A French classification to describe medical deserts: a multi-professional approach based on the first contact with the healthcare system.

IF 3 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Marie Bonal, Cindy Padilla, Guillaume Chevillard, Véronique Lucas-Gabrielli
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引用次数: 0

Abstract

Background: Increasing inequalities in accessibility to primary care has generated medical deserts. Identifying them is key to target the geographic areas where action is needed. An extensive definition of primary care has been promoted by the World Health Organization: a first level of contact with the health system, which involves the co-presence of different categories of health professionals alongside the general practitioner for the diagnosis and treatment of patients. Previous analyses have focused mainly on a single type of provider while this study proposes an integrated approach including various ones to define medical deserts in primary care.

Method: Our empirical approach focuses on the first point of contact with the health system: general practitioners, proximity primary care providers (nurses, physiotherapists, pharmacies, laboratories, and radiologists), and emergency services. A multiple analysis approach was performed, to classify French municipalities using the information on the evolution and needs of health care accessibility, combining a principal component analysis and a hierarchical ascending classification.

Results: Two clusters of medical deserts were identified with low accessibility to all healthcare professionals, socio-economic disadvantages, and a decrease in care supply. In other clusters, accessibility difficulties only concern a part of the health supply considered, which raises concern for the efficiency of primary care for optimal healthcare pathways. Even for clusters with better accessibility, issues were identified, such as a decrease and high needs of health care supply, revealing potential future difficulties.

Conclusion: This work proposes a multi-professional and multi-dimensional approach to medical deserts based mainly on an extensive definition of primary care that shows the relevance of the co-presence of various healthcare professionals. The classification also makes it possible to identify areas with future problems of accessibility and its potential consequences. This framework could be easily applied to other countries according to their available data and their health systems' specificities.

法国描述医疗沙漠的分类:基于与医疗系统首次接触的多专业方法。
背景:在获得初级保健服务方面日益加剧的不平等造成了医疗荒漠。要确定需要采取行动的地理区域,关键在于识别这些地区。世界卫生组织对初级医疗进行了广泛的定义:初级医疗是与医疗系统的第一层接触,包括不同类别的医疗专业人员与全科医生共同对患者进行诊断和治疗。以往的分析主要侧重于单一类型的医疗服务提供者,而本研究则提出了一种综合方法,包括界定初级保健中医疗荒漠的各种医疗服务提供者:我们的实证方法侧重于与医疗系统的第一接触点:全科医生、基层医疗服务提供者(护士、理疗师、药房、化验室和放射科医生)以及急诊服务。我们采用多重分析方法,结合主成分分析和分层递增分类法,利用医疗服务可及性的演变和需求信息,对法国各市进行了分类:结果:发现了两类医疗荒漠,一类是所有医疗专业人员的可及性较低,另一类是社会经济条件较差,医疗服务供应量减少。在其他集群中,可及性方面的困难只涉及医疗供应的一部分,这引起了人们对初级保健效率的关注,以优化医疗保健途径。即使是在交通便利性较好的集群中,也发现了一些问题,如医疗供应减少和需求量大,揭示了未来可能出现的困难:这项研究提出了一种多专业、多维度的医疗荒漠方法,主要基于对初级医疗的广泛定义,表明了各种医疗专业人员共同存在的重要性。这种分类方法还可以确定未来存在可及性问题的地区及其潜在后果。根据其他国家现有的数据及其卫生系统的特点,这一框架可以很容易地应用于这些国家。
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来源期刊
International Journal of Health Geographics
International Journal of Health Geographics PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -
CiteScore
10.20
自引率
2.00%
发文量
17
审稿时长
12 weeks
期刊介绍: A leader among the field, International Journal of Health Geographics is an interdisciplinary, open access journal publishing internationally significant studies of geospatial information systems and science applications in health and healthcare. With an exceptional author satisfaction rate and a quick time to first decision, the journal caters to readers across an array of healthcare disciplines globally. International Journal of Health Geographics welcomes novel studies in the health and healthcare context spanning from spatial data infrastructure and Web geospatial interoperability research, to research into real-time Geographic Information Systems (GIS)-enabled surveillance services, remote sensing applications, spatial epidemiology, spatio-temporal statistics, internet GIS and cyberspace mapping, participatory GIS and citizen sensing, geospatial big data, healthy smart cities and regions, and geospatial Internet of Things and blockchain.
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