Deborah van Gaans

Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac Event The Cardiac Accessibility and Remoteness Index for Australia (ARIA) Project

Background Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services. Methods and Results An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ≤1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people >65 years of age (32%) and indigenous people (60%). Conclusions The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world. # Clinical Perspective {#article-title-42}Background Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services. Methods and Results An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ⩽1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people >65 years of age (32%) and indigenous people (60%). Conclusions The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world.

Access to cardiac rehabilitation does not equate to attendance

Background/Aims: Timely access to appropriate cardiac care is critical for optimizing positive outcomes after a cardiac event. Attendance at cardiac rehabilitation (CR) remains less than optimal (10%–30%). Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services after a cardiac event in Australia. Methods: An expert panel defined a single patient care pathway and a hierarchy of the minimum health services for CR and secondary prevention. Using geographic information systems a numeric/alpha index was modelled to describe access before and after a cardiac event. The aftercare phase was modelled into five alphabetical categories: from category A (access to medical service, pharmacy, CR, pathology within 1 h) to category E (no services available within 1 h). Results: Approximately 96% or 19 million people lived within 1 h of the four basic services to support CR and secondary prevention, including 96% of older Australians and 75% of the indigenous population. Conversely, 14% (64,000) indigenous people resided in population locations that had poor access to health services that support CR after a cardiac event. Conclusion: Results demonstrated that the majority of Australians had excellent ‘geographic’ access to services to support CR and secondary prevention. Therefore, it appears that it is not the distance to services that affects attendance. Our ‘geographic’ lens has identified that more research on socioeconomic, sociological or psychological aspects to attendance is needed.

Issues of accessibility to health services by older Australians: a review

BackgroundThis review provides an in-depth investigation into the difficulties facing older Australians when accessing health care services.MethodsA literature search was conducted in December 2016 using Academic Premier to identify relevant publications. Key search terms were accessibility, health service, older people and Australia. Papers published between 1999 and 2016 were included. Statements of accessibility were extracted and then grouped using the five dimensions of accessibility by Penchansky and Thomas (1981): availability, accessibility, accommodation, affordability and acceptability.ResultsForty-one papers were included. Availability issues identified were inadequate health care services, particularly for culturally and linguistically diverse (CALD) populations and those residing in rural areas. Accessibility issues included difficulties accessing transport to health care services, which in turn restricted choice of appointment time. Issues of accommodation identified were long waiting times for appointments with both general practitioners and medical specialists. Affordability was a common problem, compounded by multi-morbidity requiring high health care use. Issues of acceptability centred on the role of the family, feelings of shame when receiving care from a non-family member, traditional practices and gender sensitivity.ConclusionsThe contribution of factors to health service accessibility varies according to an older person’s geographical local and their accessibility to transport, as well as their level of multi-morbidity and cultural background. Improving access to health services could be improved by matching services to the population that they serve.

Improving health care accessibility for older adults with frailty: the role of Geographical Information Systems

Population ageing, combined with an increased use of health technologies to manage co-morbidities, is driving an increased demand for health and aged care services. High usage of these services is particularly common in older adults with the geriatric condition of frailty [1]. This vulnerable population group often faces a mismatch between their care needs and access to health care services due to impairments in physical functioning and/or dependence on other people for assistance [2]. Frailty is clinically recognised as reduced strength and a lack of physiological functioning, with a concomitant high risk of disability, vulnerability, falls, and death [1]. Survival of co-morbidities, such as cancer, chronic kidney disease, cardiovascular disease and HIV, often lead to frailty [1]. Delaying or preventing frailty progression by improving access to relevant health care services is a well-recognised priority for health systems. To identify which older adults access health care services, why they access these services, and where these services are located, the use of Geographical Information System (GIS) technologies is invaluable [3]. GIS and related spatial analysis methods can show the geographical distribution of health care services, which in turn, can be overlaid on the same map as population health data [3]. Thus, GIS technologies enable us to identify ‘hotspot’ areas of high frailty prevalence which need improvements in health care provision. A promising area of future research is for GIS monitoring to capitalise on advancements in wearable devices which monitor an individual’s long-term health, physical activity, sedentary time, and their physical location [4]. Such devices include: accelerometers that can measure walking distance and detect risk of falls; and computerised watches which detect physiological measures such as heart rate and blood pressure. These wearable devices can be connected with the ‘Internet of Things’ (IoT), which is a network of physical devices (including smart phones) supported with data transition features [4]. More specifically, spatial energetics is an emerging field of research in GIS monitoring that can be used to inform health care accessibility. Spatial energetics examines the interaction between an individual’s pattern of activityrelated behaviours (such as walking/sitting) and the time of day, space, and environmental location [5]. To achieve this, Global Positioning (GPS) locational data are paired with GIS data to from high-spatial resolution data on location, which is then time-matched with data on energetics from wearable devices and smart phones [5]. The data extrapolated from these devices can inform how to optimise health services to make them more accessible and efficient when catering for older adults with frailty. For example, extrapolated data can inform on ‘walkability’ to commonly used health care services, including proximity to local public transport services, and whether the distance needed to walk is physically achievable. Overall, very little research to date has used GIS technology in health systems planning for older adults with frailty. Future research should therefore consider using advances in GIS technologies to monitor health service accessibility for this vulnerable and rapidly expanding population group. This valuable knowledge will enable health service planners to ensure that older adults with frailty have equivalent access to health care services compared with any other person without frailty. Such knowledge will also play a fundamental * Elsa Dent elsa.dent@laureate.edu.au

Modelling medications for public health research

Most patients with chronic disease are prescribed multiple medications, which are recorded in their personal health records. This is rich information for clinical public health researchers but also a challenge to analyse. This paper describes the method that was undertaken within the Public Health Research Data Management System (PHReDMS) to map medication data retrieved from individual patient health records for population health researcher’s use. The PHReDMS manages clinical, health service, community and survey research data within a secure web environment that allows for data sharing amongst researchers. The PHReDMS is currently used by researchers to answer a broad range of questions, including monitoring of prescription patterns in different population groups and geographic areas with high incidence/prevalence of chronic renal, cardiovascular, metabolic and mental health issues. In this paper, we present the general notion of abstraction network, a higher level network that sits above a terminology and offers compact and more easily understandable view of its content. We demonstrate the utilisation of abstraction network methodology to examine medication data from electronic medical records to allow a compact and more easily understandable view of its content.

Managing Aboriginal and Torres Strait Islander data for public health research

Good quality data on Aboriginal and Torres Strait Islander peoples are needed to assess the effectiveness of programs and interventions, and to evaluate policies that are designed to improve the status of, and service delivery to, Aboriginal and Torres Strait Islander peoples. Due to the lack of longitudinal data it is difficult to gain knowledge on the specific causes or consequences of changes in indigenous outcomes. Variables such as name, date of birth and address for Aboriginal and Torres Strait Islanders may be subject to more variation and be less consistently reported than other Australians. Improving the collection and management of key identifying variables for Aboriginal and Torres Strait Islanders are key to providing more quality information on this population group.

The development of a spatial model of accessibility to phase 2 cardiac rehabilitation programs

Existing Phase 2 cardiac rehabilitation services are currently underutilised and improving access will be necessary because of ageing of the population and falling case-fatality rates. The Spatial Model of Accessibility to Phase 2 Cardiac Rehabilitation Programs was developed to quantify accessibility to out-patient cardiac rehabilitation in Australia. A geographic information system (GIS) was used to combine both geographic and socio-economic aspects of accessibility. The model was developed by integrating the socio-economic information gathered by survey and incorporating a distance decay model.

Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac EventClinical Perspective

Background Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services. Methods and Results An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ≤1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people >65 years of age (32%) and indigenous people (60%). Conclusions The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world. # Clinical Perspective {#article-title-42}Background Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services. Methods and Results An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ⩽1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people >65 years of age (32%) and indigenous people (60%). Conclusions The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world.