Spatial equity and realised access to healthcare - a geospatial analysis of general practitioner enrolments in Waikato, New Zealand.
INTRODUCTION
Geographic measures of accessibility can quantify inequitable distributions of health care. Although closest distance measures are often used in Aotearoa New Zealand these may not reflect patient use of health care. This research examines patterns of patient enrolment in general practitioner (GP) services from a geospatial perspective.


METHODS
Patient enrolment records (n=137 596) from one primary health organisation were examined and geographic information systems used to determine whether patients enrolled with their closest GP service. A binomial logistic regression was performed to examine factors associated with the bypass of GP services closer to patients' homes.


RESULTS
Overall 68.1% of patients in the sample bypassed the GP service closest to their home, while rates of GP bypass varied across the Waikato region and between rural and urban areas. A binary logistic regression analysis revealed that rurality of patient residence, patient ethnicity, patient age, area-level socioeconomic deprivation, sex, distance to the closest GP clinic, clinic after-hours availability, M&#257;ori service provider status, GP and nurse full time equivalent hours, and clinic fees were statistically significant predictors of increased closest-GP bypass. While residents of major urban areas had high rates of GP bypass, this was followed by patients living in rural areas - patients living more than 20 km from the closest GP service had exceptionally high rates of GP bypass.


CONCLUSION
This study suggests that most patients in the Waikato region do not enrol with the GP service closest to their home and it outlines several factors, including rurality of residence, associated with the GP bypass. Closest distance accessibility measures may be inappropriate in mixed urban-rural settings, and researchers should consider other approaches to quantifying spatial equity. Health services should also be designed to better reflect the realities of the populations they serve.
['Whitehead|Jesse|J|', 'Pearson|Amber L|AL|', 'Lawrenson|Ross|R|', 'Atatoa-Carr|Polly|P|']
D000293:Adolescent D000328:Adult D000368:Aged D002648:Child D002675:Child, Preschool D005260:Female D058005:General Practitioners D040362:Geographic Information Systems D006297:Health Services Accessibility D006301:Health Services Needs and Demand D006280:Health Workforce D006801:Humans D007223:Infant D007231:Infant, Newborn D016015:Logistic Models D008297:Male D008875:Middle Aged D044468:Native Hawaiian or Other Pacific Islander D009520:New Zealand D012111:Residence Characteristics D012737:Sex Factors D012959:Socioeconomic Factors D062206:Spatial Analysis D014186:Transportation D055815:Young Adult
Aotearoa New Zealand general practice health equity medical geography primary health care rural health services access to health care