ARIA+ and Cardiac ARIA are not interchangeable. Systematic differences were apparent which can be attributed largely to the underlying specificity of the Cardiac ARIA (a time critical index that uses distance to the service of interest) compared to general accessibility quantified by the ARIA+ model (an index that uses distance to population centre). It is where the differences are located geographically that have a tangible impact upon the communities in these locations-i.e. peri-urban areas of the major capital cities, and around the more remote regional centres. There is a strong case for specific access models to be developed and updated to assist with efficient deployment of resources and targeted service provision. The reasoning behind the differences highlighted will be generalisable to any comparison between general and service-specific access models.
识别一般准入指数（澳大利亚可及性/偏远指数；ARIA+）和特定急性及后续心脏服务准入指数（心脏 ARIA）之间的差异。
探索性描述性设计。使用交叉表（独立性卡方检验）和地图可视化比较 ARIA+（2011 年）和心脏 ARIA（2010 年）。将分析纳入所有具有 ARIA+和心脏 ARIA 值的澳大利亚地点（n=20223）。分析单位为澳大利亚地点。
在 20223 个地点中，2757 个（占总数的 14%）具有最高水平的急性心脏准入，同时具有最高水平的一般准入。有 1029 个地点的准入情况最差（占总数的 5%）。澳大利亚约三分之二的地点被归类为具有最高水平的心脏后续护理。主要城市、内陆地区和外区域地区的地点占该类别约 98%。ARIA+与心脏 ARIA 急性（χ2=25250.73，df=28，p<0.001，Cramer's V=0.559，p<0.001）和心脏 ARIA 后续护理（χ2=17204.38，df=16，Cramer's V=0.461，p<0.001）之间存在显著关联。
尽管这两个指数之间存在显著关联，但 ARIA+和心脏 ARIA 不可互换。显然存在系统差异，这主要归因于心脏 ARIA 的特异性（使用到感兴趣的服务的距离的时间关键指数）与 ARIA+模型（使用到人口中心的距离的一般性可及性指数）相比。差异在地理上的位置对这些位置的社区产生了实际影响，即主要首都城市的城市周边地区以及更偏远的区域中心周围。强烈需要开发和更新特定的准入模型，以协助资源的有效部署和有针对性的服务提供。所强调的差异背后的原因对于任何一般和服务特定准入模型之间的比较都是普遍适用的。
