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医疗保健实践的地理信息系统绘图:英国的老年人能否公平获得牙科和医疗服务?

GIS mapping of healthcare practices: do older adults have equitable access to dental and medical care in the UK?

作者信息

Jo Olivia, Kruger Estie, Tennant Marc

机构信息

School of Human Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, 6009, Australia.

Department of Anatomy, Physiology and Human Biology, University of Western Australia, 35 Stirling Highway, Nedlands, Perth, 6009, Australia; International Research Collaborative Oral Health and Equity, University of Western Australia, Crawley, 6009, Australia.

出版信息

Br Dent J. 2021 Sep 22. doi: 10.1038/s41415-021-3406-0.

Abstract

Introduction Considering an ageing population with increasing comorbidities, access to oral and general healthcare is a growing concern. This study aimed to identify and compare access to dental and general practices. This study further aimed to ascertain if there exists a socioeconomic distribution of dental and general practices among older adults.Materials and methods A total of 13,007 dental practices and 13,759 general practices were mapped using geographic information system software, and overlaid with the UK older adult population and deprivation data by health areas. Data analysis was carried out by creating a geographical distribution map and by using descriptive statistics, Gini coefficients and Lorenz curves.Results NHS Central London Clinical Commissioning Group (CCG) held the highest dental practice-to-population ratio of 958 practices per 100,000 older adults, while NHS Manchester CCG held the highest general practice-to-population ratio of 264.4 general practices per 100,000 older adults. England had the highest Gini coefficients for general and dental practice at 0.214 and 0.195, respectively. Both dental and general practices were socioeconomically distributed among older adults in England, Wales and Northern Ireland, but not in Scotland.Conclusions An increasing proportion of older adults need access to healthcare that is based on clinical need, not the ability to pay; a founding principle of the NHS. This nation-wide study captures inequities in the spatial accessibility for older adults in the UK.

摘要

引言 考虑到人口老龄化且合并症增多,获得口腔和普通医疗保健成为日益令人担忧的问题。本研究旨在确定并比较获得牙科和普通医疗服务的情况。本研究还旨在确定老年人中牙科和普通医疗服务是否存在社会经济分布差异。

材料与方法 使用地理信息系统软件绘制了总共13007家牙科诊所和13759家普通诊所的地图,并与英国老年人人口数据和按健康区域划分的贫困数据叠加。通过创建地理分布图并使用描述性统计、基尼系数和洛伦兹曲线进行数据分析。

结果 英国国民医疗服务体系(NHS)伦敦市中心临床委托小组(CCG)的牙科诊所与人口比例最高,每10万名老年人中有958家诊所,而NHS曼彻斯特CCG的普通诊所与人口比例最高,每10万名老年人中有264.4家诊所。英格兰普通医疗和牙科服务的基尼系数最高,分别为0.214和0.195。在英格兰、威尔士和北爱尔兰,老年人中的牙科和普通医疗服务在社会经济方面存在分布差异,但在苏格兰并非如此。

结论 越来越多的老年人需要获得基于临床需求而非支付能力的医疗保健服务,这是NHS的一项基本原则。这项全国性研究揭示了英国老年人在空间可及性方面的不平等。

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