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. 2023 Jul 24;23(1):786.
doi: 10.1186/s12913-023-09751-7.

Accessibility to specialist palliative care services in Germany: a geographical network analysis

Daniela Gesell  1 , Farina Hodiamont  2 , Claudia Bausewein  2 , Daniela Koller  3
Affiliations

Accessibility to specialist palliative care services in Germany: a geographical network analysis

Daniela Gesell et al. BMC Health Serv Res. .

Abstract

Background: The need for palliative care will increase over the next years because of the rise in deaths from chronic illness and demographic changes. The provision of specialist palliative care (SPC) in Germany (palliative care units (PCU), specialist palliative home care (SPHC) teams and palliative care advisory (PCA) teams) has been expanded in recent years. Despite the increasing availability, there is still insufficient coverage with long travel times. The aim was to describe the spatial distribution of SPC services in Germany, to calculate the potential accessibility of facilities and to assess potential spatial under-provision.

Methods: Retrospective cross-sectional study with regional analysis of SPC services in Germany. Addresses of SPC services registered online were geocoded, accessibility and network analyses were conducted, and proportion of the population living up to 60 minutes driving time were calculated.

Results: A total of 673 facilities were included. Their distribution is heterogeneous with every fourth of the 401 districts (110/401; 27.4%) lacking a SPC service. In half of the area of Germany the existing PCU and SPHC teams are within reach of 30 minutes, with nearly 90% of the population living there. Hospitals providing PCA teams can be reached within 30 minutes in 17% of the total area with provision for 43% of the population.

Conclusions: A high coverage of SPHC teams and PCU indicates a good spatial distribution in Germany but no complete adequate provision of SPC services, especially for PCA teams. There is a persistent need for further implementation of hospital PCA teams.

Keywords: Accessibility; GIS; Geographical network analysis; Specialist palliative care.

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Conflict of interest statement

The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication.

Figures

Fig. 1
Fig. 1
A. Distribution of PCU throughout Germany per 100,000 inhabitants on district level; B. Surface coverage of PCU throughout Germany
Fig. 2
Fig. 2
A. Distribution of PCA teams throughout Germany per 100,000 inhabitants on district level; B. Surface coverage of PCA teams throughout Germany
Fig. 3
Fig. 3
A. Distribution of SPHC teams throughout Germany per 100,000 inhabitants on district level; B. Surface coverage of SPHC teams throughout Germany
See this image and copyright information in PMC

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