A geospatial approach to understanding inequalities in accessibility to primary care among vulnerable populations

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.

Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario

“…Evidence shows that a strong primary care system leads to a healthier population (Starfield et al ). Accordingly, addressing inequality in accessibility to PCPs is a concern in Ontario (Canadian Institute for Health Information ; Gilliland et al ) and around the world (Hefford et al ). Since the Alma‐Ata declaration in 1978, primary care has been acknowledged as an essential foundation in achieving health for all (World Health Organization ), however decades of cost cutting and acute‐care focus have eroded this foundation.…”

“…Evidence shows that a strong primary care system leads to a healthier population (Starfield et al 2005). Accordingly, addressing inequality in accessibility to PCPs is a concern in Ontario (Canadian Institute for Health Information 2012; Gilliland et al 2019) and around the world The Canadian Geographer / Le Géographe canadien 2020, 64(1): 65-78…”

“…Contextual factors (e.g., place of residence, distance to facilities, and transport infrastructure) can serve as barriers or facilitators to accessing health care resources (Chan et al 2006;Cinnamon et al 2008;McDonald et al 2017;Wang et al 2017), which are in turn associated with health outcomes (Subramanian 2004;Holtz et al 2014). Health care accessibility is inversely associated with distance or travel time and is sensitive to where people are located within a large metropolitan area (Guagliardo et al 2004;Charreire and Combier 2009;Bauer et al 2016;Shah et al 2016;Gilliland et al 2019) and/or across the urban-rural continuum (Cinnamon et al 2008;McGrail and Humphreys 2015;McDonald et al 2017;Shah et al 2017). Even within urban areas, transportation is one of the most commonly cited barriers to primary care access (McColl et al 2015;South East Local Health Integration Network 2015).…”

Comparison of patient perceptions of primary care quality across healthcare facilities in Korea: A cross-sectional study

“…The 7 domains consisted of: first contact (accessibility of care at the time of need and its utilization towards solving a new health problem), comprehensiveness (a range of services encompassing common problems in the population), continuity (the longitudinal use of a regular source of care over time, focusing on the long-term health of a person, rather than the short-term duration of the disease), coordination (the role of coordinating other specialist services or resources that patients may need), personalized care (a holistic approach that considers physical, mental, and spiritual well-being), family/community orientation (the inclusion of family health concerns in decision-making and the provider's knowledge of community health needs), and trust/satisfaction. [6,27,[30][31][32] Responses were obtained using a 5-point Likert scale (5 = strongly agree, 4 = agree, 3 = neutral, 2 = disagree, 1 = strongly disagree). Subtotal scores for each domain were yielded by adding up the subordinate item scores.…”

A Spatio-Temporal Analysis of the Health Situation in Poland Based on Functional Discriminant Coordinates

“…There are numerous articles about the spatial variation in the health situation, health inequalities or health conditions at the local or national level (see, for instance, Gilliland et al [28], Wang and Nie [29], Chen et al [30]). In the case of Poland, various analyses have been conducted to investigate regional inequalities in the health status of the population (Wierzbicka [31], Bem et al [32]).…”