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      Spatial accessibility of primary care: concepts, methods and challenges

      review-article
      1 , 2 ,
      International Journal of Health Geographics
      BioMed Central

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          Abstract

          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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          Most cited references78

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          How Accessibility Shapes Land Use

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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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              Space-Time and Integral Measures of Individual Accessibility: A Comparative Analysis Using a Point-based Framework

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                Author and article information

                Journal
                Int J Health Geogr
                International Journal of Health Geographics
                BioMed Central (London )
                1476-072X
                2004
                26 February 2004
                : 3
                : 3
                Affiliations
                [1 ]Center for Health Services and Community Research, Children's National Medical Center, Washington, DC, USA
                [2 ]Department of Prevention and Community Health, The George Washington University School of Public Health and Health Services, Washington, DC, USA
                Article
                1476-072X-3-3
                10.1186/1476-072X-3-3
                394340
                14987337
                bbdfbabf-3a30-43b2-9f96-02da3ff2fd08
                Copyright © 2004 Guagliardo; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
                History
                : 19 January 2004
                : 26 February 2004
                Categories
                Review

                Public health
                Public health

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