Some Methods for Measuring the Geographic Accessibility of Medical Services in Rural Regions

Thouez, Jean-Pierre; Bodson, Paul; Joseph, Alun E.

doi:10.1097/00005650-198801000-00004

Cited by 45 publications

(21 citation statements)

References 25 publications

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“…The positive association between MOVE!® utilization and urban geographic location is consistent with previous obesity management literature [8] and health services utilization (generally) [19]. Veterans living further away from the VHA hospital are less likely to attend the program, due to proximity-related barriers.…”

Section: Discussionsupporting

confidence: 86%

MOVE: weight management program across the veterans health administration: patient- and facility-level predictors of utilization

Maciejewski

Harris

2013

BMC Health Serv Res

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BackgroundHealth care systems initiating major behavioral health programs often face challenges with variable implementation and uneven patient engagement. One large health care system, Veterans Health Administration (VHA), recently initiated the MOVE!® Weight Management Program, but it is unclear if veterans most in need of MOVE!® services are accessing them. The purpose of this study was to examine patient and facility factors associated with MOVE!® utilization (defined as 1 or more visits) across all VHA facilities.MethodsUsing national administrative data in a retrospective cohort study of eligible overweight (25 < = body mass index (BMI) < 30 and at least one obesity associated comorbidity) and obese (BMI > =30) VHA outpatients, we examined variation in and predictors of MOVE!® utilization in fiscal year (FY) 2010 using generalized linear mixed models.Results4.39% (n = 90,230) of all eligible overweight and obese patients using VHA services utilized MOVE!® services at least once in FY 2010. Facility-level MOVE! Utilization rates ranged from 0.05% to 16%. Veterans were more likely to have at least one MOVE!® visit if they had a higher BMI, were female, unmarried, younger, a minority, or had a psychiatric or obesity-related comorbidity.ConclusionsAlthough substantial variation exists across VHA facilities in MOVE!® utilization rates, Veterans most in need of obesity management services were more likely to access MOVE!®, although at a low level. However, there may still be many Veterans who might benefit but are not accessing these services. More research is needed to examine the barriers and facilitators of MOVE!® utilization, particularly in facilities with unusually high and low reach.

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Section: Discussionsupporting

confidence: 86%

MOVE: weight management program across the veterans health administration: patient- and facility-level predictors of utilization

Maciejewski

Harris

2013

BMC Health Serv Res

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“…61,64 We also focus on potential spatial access to ESAP pharmacies, which concerns reasonable possible use, rather than revealed (or actual) service use. 61,[65][66][67] We operationalized this construct in a two-stage process. In stage 1, we mapped all pharmacies enrolled in ESAP each year of the study period.…”

Section: Methodsmentioning

confidence: 99%

Temporal Trends in Spatial Access to Pharmacies that Sell Over-the-Counter Syringes in New York City Health Districts: Relationship to Local Racial/Ethnic Composition and Need

et al. 2009

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Pharmacies that sell over-the-counter (OTC) syringes are a major source of sterile syringes for injection drug users in cities and states where such sales are legal. In these cities and states, however, black injectors are markedly less likely to acquire syringes from pharmacies than white injectors. The present analysis documents spatial and temporal trends in OTC pharmacy access in New York City health districts over time (2001)(2002)(2003)(2004)(2005)(2006) and investigates whether these trends are related to district racial/ ethnic composition and to local need for OTC pharmacies. For each year of the study period, we used kernel density estimation methods to characterize spatial access to OTC pharmacies within each health district. Higher values on this measure indicate better access to these pharmacies. "Need" was operationalized using two different measures: the number of newly diagnosed injection-related AIDS cases per 10,000 residents (averaged across 1999-2001), and the number of drug-related hospital discharges per 10,000 residents (averaged across 1999-2001). District sociodemographic characteristics were assessed using 2000 US decennial census data. We used hierarchical linear models (HLM) for descriptive and inferential analyses and investigated whether the relationship between need and temporal trajectories in the Expanded Syringe Access Demonstration Program access varied by district racial/ethnic composition, controlling for district poverty rates. HLM analyses indicate that the mean spatial access to OTC pharmacies across New York City health districts was 12.71 in 2001 and increased linearly by 1.32 units annually thereafter. Temporal trajectories in spatial access to OTC pharmacies depended on both need and racial/ethnic composition. Within high-need districts, OTC pharmacy access was twice as high in 2001 and increased three times faster annually, in districts with higher proportions of non-Hispanic white residents than in districts with low proportions of these residents. In low-need districts, "whiter" districts had substantially greater baseline access to OTC pharmacies than districts with low proportions of non-Hispanic white residents. Access remained stable thereafter in low-need districts, regardless of racial/ethnic composition. Conclusions were consistent across both measures of "need" and persisted after controlling for local poverty rates. In both high-and low-need districts, spatial access to OTC pharmacies was greater in "Whiter" districts in 2001; in high-need 929districts, access also increased more rapidly over time in "whiter" districts. Ensuring equitable spatial access to OTC pharmacies may reduce injection-related HIV transmission overall and reduce racial/ethnic disparities in HIV incidence among injectors.

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“…O entendimento da mobilidade e acessibilidade em áreas ruralizadas se faz sobre o trinômio distância-tempo-custo, esta é uma questão que se sobressai em diversos estudos sobre o assunto (Shannon;Bashshur;Metzner, 1969;Thouez;Bodson;Joseph, 1988;Higgs;White, 1997;Nemet;Bailey, 2000;Martin et al, 2002;Brabyn;Barnett, 2004;Arcury et al, 2005). Aqui, o enfoque é para a rede de rodovias rurais como promotora de condições ótimas de viagem, e esse aspecto se reflete na compreensão da mobilidade das populações no campo e, consequentemente, em seu acesso aos serviços de saúde.…”

Section: Acessibilidade E Mobilidade Geográficaunclassified

“…A promoção do acesso igualitário aos serviços médicos é uma das preocupações do sistema de atenção à saúde (Brasil, 2002) e o grau de acesso real aos serviços de saúde depende, segundo Abel-Smith e Leiserson (apud Unglerti;Rosenburgi;Junqueira, 1987), da distância que se deve percorrer para obtê-los, do tempo de viagem e do seu custo. No caso da população rural, a distância e o tempo de viagem são elementos de grande importância para a avaliação do acesso aos serviços de saúde (Bentham;Haynes, 1985, p. 237;Thouez;Bodson;Joseph, 1988, p. 35;Martin et al, 2002, p. 4).…”

Section: Introductionunclassified

O tempo de viagem da população rural aos serviços de saúde mapeado em sistemas de informação geográfica (SIG)

Ferreira

Raffo

2014

GEOUSP (Online)

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Some Methods for Measuring the Geographic Accessibility of Medical Services in Rural Regions

Cited by 45 publications

References 25 publications

MOVE: weight management program across the veterans health administration: patient- and facility-level predictors of utilization

MOVE: weight management program across the veterans health administration: patient- and facility-level predictors of utilization

Temporal Trends in Spatial Access to Pharmacies that Sell Over-the-Counter Syringes in New York City Health Districts: Relationship to Local Racial/Ethnic Composition and Need

O tempo de viagem da população rural aos serviços de saúde mapeado em sistemas de informação geográfica (SIG)

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