Abstract
Many Canadians experience unequal access to primary care services, despite living in a country with a universal health care system. Health inequalities affect all Canadians but have a much stronger impact on the health of vulnerable populations. Health inequalities are preventable differences in the health status or distribution of health resources as experienced by vulnerable populations. A geospatial approach was applied to examine how closely the distribution of primary care providers (PCPs) in London, Ontario meet the needs of vulnerable populations, including people with low income status, seniors, lone parents, and linguistic minorities. Using enhanced two step floating catchment area (E2SFCA) method, an index of geographic access scores for all PCPs and PCPs speaking French, Arabic, and Spanish were separately developed at the dissemination area (DA) level. To analyze how PCPs are distributed, comparative analyses were performed in association with specific vulnerable groups. Geographical accessibility to all PCPs, and PCPs who speak specific minority languages vary considerably across the city of London. Access scores for French- and Arabic-speaking PCPs are found comparatively high (mean = 2.85 and 1.01 respectively) as compared to Spanish-speaking PCPs (mean = 0.47). Additionally, many areas with high proportions of vulnerable populations experience low accessibility. Despite its exploratory nature, this study offers insight into intra-urban distributions of geographical accessibility to primary care resources for vulnerable groups. These findings can facilitate health researchers and policymakers in the development of recommendations to increase levels of accessibility of specific population groups in underserved areas.
Highlights
Primary health care (PHC) is acknowledged as a foundation of any high performing health care system that provides access to health care services for all health-related needs and problems, providing person-focused care over time in a continuous and coordinated fashion [1]
This data included the name of the primary care providers (PCPs), office address, and languages spoken of all PCPs that reside within the Southwestern Ontario region encompassing the city of London
The city of London has a variety of PCPs that practice primary care in languages other than English, with 13 of them practicing in French, seven in Arabic, and four in Spanish
Summary
Primary health care (PHC) is acknowledged as a foundation of any high performing health care system that provides access to health care services for all health-related needs and problems, providing person-focused care over time in a continuous and coordinated fashion [1]. Across Canadian provinces, PHC models include a wide range of provider groups and clinicians, each with their own funding and accountability relationships [1, 2] Among these PHC practitioners/professionals, family physicians and nurse practitioners provide a full range of primary care services, and are the gatekeepers who facilitate easier access to many other health care services [3, 4]. Canadian provinces and territories have made considerable progress implementing PHC reform strategies to improve access and quality of health services; despite these efforts many Canadians continue to experience unequal access to health care [5,6,7] This is an increasingly prevalent issue because of recent demographic shifts in Canada, including an aging population, growing income inequality, changing immigration patterns, and increasing urbanization of the population. Those without access to an interpreter may experience errors in translation or in understanding the implications of their health status [12, 15, 16]
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