Spatial accessibility of primary care: concepts, methods and challenges

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.

Figure 1

Kernel densities of pediatric services (top) and children (middle). Bottom layer is the two-dimensional representation of populated areas of Washington, DC.

Figure 2

Layer of provider-to-population ratios overlaid by census tract borders, Washington, DC.

Figure 3

Space-time "aquarium" showing the paths of African American (purple) and Asian American (blue) women in Portland, Oregon, over the course of a typical day. The vertical dimension is time. (Reprinted with the permission of the creator, Mei-Po Kwan, Department of Geography, Ohio State University.)