Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil
Tóm tắt
Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access to emergency and surgical care. However more investments in are necessary to improve small hospitals capabilities to fill this gap.
Tài liệu tham khảo
Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C, Joshipura M. Emergency medical systems in low- and middle-income countries: recommendations for action. Bull World Health Organ. 2005;83(8):626–31.
Clancy CM. Acute care quality improves while barriers to access remain: AHRQ’s 2012 healthcare quality and disparities reports. Am J Med Qual. 2013;28:443–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23880776. [cited 23 Dec 2016].
Ensor T, Cooper S. Overcoming barriers to health service access: influencing the demand side. Health Policy Plan. 2004;19:69–79. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Overcoming+barriers+to+health+service+access%3A+influencing+the+demand+side. [cited 23 Dec 2016].
Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: an analytical framework for selectingappropriate interventions in low-income Asian countries. Health Policy Plan. 2012;27:288–300.
Guagliardo MF. Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr. 2004;3:3. Available from: https://ij-healthgeographics.biomedcentral.com/articles/10.1186/1476-072X-3-3.
Belleudi V, Sciattella P, Agabiti N, Di Martino M, Di Domenicantonio R, Davoli M, et al. Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study. BMC Public Health. 2016;16:408. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3019-8
Pirkle CML, Fournier P, Tourigny C, Sangaré K, Haddad S. Emergency obstetrical complications in a rural african setting (kayes, mali): the link between travel time and in-hospital maternal mortality. Matern Child Health J. 2011;15:1081–7.
Haynes R, Jones AP, Sauerzapf V, Zhao H. Validation of travel times to hospital estimated by GIS. Int J Health Geogr. 2006;5:40. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1586189&tool=pmcentrez&rendertype=abstract
Cheng G, Zeng X, Duan L, Lu X, Sun H, Jiang T, et al. Spatial difference analysis for accessibility to high level hospitals based on travel time in Shenzhen, China. Habitat Int. 2016;53:485–94. Available from: http://dx.doi.org/10.1016/j.habitatint.2015.12.023
Nicholl J, West J, Goodacre S, Turner J. The relationship between distance to hospital and patient mortality in emergencies: an observational study. Emerg Med J. 2007;24:665–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17711952. [cited 23 Dec 2016].
Carr BG, Addyson DK. Geographic information systems amd emergency care planning. Acad Emerg Med. 2010;17:1274–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21416801. [cited 23 Dec 2016].
Rammohan A, Iqbal K, Awofeso N. Reducing neonatal mortality in India: critical role of access to emergency obstetric care. PLoS One. 2013;8:e57244.
Ripley DC, Kwong PL, Vogel WB, Kurichi JE, Bates BE, Davenport C. How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke? Med Care. 2015;53:501–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25961660.
Posnett J. Is bigger better? Concentration in the provision of secondary care. BMJ. 1999;319:1063–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10521207. [cited 23 Dec 2016].
Posnett J. Are bigger hospitals better? Mckee M, Healy J. Hosp. A Chang. Eur. Buckingham: Open University Press; 2002.
Forgia GM La, Couttolenc BF. Desempenho Hospitalar No Brasil: Em Busca Da Excelência. Ed. Singul. 2009;496 p.
Kearns R, Moon G. From medical to health geography: novelty, place and theory after a decade of change. Prog Hum Geogr. 2002;26:605–25.
Mayer JD. Relations between two traditions of medical geography: health systems planning and geographical epidemiology. Prog Hum Geogr. 1982;6:216–30. Available from: http://phg.sagepub.com/lookup/doi/10.1177/030913258200600203. [cited 23 Dec 2016].
Sui DZ. Geographic information systems and medical geography: toward a new synergy. Geogr Compass. 2007;1:556–82. Available from: http://doi.wiley.com/10.1111/j.1749-8198.2007.00027.x. [cited 23 Dec 2016].
Andrews GJ, Moon G. Space, place, and the evidence base: part I-an introduction to health geography. Worldviews Evidence-Based Nurs. 2005;2:55–62. Available from: http://doi.wiley.com/10.1111/j.1741-6787.2005.05004.x. [cited 23 Dec 2016].
Higgs G. A literature review of the use of GIS-based measures of access to health care services. Heal Serv Outcomes Res Methodol. 2004;5(2):119–39. Available from: http://link.springer.com/10.1007/s10742-005-4304-7.
Luan H, Law J. Web GIS-based public health surveillance systems: a systematic review. ISPRS Int J Geo-Information. 2014;3:481–506. Available from: http://www.mdpi.com/2220-9964/3/2/481/. [cited 23 Dec 2016].
Brasil. Departamento de Informática do SUS - DATASUS. Informações de Saúde (TABNET). 2015. Available from: http://www2.datasus.gov.br/DATASUS/index.php?area=02. Accessed June 2015.
Barbosa ACQ, Rocha TAH, da SNC, Amaral PV, do CM, Fachini LA, et al. Estudo de hospitais de pequeno porte brasileiros - Diagnóstico, avaliação e espacialização. Primeira e. Belo Horizonte: Imprensa universitária da UFMG; 2014.
Instituto Brasileiro de Geografia e Estatística. Estatísticas sociodemograficas do Brasil. 2014. Available from: http://www.ibge.gov.br/home/.
Foundation PS. Python. 2016. Available from: http://www.python.org
Esri. ArcGis desktop: release 10. Redlands: Environmental Systems Research Institute; 2011.
MR MG. Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements. Int J Health Geogr. 2012;11:50. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3520708&tool=pmcentrez&rendertype=abstract. [cited 23 Dec 2016].
Luo J, Tian L, Luo L, Yi H, Wang F. Two-step optimization for spatial accessibility improvement: a case study of health care planning in rural China. Biomed Res Int. 2017;2017:12.
Ugá MAD, Lopez EM. Os hospitais de pequeno porte e sua inserção no SUS. Ciência & Saúde Coletiva. 2007;12(4):915–28. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000400013.
Getis A, Ord JK. The analysis of spatial association by use of distance statistics. Geogr Anal. 2010;24:189–206. Available from: http://doi.wiley.com/10.1111/j.1538-4632.1992.tb00261.x. [cited 23 Dec 2016].
Songchitruksa P, Zeng X. Getis-Ord spatial statistics to identify hot spots by using incident management data. Transp Res Rec J. 2010;2165:42–51. Available from: http://trrjournalonline.trb.org/doi/10.3141/2165-05. [cited 23 Dec 2016].
Oliveira EX, Carvalho MS, Travassos C. The territorial basis of the Brazilian National Health System: mapping hospital networks. Cad Saude Publica. 2004;20:386–402. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15073618
de OEXG, Travassos C, Carvalho MS. Acesso à internação hospitalar nos municípios brasileiros em 2000: territórios do Sistema Único de Saúde. Cad Saude Publica. 2004;20:S298–309. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2004000800023&lng=pt&nrm=iso&tlng=pt. [cited 23 Dec 2016].