School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia.
Research Unit, Colac Area Health, Colac, Vic, Australia.
BMC Health Serv Res. 2023 Apr 1;23(1):330. doi: 10.1186/s12913-023-09342-6.
Australia's inequitable distribution of health services is well documented. Spatial access relates to the geographic limitations affecting the availability and accessibility of healthcare practitioners and services. Issues associated with spatial access are often influenced by Australia's vast landmass, challenging environments, uneven population concentration, and sparsely distributed populations in rural and remote areas. Measuring access contributes to a broader understanding of the performance of health systems, particularly in rural/remote areas. This systematic review synthesises the evidence identifying what spatial measures and geographic classifications are used and how they are applied in the Australian peer-reviewed literature.
A systematic search of peer-reviewed literature published between 2002 and 2022 was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Search terms were derived from three major topics, including: [1] Australian population; [2] spatial analysis of health service accessibility; and [3] objective physical access measures.
Database searches retrieved 1,381 unique records. Records were screened for eligibility, resulting in 82 articles for inclusion. Most articles analysed access to primary health services (n = 50; 61%), followed by specialist care (n = 17; 21%), hospital services (n = 12; 15%), and health promotion and prevention (n = 3; 4%). The geographic scope of the 82 articles included national (n = 33; 40%), state (n = 27; 33%), metropolitan (n = 18; 22%), and specified regional / rural /remote area (n = 4; 5%). Most articles used distance-based physical access measures, including travel time (n = 30; 37%) and travel distance along a road network (n = 21; 26%), and Euclidean distance (n = 24; 29%).
This review is the first comprehensive systematic review to synthesise the evidence on how spatial measures have been applied to measure health service accessibility in the Australian context over the past two decades. Objective and transparent access measures that are fit for purpose are imperative to address persistent health inequities and inform equitable resource distribution and evidence-based policymaking.
澳大利亚的医疗服务分配不均是有据可查的。空间可达性涉及到影响医疗保健从业者和服务的可用性和可及性的地理限制。与空间可达性相关的问题通常受到澳大利亚幅员辽阔、环境恶劣、人口分布不均以及农村和偏远地区人口稀少等因素的影响。衡量可达性有助于更全面地了解卫生系统的绩效，特别是在农村/偏远地区。本系统评价综合了证据，确定了在澳大利亚同行评议文献中使用了哪些空间测量和地理分类，以及如何应用这些测量和分类。
采用系统评价和荟萃分析的首选报告项目（PRISMA）方法，对 2002 年至 2022 年期间发表的同行评议文献进行了系统搜索。检索词源自三个主要主题，包括：[1]澳大利亚人口；[2]卫生服务可达性的空间分析；和[3]客观物理可达性测量。
数据库检索共检索到 1381 条独特记录。对记录进行了资格筛选，最终纳入 82 篇文章。大多数文章分析了初级卫生服务的可达性（n=50；61%），其次是专科护理（n=17；21%）、医院服务（n=12；15%）和健康促进和预防（n=3；4%）。82 篇文章的地理范围包括全国（n=33；40%）、州（n=27；33%）、大都市（n=18；22%）和指定的区域/农村/偏远地区（n=4；5%）。大多数文章使用基于距离的物理可达性测量方法，包括旅行时间（n=30；37%）和沿路网的旅行距离（n=21；26%）和欧几里得距离（n=24；29%）。
这是首次对过去 20 年来如何在澳大利亚背景下应用空间测量来衡量卫生服务可达性的证据进行综合系统评价。客观透明的可达性测量方法是解决持续存在的卫生不公平问题和为公平资源分配和循证决策提供信息的必要条件。
