Urban and rural differences in geographical accessibility to inpatient palliative and end-of-life (PEoLC) facilities and place of death: a national population-based study in England, UK

Abstract

Background Little is known about the role of geographic access to inpatient palliative and end of life care (PEoLC) facilities in place of death and how geographic access varies by settlement (urban and rural). This study aims to fill this evidence gap. Methods Individual-level death data in 2014 (N = 430,467, aged 25 +) were extracted from the Office for National Statistics (ONS) death registry and linked to the ONS postcode directory file to derive settlement of the deceased. Drive times from patients’ place of residence to nearest inpatient PEoLC facilities were used as a proxy estimate of geographic access. A modified Poisson regression was used to examine the association between geographic access to PEoLC facilities and place of death, adjusting for patients’ socio-demographic and clinical characteristics. Two models were developed to evaluate the association between geographic access to inpatient PEoLC facilities and place of death. Model 1 compared access to hospice, for hospice deaths versus home deaths, and Model 2 compared access to hospitals, for hospital deaths versus home deaths. The magnitude of association was measured using adjusted prevalence ratios (APRs). Results We found an inverse association between drive time to hospice and hospice deaths (Model 1), with a dose–response relationship. Patients who lived more than 10 min away from inpatient PEoLC facilities in rural areas (Model 1: APR range 0.49–0.80; Model 2: APR range 0.79–0.98) and urban areas (Model 1: APR range 0.50–0.83; Model 2: APR range 0.98–0.99) were less likely to die there, compared to those who lived closer (i.e. ≤ 10 min drive time). The effects were larger in rural areas compared to urban areas. Conclusion Geographic access to inpatient PEoLC facilities is associated with where people die, with a stronger association seen for patients who lived in rural areas. The findings highlight the need for the formulation of end of life care policies/strategies that consider differences in settlements types. Findings should feed into local end of life policies and strategies of both developed and developing countries to improve equity in health care delivery for those approaching the end of life. Electronic supplementary material The online version of this article (10.1186/s12942-019-0172-1) contains supplementary material, which is available to authorized users.

Regional variations in geographic access to inpatient hospices and Place of death: A Population-based study in England, UK

“…Existing studies have used national level estimates, which can mask nuances in regional level geographic access. For example, in a previous national population-based study we found rural-urban variations in geographic access to hospices, with urban dwellers having better access to inpatient hospice facilities compared to their rural counterparts [19]. Our findings were, however, limited in the extent to which they may be generalisable to regions within England, UK.…”

“…Geographic access was the explanatory variable analysed in categories (0-10 minutes, 10-30 minutes, 30-50 minutes and Over 50 minutes). We analysed access as categorical variable to facilitate easy comparison across regions and to compare findings with previous study [19]. Geographic access was measured by calculating drive times from patients' place of residence to nearest hospices taking into account the speed limits of various road types.…”

Improving geographical accessibility modeling for operational use by local health actors

“…Despite the increasing use of geographical information systems and spatial analyses to better understand health care access in developing countries, there are still important gaps in its application. Studies in high income countries provide accurate estimates of geographical access to services due to the wider availability of electronic health information systems and GIS data, as well as good transport infrastructure [63,[67][68][69][70]. In contrast, studies in developing countries typically use either Euclidean distances to obtain a basic measure of distance, or road networks in combination with friction surfaces to obtain estimates of travel time to PHC because the real network of footpaths is rarely available [21,27,41].…”

Fully Integrated Oncology and Palliative Care Services at a Local Hospital in Mid-Norway: Development and Operation of an Innovative Care Delivery Model

“…Most Norwegian cancer patients (around 65%) die in their communities, either at home (10-15%) or in nursing homes (around 50%) [52]. A population-based study from England, UK, showed that patients living in rural areas had worse geographic access to hospitals than patients living in urban areas and were more likely to die at home [53]. Norway is a sparsely populated country, and many Norwegians have long travel distances to hospitals and to palliative care units.…”