Abstract
BackgroundGeographical accessibility is important in accessing healthcare services. Measuring it has evolved alongside technological and data analysis advances. High correlations between different methods have been detected, but no comparisons exist in the context of palliative and end of life care (PEoLC) studies. To assess how geographical accessibility can affect PEoLC, selection of an appropriate method to capture it is crucial.We therefore aimed to compare methods of measuring geographical accessibility of decedents to PEoLC-related facilities in South London, an area with well-developed SPC provision.MethodsIndividual-level death registration data in 2012 (n = 18,165), from the Office for National Statistics (ONS) were linked to area-level PEoLC-related facilities from various sources. Simple and more complex measures of geographical accessibility were calculated using the residential postcodes of the decedents and postcodes of the nearest hospital, care home and hospice. Distance measures (straight-line, travel network) and travel times along the road network were compared using geographic information system (GIS) mapping and correlation analysis (Spearman rho).ResultsBorough-level maps demonstrate similarities in geographical accessibility measures. Strong positive correlation exist between straight-line and travel distances to the nearest hospital (rho = 0.97), care home (rho = 0.94) and hospice (rho = 0.99). Travel times were also highly correlated with distance measures to the nearest hospital (rho range = 0.84–0.88), care home (rho = 0.88–0.95) and hospice (rho = 0.93–0.95). All correlations were significant at p < 0.001 level.ConclusionsDistance-based and travel-time measures of geographical accessibility to PEoLC-related facilities in South London are similar, suggesting the choice of measure can be based on the ease of calculation.
Highlights
Geographical accessibility is important in accessing healthcare services
In North America high correlations were found between straight-line and driving distances to hospitals [10], and between straight-line distances and travel times [11], in metropolitan areas [12]. These findings suggest that road distances only marginally improved predictive accuracy over using straight-line distances
The median distances to the nearest care home and hospices were shorter and longer respectively, reflecting the number of each within South London included in the analysis
Summary
Geographical accessibility is important in accessing healthcare services. Measuring it has evolved alongside technological and data analysis advances. Travel distances and times are more suitable where road networks deviate from straight lines but assume access to a private car and that constant traffic flows are uninterrupted by roadworks, accidents, congestion or adverse meteorological conditions. These simpler methods ignore the size and capacity of the nearest healthcare provider or other factors possibly influencing access decisions (e.g. quality, reputation). More complex models (gravity and floating catchment methods) can take provider factors and boundaries into account They require complex computation and more data processing capacity and produce results that may be difficult to interpret and compare
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