PDF(Pubmed)
Abstract：
Geographical context is an important consideration for health system design to promote equality in access to care for patients with childhood heart disease (CHD), particularly those living in regional, rural, and remote areas. To help inform future policy and practice recommendations, this study aimed to (i) describe the geographic distribution of high-risk CHD patients accessing an Australian state-wide specialist service and (ii) estimate travel time for accessing healthcare via general practitioners (primary), nearest paediatric centre (secondary) and specialist paediatric cardiac centre (tertiary).
Participants included a cohort of children (0-18 year) who accessed state-wide specialist CHD services over a 3-year period (2019-2021) in Queensland, Australia. Locations for patient residence, general practitioner, closest paediatric centre and tertiary cardiac centre were mapped using geographical information system (GIS) software (ArcGIS Online). Travel distance and times were estimated using a Google Maps Application Programming Interface (API).
1019 patients (median age 3.8 years) had cardiac intervention and were included in the sample. Of this cohort, 30.2% lived outside the heavily urbanised South East Queensland (SEQ) area where the tertiary centre is located. These patients travel substantially further and longer to access tertiary level care (but not secondary or primary level care) compared to those in SEQ. Median distance for patients residing outside SEQ to access tertiary care was 953 km with a travel time of 10 h 43 min. This compares to 5.5 km to the general practitioner and 20.6 km to a paediatric service (8.9 and 54 min respectively).
This geographical mapping of CHD services has demonstrated a key challenge inherent in providing specialist cardiac care to children in a large state-based healthcare system. A significant proportion of high-risk patients live large distances from tertiary level care. The greater accessibility of primary care services highlights the importance of supporting primary care physicians outside metropolitan areas to acquire or build the ability and capacity to care for children with CHD. Strengthening local primary and secondary services not only has the potential to improve the outcomes of high-risk patients, but also to reduce costs and burden associated with potentially avoidable travel from regional, rural, or remote areas to access specialist CHD services.
Participants included a cohort of children (0-18 year) who accessed state-wide specialist CHD services over a 3-year period (2019-2021) in Queensland, Australia. Locations for patient residence, general practitioner, closest paediatric centre and tertiary cardiac centre were mapped using geographical information system (GIS) software (ArcGIS Online). Travel distance and times were estimated using a Google Maps Application Programming Interface (API).
1019 patients (median age 3.8 years) had cardiac intervention and were included in the sample. Of this cohort, 30.2% lived outside the heavily urbanised South East Queensland (SEQ) area where the tertiary centre is located. These patients travel substantially further and longer to access tertiary level care (but not secondary or primary level care) compared to those in SEQ. Median distance for patients residing outside SEQ to access tertiary care was 953 km with a travel time of 10 h 43 min. This compares to 5.5 km to the general practitioner and 20.6 km to a paediatric service (8.9 and 54 min respectively).
This geographical mapping of CHD services has demonstrated a key challenge inherent in providing specialist cardiac care to children in a large state-based healthcare system. A significant proportion of high-risk patients live large distances from tertiary level care. The greater accessibility of primary care services highlights the importance of supporting primary care physicians outside metropolitan areas to acquire or build the ability and capacity to care for children with CHD. Strengthening local primary and secondary services not only has the potential to improve the outcomes of high-risk patients, but also to reduce costs and burden associated with potentially avoidable travel from regional, rural, or remote areas to access specialist CHD services.
摘要：
背景：地理环境是卫生系统设计的重要考虑因素，以促进儿童心脏病（CHD）患者获得护理的平等。特别是那些生活在区域，农村,和偏远地区。为了帮助提供未来的政策和实践建议，这项研究旨在（i）描述高风险CHD患者的地理分布访问澳大利亚全州专科服务和（ii）估计旅行时间通过全科医生（主要），最近的儿科中心(二级)和专科儿科心脏中心(三级)。
方法：参与者包括一组儿童（0-18岁），他们在3年（2019-2021年）期间在昆士兰州获得了全州的专科冠心病服务。澳大利亚。患者住所的位置，全科医生,使用地理信息系统（GIS）软件（ArcGISOnline）绘制了最近的儿科中心和三级心脏中心。使用Google地图应用程序编程接口（API）估算旅行距离和时间。
结果：1019名患者（中位年龄3.8岁）接受了心脏介入治疗，并纳入样本。在这个队列中，30.2％的人居住在三级中心所在的昆士兰州东南部（SEQ）地区以外。与SEQ.居住在SEQ以外的患者获得三级护理的中位距离为953km，行进时间为10h43分钟。相比之下，全科医生距离5.5公里，儿科服务距离20.6公里（分别为8.9和54分钟）。
结论：这种CHD服务的地理映射显示了在大型国家医疗保健系统中为儿童提供专科心脏护理所固有的关键挑战。相当比例的高风险患者生活在距离三级护理很远的地方。初级保健服务的更大可及性凸显了支持大都市地区以外的初级保健医生获得或建立照顾冠心病儿童的能力和能力的重要性。加强本地一级和二级服务,不仅有可能改善高危病人的预后,而且为了减少与潜在可避免的区域旅行相关的成本和负担，农村,或偏远地区访问专业CHD服务。
方法：参与者包括一组儿童（0-18岁），他们在3年（2019-2021年）期间在昆士兰州获得了全州的专科冠心病服务。澳大利亚。患者住所的位置，全科医生,使用地理信息系统（GIS）软件（ArcGISOnline）绘制了最近的儿科中心和三级心脏中心。使用Google地图应用程序编程接口（API）估算旅行距离和时间。
结果：1019名患者（中位年龄3.8岁）接受了心脏介入治疗，并纳入样本。在这个队列中，30.2％的人居住在三级中心所在的昆士兰州东南部（SEQ）地区以外。与SEQ.居住在SEQ以外的患者获得三级护理的中位距离为953km，行进时间为10h43分钟。相比之下，全科医生距离5.5公里，儿科服务距离20.6公里（分别为8.9和54分钟）。
结论：这种CHD服务的地理映射显示了在大型国家医疗保健系统中为儿童提供专科心脏护理所固有的关键挑战。相当比例的高风险患者生活在距离三级护理很远的地方。初级保健服务的更大可及性凸显了支持大都市地区以外的初级保健医生获得或建立照顾冠心病儿童的能力和能力的重要性。加强本地一级和二级服务,不仅有可能改善高危病人的预后,而且为了减少与潜在可避免的区域旅行相关的成本和负担，农村,或偏远地区访问专业CHD服务。
