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Spatial accessibility of primary care: concepts, methods and challenges.

Guagliardo MF - Int J Health Geogr (2004)

Bottom Line: Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S.For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live.Fortunately, some advances are occurring on the methodological front.These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas.This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Health Services and Community Research, Children's National Medical Center, Washington, DC, USA. markg@gwu.edu

ABSTRACT
Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S.For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live. First, explicit definitions and conceptualizations of healthcare access have not been widely used to guide research. An additional barrier to progress has been an overwhelming concern about affordability of care, which has garnered the majority of attention and research resources. Also, the most popular measures of spatial accessibility to care - travel impedance to nearest provider and supply level within bordered areas - lose validity in congested urban areas. Better measures are needed. Fortunately, some advances are occurring on the methodological front. These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas.This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.

No MeSH data available.


Related in: MedlinePlus

Space-time "aquarium" showing the paths of African American (purple) and Asian American (blue) women in Portland, Oregon, over the course of a typical day. The vertical dimension is time. (Reprinted with the permission of the creator, Mei-Po Kwan, Department of Geography, Ohio State University.)
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Figure 3: Space-time "aquarium" showing the paths of African American (purple) and Asian American (blue) women in Portland, Oregon, over the course of a typical day. The vertical dimension is time. (Reprinted with the permission of the creator, Mei-Po Kwan, Department of Geography, Ohio State University.)

Mentions: Others have argued that daily activity spaces are more representative of an individual's "location" than residential address [24,71]. Patients may find it convenient to obtain primary care near their work or shopping locations, a convenience that is overlooked by traditional studies based on residential address. Kwan [72-78] is working to address this problem for all forms of social science inquiry. She and colleagues ask subjects to keep daily activity diaries to record their movements and time of day. From these data Kwan builds 3-dimensional models – time being the third dimension – of subject movement. These "aquarium" visualizations of personal location and movement are remarkable and can reveal how very different, spatially and temporally, life can be for different gender and race/ethnicity groups. Figure 3, provided by Kwan, is a good illustration. It shows how existence in space-time differs for samples of African-American and Asian women in Portland, Oregon. It might be fruitful for health services researchers to attempt to match the space-time representation of the residents of various communities with the space-time availability of primary care providers in order to better identify gaps and disparities in space-time accessibility. Unfortunately the diary data are difficult to collect and the modeling methods are not yet generally available to researchers.


Spatial accessibility of primary care: concepts, methods and challenges.

Guagliardo MF - Int J Health Geogr (2004)

Space-time "aquarium" showing the paths of African American (purple) and Asian American (blue) women in Portland, Oregon, over the course of a typical day. The vertical dimension is time. (Reprinted with the permission of the creator, Mei-Po Kwan, Department of Geography, Ohio State University.)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC394340&req=5

Figure 3: Space-time "aquarium" showing the paths of African American (purple) and Asian American (blue) women in Portland, Oregon, over the course of a typical day. The vertical dimension is time. (Reprinted with the permission of the creator, Mei-Po Kwan, Department of Geography, Ohio State University.)
Mentions: Others have argued that daily activity spaces are more representative of an individual's "location" than residential address [24,71]. Patients may find it convenient to obtain primary care near their work or shopping locations, a convenience that is overlooked by traditional studies based on residential address. Kwan [72-78] is working to address this problem for all forms of social science inquiry. She and colleagues ask subjects to keep daily activity diaries to record their movements and time of day. From these data Kwan builds 3-dimensional models – time being the third dimension – of subject movement. These "aquarium" visualizations of personal location and movement are remarkable and can reveal how very different, spatially and temporally, life can be for different gender and race/ethnicity groups. Figure 3, provided by Kwan, is a good illustration. It shows how existence in space-time differs for samples of African-American and Asian women in Portland, Oregon. It might be fruitful for health services researchers to attempt to match the space-time representation of the residents of various communities with the space-time availability of primary care providers in order to better identify gaps and disparities in space-time accessibility. Unfortunately the diary data are difficult to collect and the modeling methods are not yet generally available to researchers.

Bottom Line: Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S.For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live.Fortunately, some advances are occurring on the methodological front.These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas.This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Health Services and Community Research, Children's National Medical Center, Washington, DC, USA. markg@gwu.edu

ABSTRACT
Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S.For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live. First, explicit definitions and conceptualizations of healthcare access have not been widely used to guide research. An additional barrier to progress has been an overwhelming concern about affordability of care, which has garnered the majority of attention and research resources. Also, the most popular measures of spatial accessibility to care - travel impedance to nearest provider and supply level within bordered areas - lose validity in congested urban areas. Better measures are needed. Fortunately, some advances are occurring on the methodological front. These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas.This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.

No MeSH data available.


Related in: MedlinePlus