Meise U, Kemmler G, Kurz M, Rössler W
Universitätsklinik für Psychiatrie Innsbruck.
Gesundheitswesen. 1996 Jul;58(1 Suppl):29-37.
The goal of reasonable accessibility of specialised care to all those who need it must be kept in mind when planning to establish mental health service in the community. For methodological purposes, an attempt is made to quantify and thus render measurable the accessibility factor, also to be called "quality of location", based on "spatial" as well as "non-spatial" indicators. In many areas of community life involving planning and political decision making, the importance of such an approach cannot be underestimated. On the basis of the 1989 case register in the Austrian State of Tyrol, we investigated the relationship between administrative prevalence and the distance between the patient's home and the nearest hospital providing in-patient care, this distance being measured in terms of the time it takes to get to the hospital by public transportation. Our investigation confirmed the phenomenon described for the first time in 1852 by E. Jarvis, that there is an inverse relationship between the frequency of hospital admission and the geographical distance patients had to travel. This observation was validated, first of all, by excluding the possibility of selective migration influencing the inverse relationship between utilisation of available facilities by patients and the distance from their homes, and, secondly, by making suitable adjustments for the influence of "non-spatial" indicators such as rural/urban differences, socio-demographic variables and economic factors as indicated by the census figures. In the health service region we investigated, comprising of small town/rural areas, it was found that the Jarvis effect was slightly weakened; this observation, however, could not be explained solely in terms of the "non-spatial" indicators. What is new in the present investigation is the use of time as a dimension in the description of quality of location, as well as the approach combining the two sets of indicators, the "spatial" and the "non-spatial", which have hitherto been considered isolated from each other. Using the temporal dimension, it was possible to determine the time limit, i.e. the "sensitivity to distance" which can be looked upon as defining reasonable accessibility to in-patient care. This turned out to be about 30 to 45 minutes of travel by public transportation, this being shorter than the figure given by the German Mental Health Service survey. In summary, our investigation shows that the temporal dimension-the distance between home and hospital measured in terms of the time it takes to get to the hospital-is the most significant determinant of the quality of location; socio-demographic and economic factors play merely a secondary role.
在规划社区心理健康服务时，必须牢记让所有有需要的人都能合理获得专科护理这一目标。出于方法学目的，我们试图基于“空间”和“非空间”指标对可及性因素进行量化，从而使其可衡量，该因素也可称为“选址质量”。在社区生活中许多涉及规划和政治决策的领域，这种方法的重要性不可低估。基于奥地利蒂罗尔州1989年的病例登记册，我们研究了行政患病率与患者住所与提供住院护理的最近医院之间的距离的关系，此距离通过乘坐公共交通工具前往医院所需的时间来衡量。我们的调查证实了E.贾维斯在1852年首次描述的现象，即住院频率与患者必须出行的地理距离之间存在反比关系。这一观察结果首先通过排除选择性迁移影响患者对现有设施的利用率与其住所距离之间反比关系的可能性得到验证，其次通过对人口普查数据所示的农村/城市差异、社会人口变量和经济因素等“非空间”指标的影响进行适当调整得到验证。在我们调查的包括小镇/农村地区的医疗服务区域，发现贾维斯效应略有减弱；然而，这一观察结果不能仅用“非空间”指标来解释。本研究的新颖之处在于在描述选址质量时使用时间作为一个维度，以及将“空间”和“非空间”这两组指标结合起来的方法，这两组指标迄今为止一直被视为相互孤立的。利用时间维度，可以确定时间限制，即“距离敏感性”，它可被视为界定住院护理合理可及性的标准。结果表明，乘坐公共交通工具出行约30至45分钟，这比德国心理健康服务调查给出的数字要短。总之，我们的调查表明，时间维度——以到达医院所需时间衡量的住所与医院之间的距离——是选址质量的最重要决定因素；社会人口和经济因素仅起次要作用。
