[Spatial access to palliative care units in Germany: integrated analysis of availability and accessibility using the E2SFCA method].

Abstract

Introduction: Demographic change and rising patient numbers pose challenges for local access to palliative care units. Availability and accessibility as dimensions of spatial access, which have mostly been considered separately in previous studies, are integrated using the method "Enhanced Two-Step Floating Catchment Area" (E2SFCA) in order to identify regional differences by providing a more realistic picture of the care situation.

Methods: At the community level, an access index (Z_i) was calculated using the E2SFCA method. It was based on population data , bed capacity, and accessibility within a 30-minute drive. The index was divided into quintiles and assigned to categories with low (Q1, Q2), medium (Q3), and high access index (Q4, Q5).

Results: Access to the 372 palliative care units identified in Germany varies greatly between and within urban and rural areas. In sparsely populated areas, care services lead to above-average access. At the same time, long travel times arise in more remote communities (e.g., Mecklenburg-Western Pomerania). Urban regions often achieve high access indices due to a high density of services. A high population density results in average access when services are available (e.g., North Rhine-Westphalia).

Discussion and conclusion: Most people in Germany could reach palliative care units within 30 min, with large regional differences. The E2SFCA method, applied for the first time to palliative care units, offers a more precise analysis than studies based on district-specific bed capacities and number of inhabitants. In order to reflect the actual regional care situation, the care provision in areas with poor access must be examined in detail.