Spatial equity and realised access to healthcare - a geospatial analysis of general practitioner enrolments in Waikato, New Zealand.

Jesse Whitehead,Polly Atatoa-Carr,Ross Lawrenson,Amber Pearson

doi:10.22605/rrh5349

Abstract

Geographic measures of accessibility can quantify inequitable distributions of health care. Although closest distance measures are often used in Aotearoa New Zealand these may not reflect patient use of health care. This research examines patterns of patient enrolment in general practitioner (GP) services from a geospatial perspective. Patient enrolment records (n=137 596) from one primary health organisation were examined and geographic information systems used to determine whether patients enrolled with their closest GP service. A binomial logistic regression was performed to examine factors associated with the bypass of GP services closer to patients' homes. Overall 68.1% of patients in the sample bypassed the GP service closest to their home, while rates of GP bypass varied across the Waikato region and between rural and urban areas. A binary logistic regression analysis revealed that rurality of patient residence, patient ethnicity, patient age, area-level socioeconomic deprivation, sex, distance to the closest GP clinic, clinic after-hours availability, Māori service provider status, GP and nurse full time equivalent hours, and clinic fees were statistically significant predictors of increased closest-GP bypass. While residents of major urban areas had high rates of GP bypass, this was followed by patients living in rural areas - patients living more than 20 km from the closest GP service had exceptionally high rates of GP bypass. This study suggests that most patients in the Waikato region do not enrol with the GP service closest to their home and it outlines several factors, including rurality of residence, associated with the GP bypass. Closest distance accessibility measures may be inappropriate in mixed urban-rural settings, and researchers should consider other approaches to quantifying spatial equity. Health services should also be designed to better reflect the realities of the populations they serve.

Highlights

MethodsPatient enrolment records (n=137 596) from one primary health organisation were examined and geographic information systems used to determine whether patients enrolled with their closest general practitioner (GP) service
Geographic measures of accessibility can quantify inequitable distributions of health care
The analysis of more than 130 000 patient enrolment records indicates that almost 70% of Hauraki primary health organisations (PHOs) patients in the Waikato region are not enrolled with a general practitioner (GP) clinic closest to their residential address, and that rates of GP bypass vary according to several key factors

Summary

Methods

Patient enrolment records (n=137 596) from one primary health organisation were examined and geographic information systems used to determine whether patients enrolled with their closest GP service. The anonymised patient enrolment records (n=137 596) of Hauraki PHO’s 36 GP clinics, 11 of which are Māori service provider clinics (MSPC), and information about GP and nurse full time equivalent (FTE) hours at each clinic was provided in December 2017. Enrolment records included each patient’s age, residential address with associated GPS coordinates, a geocoding uncertainty score, ethnicity Predictor variables included patient residential area (major urban, medium urban, small urban or rural), ethnicity (European, Māori, Pacific, Asian, other), age (in bands of 0–4, 5–14, 15–24, 25–44, 45–64 and ≥65 years) , area-level deprivation (NZDep2013 quintile), sex (male or female), distance to closest GP, clinic after-hours availability, MSPC status, clinic total FTE hours and clinic fees. Interaction effects were calculated for ethnicity and age, ethnicity and deprivation, and residential area and deprivation

Results

Discussion

Conclusion