Int J Health Geogr - The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model.

Tópicos

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Resumo

CKGROUND: Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients.METHODS: Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity) of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model), and the other that takes into account both the road distance and facility capacity (capacity-distance model). Simulations of closures of rural and urban facilities were then conducted.RESULTS: The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, p<0.001). In the capacity-distance model 36.1% of patients commuted to the facilities which were different from the facilities in the distance model, creating a substantial gap of commuting time between the two models. In the simulation, when five rural public facilitiess were closed, Gini coefficient of commuting times among the patients increased by 16%, indicating a substantial worsening of equity, and the number of patients with commuting times longer than 90 minutes increased by 72 times. In contrast, closure of four urban public facilities with similar capacities did not affect these values.CONCLUSIONS: Closures of dialysis facilities in rural areas have a substantially larger impact on equity of commuting times among dialysis patients than closures of urban facilities. The accessibility simulations using the capacity-distance model will provide an analytic framework upon which rational resource distribution policies might be planned.

Resumo Limpo

ckground frequent longterm commut requir dialysi patient access thus affect qualiti live paper new model access measur propos geograph distanc facil capac taken account simul closur rural facil capac transfer urban rural facil conduct evalu impact phenomena equiti access among dialysi patientsmethod post code inform august patient certifi municip hiroshima prefectur first third grade renal disabl collect inform post code maximum number outpati capac dialysi facil also collect use geograph inform system patient commut time calcul two model one take account road distanc distanc model take account road distanc facil capac capacitydist model simul closur rural urban facil conductedresult median commut time among rural patient twice long among urban patient versus minut p capacitydist model patient commut facil differ facil distanc model creat substanti gap commut time two model simul five rural public facilitiess close gini coeffici commut time among patient increas indic substanti worsen equiti number patient commut time longer minut increas time contrast closur four urban public facil similar capac affect valuesconclus closur dialysi facil rural area substanti larger impact equiti commut time among dialysi patient closur urban facil access simul use capacitydist model will provid analyt framework upon ration resourc distribut polici might plan

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