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      Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements

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          Abstract

          Background

          The two step floating catchment area (2SFCA) method has emerged in the last decade as a key measure of spatial accessibility, particularly in its application to primary health care access. Many recent ‘improvements’ to the original 2SFCA method have been developed, which generally either account for distance-decay within a catchment or enable the usage of variable catchment sizes. This paper evaluates the effectiveness of various proposed methods within these two improvement groups. Moreover, its assessment focuses on how well these improvements operate within and between rural and metropolitan populations over large geographical regions.

          Results

          Demonstrating these improvements to the whole state of Victoria, Australia, this paper presents the first comparison between continuous and zonal (step) decay functions and specifically their effect within both rural and metropolitan populations. Especially in metropolitan populations, the application of either type of distance-decay function is shown to be problematic by itself. Its inclusion necessitates the addition of a variable catchment size function which can enable the 2SFCA method to dynamically define more appropriate catchments which align with actual health service supply and utilisation.

          Conclusion

          This study assesses recent ‘improvements’ to the 2SFCA when applied over large geographic regions of both large and small populations. Its findings demonstrate the necessary combination of both a distance-decay function and variable catchment size function in order for the 2SFCA to appropriately measure healthcare access across all geographical regions.

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          Most cited references37

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          Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region

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            Spatial accessibility of primary care: concepts, methods and challenges

            Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S. For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live. First, explicit definitions and conceptualizations of healthcare access have not been widely used to guide research. An additional barrier to progress has been an overwhelming concern about affordability of care, which has garnered the majority of attention and research resources. Also, the most popular measures of spatial accessibility to care – travel impedance to nearest provider and supply level within bordered areas – lose validity in congested urban areas. Better measures are needed. Fortunately, some advances are occurring on the methodological front. These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas. This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.
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              An enhanced two-step floating catchment area (E2SFCA) method for measuring spatial accessibility to primary care physicians.

              Wei Luo, Yi Qi (2009)
              This paper presents an enhancement of the two-step floating catchment area (2SFCA) method for measuring spatial accessibility, addressing the problem of uniform access within the catchment by applying weights to different travel time zones to account for distance decay. The enhancement is proved to be another special case of the gravity model. When applying this enhanced 2SFCA (E2SFCA) to measure the spatial access to primary care physicians in a study area in northern Illinois, we find that it reveals spatial accessibility pattern that is more consistent with intuition and delineates more spatially explicit health professional shortage areas. It is easy to implement in GIS and straightforward to interpret.
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                Author and article information

                Journal
                Int J Health Geogr
                Int J Health Geogr
                International Journal of Health Geographics
                BioMed Central
                1476-072X
                2012
                16 November 2012
                : 11
                : 50
                Affiliations
                [1 ]Gippsland Medical School, Monash University, Northways Road, Churchill, VIC, 3842, Australia
                [2 ]Centre of Research Excellence in Rural and Remote Primary Health Care, Gippsland, Australia
                Article
                1476-072X-11-50
                10.1186/1476-072X-11-50
                3520708
                23153335
                73ea47c6-4a0c-4626-84f3-da5cd765c057
                Copyright ©2012 McGrail; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 September 2012
                : 6 November 2012
                Categories
                Research

                Public health
                primary health care,access to health care,service catchments,rural health,medical geography,spatial accessibility

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