Journal of Remote Sensing & GIS

Abstract

Underserved Rural Areas: A Systematic Review of Primary Care Geographical Access using Gravity Models

Christian Simoneau*

Background: Health services are important for quality of life and employment, but are often seen as an expense, not an investment. Canadians in rural areas have lower health levels than urban residents and higher mortality rates for several diseases and conditions. The lack of healthcare services in remote areas leads to poor health, worsened by difficulty accessing primary care doctors and specialists.

Aim: We analyzed literature on geographic access methods to primary care in non-urban settings and conducted a systematic review to assess studies using gravity models. The goal was to explore the use, application, and operationalization of Floating Catchment Area (FCA) methods and their ability to identify variations in access in non-urban areas.

Methods: We completed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method of all published studies on geographical access to primary care in advanced economies in six databases: ABI/INFORM, MEDLINE, Science Direct, Scopus, Web of Science and Wiley Online Library. Two forms were developed for data synthesis: a data extraction form with 14 categories, and a quality evaluation form based on the Consolidated Standards of Reporting Trials (CONSORT) model with 19 categories. These forms collected information on various factors, including author, title, publication year, country, geographic zone, primary care definition, primary care provider supply, method, census subdivision, catchment size, distance type, space decay, access index, main results, concept definitions, conflict of interest, and others.

Results: This review includes 32 papers on physical access to primary care. Most studies used secondary data and the Enhanced Two-Step Floating Catchment Area (E2SFCA) method, which was found to be more sensitive in identifying deficits in rural access. However, many studies lacked clear definitions and there was no clear consensus concerning the definition of a primary care provider. A limitation of this study was that the articles were primarily written in English.

Conclusion: Healthcare policymakers and providers should consider rural populations’ unique transportation needs when designing healthcare access initiatives. Barriers to improving access may include a lack of political will, funding, or understanding of rural needs. The E2SFCA method is more sensitive than Physician-to-Population Ratios (PPR) in identifying underserved rural populations, but has not been widely used in Quebec. Future research should compare these methods and develop recommendations for improving access to primary care for rural populations.

Published Date: 2023-10-19; Received Date: 2023-09-18