Tayyab Ikram Shah

Neighbourhoods and potential access to health care: The role of spatial and aspatial factors

The availability of, and access to, primary health care is one neighbourhood characteristic that has the potential to impact health thus representing an important area of focus for neighbourhood-health research. This research examines neighbourhood access to primary health care in the city of Mississauga, Ontario, Canada. A modification of the Two Step Floating Catchment Area method is used to measure multiple spatial and aspatial (social) dimensions of potential access to primary health care in natural neighbourhoods of Mississauga. The analysis reveals that neighbourhood-level potential access to primary care is dependant on spatial and aspatial dimensions of access selected for examination. The results also show that potential accessibility is reduced for linguistic minorities as well as for recent immigrant populations who appear, on the surface, to have better access to walk-in clinics than dedicated physicians. The research results reinforce the importance of focusing on intra-urban variations in access to care and demonstrate the utility of a new approach for studying neighbourhood impacts that better represents spatial variations in health care access and demand.

Access to Primary Health Care: Does Neighborhood of Residence Matter?

Neighborhood social and physical contexts have the ability to impact health and health behaviors of residents. One neighborhood characteristic that remains underexamined in the research is access to health care resources. This research examines potential (geographical) access to primary health care in the city of Mississauga, Ontario, Canada. A modification of the two-step floating catchment area method that better suits the study of locally relevant natural neighborhood units is presented. Potential access to health care is measured in each of Mississaugas neighborhoods considering several spatial and aspatial (i.e., social) characteristics of the population and of physicians, including the raw abundance of physicians, languages spoken by physicians and patients, and whether physicians are accepting new patients. Neighborhood-level results are compared to census tracts. The results of this analysis reveal that potential access significantly differs between neighborhoods for all spatial and aspatial dimensions of access. Accessibility is considerably reduced for linguistic minorities and for those who might not have a dedicated family physician as compared to the general population. This research contributes to the existing body of literature on neighborhoods and health by demonstrating the utility of an alternative methodology for developing a more comprehensive understanding of access to health care within natural geographical neighborhoods.

Investigating impacts of positional error on potential health care accessibility.

Accessibility to health services at the local or community level is an effective approach to measuring health care delivery in various constituencies in Canada and the United States. GIS and spatial methods play an important role in measuring potential access to health services. The Three-Step Floating Catchment Area (3SFCA) method is a GIS based procedure developed to calculate potential (spatial) accessibility as a ratio of primary health care (PHC) providers to the surrounding population in urban settings. This method uses PHC provider locations in textual/address format supplied by local, regional, or national health authorities. An automated geocoding procedure is normally used to convert such addresses to a pair of geographic coordinates. The accuracy of geocoding depends on the type of reference data and the amount of value-added effort applied. This research investigates the success and accuracy of six geocoding methods as well as how geocoding error affects the 3SFCA method. ArcGIS software is used for geocoding and spatial accessibility estimation. Results will focus on two implications of geocoding: (1) the success and accuracy of different automated and value-added geocoding; and (2) the implications of these geocoding methods for GIS-based methods that generalise results based on location data.

Geographic access to healthy and unhealthy food sources for children in neighbourhoods and from elementary schools in a mid-sized Canadian city

We examined location-related accessibility to healthy and unhealthy food sources for school going children in Saskatoon, Saskatchewan. We compared proximity to food sources from school sites and from small clusters of homes (i.e., dissemination blocks) as a proxy for home location. We found that (1) unhealthy food sources are more prevalent near schools in lower income than higher income neighbourhoods; (2) unhealthy compared to healthy food sources are more accessible from schools as well as from places of residence; and (3) while some characteristics of neighbourhood low socio-economic status are associated with less accessibility to healthy food sources, there is no consistent pattern of access. Greater access to unhealthy food sources from schools in low-income neighbourhoods is likely a reflection of the greater degree of commercialization. Our spatial examination provides a more nuanced understanding of accessibility through our approach of comparing place of residence and school access to food sources.

Mapping the Physiotherapy Profession in Saskatchewan: Examining Rural versus Urban Practice Patterns

PURPOSE People living in rural and remote regions need support to overcome difficulties in accessing health care. The objectives of the study were (1) to compare demographic characteristics, professional engagement indicators, and clinical characteristics between physiotherapists practising in rural settings and those practising in urban settings and (2) to map the distribution of physiotherapists in Saskatchewan. METHOD This cross-sectional study used de-identified data collected from the 2013 Saskatchewan College of Physical Therapists membership renewal (n=643), linked with the Saskatchewan Physiotherapy Associations (SPA) 2012 membership list and a list of physiotherapists who had served as clinical instructors. Employment location (rural vs. urban) was determined by postal code. RESULTS Only 11.2% of Saskatchewan physiotherapists listed a rural primary employment location, and a higher density of physiotherapists per 10,000 people work in health regions with large urban centres. Compared with urban physiotherapists, rural physiotherapists are more likely to provide direct patient care, to provide care to people of all ages, and to have a mixed client level, and they are less likely to be SPA members. CONCLUSIONS Rural and urban physiotherapists in Saskatchewan have different practice and professional characteristics. This information may have implications for health human resource recruitment and retention policies as well as advocacy for equitable access to physiotherapy care in rural and remote regions.

Measuring geographical accessibility to rural and remote health care services: Challenges and considerations

This research is focused on methodological challenges and considerations associated with the estimation of the geographical aspects of access to healthcare with a focus on rural and remote areas. With the assumption that GIS-based accessibility measures for rural healthcare services will vary across geographic units of analysis and estimation techniques, which could influence the interpretation of spatial access to rural healthcare services. Estimations of geographical accessibility depend on variations of the following three parameters: 1) quality of input data; 2) accessibility method; and 3) geographical area. This research investigated the spatial distributions of physiotherapists (PTs) in comparison to family physicians (FPs) across Saskatchewan, Canada. The three-steps floating catchment areas (3SFCA) method was applied to calculate the accessibility scores for both PT and FP services at two different geographical units. A comparison of accessibility scores to simple healthcare provider-to-population ratios was also calculated. The results vary considerably depending on the accessibility methods used and the choice of geographical area unit for measuring geographical accessibility for both FP and PT services. These findings raise intriguing questions regarding the nature and extent of technical issues and methodological considerations that can affect GIS-based measures in health services research and planning. This study demonstrates how the selection of geographical areal units and different methods for measuring geographical accessibility could affect the distribution of healthcare resources in rural areas. These methodological issues have implications for determining where there is reduced access that will ultimately impact health human resource priorities and policies.

Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas

Background Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods. Methods This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population), was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms) used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons). An integrated geocoding approach was used to establish PHC locations. Results The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs. Conclusions The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood level. In particular, the results show that the low access neighbourhoods tend to be clustered in the neighbourhoods at the urban periphery and immediately surrounding the downtown area.

Exploring the intra-urban variations in the relationship among geographic accessibility to PHC services and socio-demographic factors

In this study, we investigate the intra-urban variations in the relationships among various socio-demographic factors and geographical accessibility to primary health care (PHC) services using a local regression model. Geographic accessibility to PHC services is calculated at a local scale for two Canadian urban centers (Calgary, AB and Toronto, ON) using a three-step floating catchment area (3SFCA) method. Socio-demographic factors were derived from 2006 Canada census data. The regression analysis was performed using two different methods: 1) a single regression model for both cities together, using a regional dummy variable, and 2) separate models for each city. A similar modeling procedure was applied for both methods: first, a best Ordinary Least Squares (OLS) regression model was determined using a forward step-wise approach in SPSS software. Next, to test the spatial non-stationarity in the regression residuals, the best OLS model was repeated in ArcGIS. Further, to explore whether or not regression coefficients vary across space, we applied the geographically weighted regression (GWR) method with an adaptive spatial kernel. The GWR results exhibit the intra-urban variations in the relationships between socio-demographic factors and the accessibility score. A comparison of the GWR models demonstrates the benefit of local spatial regression in disaggregating the relationships between socio-demographic variables and the geographical accessibility to PHC services at a local scale; however, our results suggest that a more careful modeling approach is required when analysing the data with spatial effects.

Variation in the Geographic Distribution of Physiotherapy Student Clinical Placements in Rural Saskatchewan

Purpose: Rural and remote Saskatchewan has a shortage of physiotherapists. Positive student experiences in rural and remote communities may influence whether graduates choose to work in these settings. The intention of the first full-time, 4-week clinical placement (CP) in the Master of Physical Therapy programme at the University of Saskatchewan is to provide clinical experiences in rural settings outside Saskatoon and Regina. This study examines the geographic distribution of and yearly variation in these CPs to determine whether this stated intent is being realized. Method: We analyzed the locations of physiotherapy student CPs from 2008 to 2016 using geospatial mapping. Results: Spatial patterning using mapping identified variability in the number of rural placements in geographical regions in Saskatchewan over a 9-year period. An average of 75% of CP experiences occurred in rural locations outside the two major cities in Saskatchewan between 2008 and 2016 (ranging from 58% in 2015 to 84% in 2009). Conclusions: The goal of providing all University of Saskatchewan physiotherapy students with a rural experience for their first CP is not being met. Securing more CPs in rural settings may have a positive impact on recruitment of physiotherapists to these communities.