Int J Health Geogr - Accessibility to health care facilities in Montreal Island: an application of relative accessibility indicators from the perspective of senior and non-senior residents.

Tópicos

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Resumo

CKGROUND: Geographical access to health care facilities is known to influence health services usage. As societies age, accessibility to health care becomes an increasingly acute public health concern. It is known that seniors tend to have lower mobility levels, and it is possible that this may negatively affect their ability to reach facilities and services. Therefore, it becomes important to examine the mobility situation of seniors vis-a-vis the spatial distribution of health care facilities, to identify areas where accessibility is low and interventions may be required.METHODS: Accessibility is implemented using a cumulative opportunities measure. Instead of assuming a fixed bandwidth (i.e. a distance threshold) for measuring accessibility, in this paper the bandwidth is defined using model-based estimates of average trip length. Average trip length is an all-purpose indicator of individual mobility and geographical reach. Adoption of a spatial modelling approach allows us to tailor these estimates of travel behaviour to specific locations and person profiles. Replacing a fixed bandwidth with these estimates permits us to calculate customized location- and person-based accessibility measures that allow inter-personal as well as geographical comparisons.DATA: The case study is Montreal Island. Geo-coded travel behaviour data, specifically average trip length, and relevant traveller's attributes are obtained from the Montreal Household Travel Survey. These data are complemented with information from the Census. Health care facilities, also geo-coded, are extracted from a comprehensive business point database. Health care facilities are selected based on Standard Industrial Classification codes 8011-21 (Medical Doctors and Dentists).RESULTS: Model-based estimates of average trip length show that travel behaviour varies widely across space. With the exception of seniors in the downtown area, older residents of Montreal Island tend to be significantly less mobile than people of other age cohorts. The combination of average trip length estimates with the spatial distribution of health care facilities indicates that despite being more mobile, suburban residents tend to have lower levels of accessibility compared to central city residents. The effect is more marked for seniors. Furthermore, the results indicate that accessibility calculated using a fixed bandwidth would produce patterns of exposure to health care facilities that would be difficult to achieve for suburban seniors given actual mobility patterns.CONCLUSIONS: The analysis shows large disparities in accessibility between seniors and non-seniors, between urban and suburban seniors, and between vehicle owning and non-owning seniors. This research was concerned with potential accessibility levels. Follow up research could consider the results reported here to select case studies of actual access and usage of health care facilities, and related health outcomes.

Resumo Limpo

ckground geograph access health care facil known influenc health servic usag societi age access health care becom increas acut public health concern known senior tend lower mobil level possibl may negat affect abil reach facil servic therefor becom import examin mobil situat senior visavi spatial distribut health care facil identifi area access low intervent may requiredmethod access implement use cumul opportun measur instead assum fix bandwidth ie distanc threshold measur access paper bandwidth defin use modelbas estim averag trip length averag trip length allpurpos indic individu mobil geograph reach adopt spatial model approach allow us tailor estim travel behaviour specif locat person profil replac fix bandwidth estim permit us calcul custom locat personbas access measur allow interperson well geograph comparisonsdata case studi montreal island geocod travel behaviour data specif averag trip length relev travel attribut obtain montreal household travel survey data complement inform census health care facil also geocod extract comprehens busi point databas health care facil select base standard industri classif code medic doctor dentistsresult modelbas estim averag trip length show travel behaviour vari wide across space except senior downtown area older resid montreal island tend signific less mobil peopl age cohort combin averag trip length estim spatial distribut health care facil indic despit mobil suburban resid tend lower level access compar central citi resid effect mark senior furthermor result indic access calcul use fix bandwidth produc pattern exposur health care facil difficult achiev suburban senior given actual mobil patternsconclus analysi show larg dispar access senior nonsenior urban suburban senior vehicl own nonown senior research concern potenti access level follow research consid result report select case studi actual access usag health care facil relat health outcom

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