The application of spatial measures to analyse health service accessibility in Australia: a systematic review.

Abstract

Background/aim: Australia’s inequitable distribution of health services is well documented, and issues associated with spatial access are often influenced by Australia’s vast landmass, challenging geographical environments, and sparsely distributed populations in rural and remote areas. Spatial access relates to the geographic limitations affecting the availability and accessibility of healthcare practitioners and services. Measuring access contributes to a broader understanding of the performance of health systems, particularly in rural areas. Geographic Information Systems (GIS) in health service research focuses on the geographical dimension of access and is used to analyse geographical inequalities and create improved measures of accessibility. This study aims to critically appraise literature that uses GIS to spatially analyse health service access in Australia to understand which spatial measures and geographical classifications are used and how they are applied. Population/setting: Australian health services across all levels of remoteness. Methods: A systematic search of peer-reviewed literature published between 2002 and 2022 was performed. Search terms were derived from three major topics, including [1] Australian population; [2] spatial analysis of health service accessibility; and [3] objective physical access measures and spatial models applied. Results: Database searches retrieved 1,381 records after removing duplicates. Records were screened for eligibility, resulting in 91 studies for inclusion. Preliminary analyses show accessibility to dental services (n=21), general practice (n=14), hospital (n=13), cancer services (n=11), and cardiac services (n=11) were the most reported disciplines. The most reported access measures were distance or travel time to health service, and number of practices, services, or providers per defined geographical area. Conclusion: The preliminary results show heterogeneous methods were used, mainly across clinical disciplines, making it hard to compare access across different types of health professions. To classify remoteness, some studies apply distance buffers around a General Post Office, and others use the Accessibility and Remoteness Index for Australia (ARIA+). Translational impact/implications for future practice: GIS advancements have led to better capability to spatially examine health service access; however, there is need for a streamlined approach to measuring access across clinical disciplines. Consistent spatial measures and geographical classifications are required to accurately compare geographic areas, inform decision-making, and develop health policies