Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10316/105837 https://doi.org/10.1136/bmjopen-2019-033777 |
Resumo: | Objectives Studies have suggested that material deprivation is strongly associated with negative health outcomes, and lower usage of various levels of healthcare. We aim to analyse geographical access to emergency medical services (EMSs) and hospital emergency units by EMS in relation to deprivation in the Lisbon Metropolitan Area (LMA), Portugal. Design This study estimates road network-based access times from the centroids of statistical sections (census block groups equivalent) to locations of EMS and hospital emergency services. Each statistical section has been linked to a Material Deprivation Index (MDI). A non-parametric analysis of variance (ANOVA) was undertaken to compare MDI-linked statistical sections in terms of access to emergency care. Geographical access analysis was conducted for 2018. Primary outcome measure Road network-based access time (in minutes) for EMSs to statistical sections and then on to emergency units in hospitals. Results Overall, 82.4% of the LMA population is located less than a 10 min drive from an EMS without transport, and 99.1% from an EMS with transport. Travel time from EMS with transport to hospital is potentially less than 20 min for 95.2% of the population. However, 63.1% of residents living beyond a 30 min threshold (total time from emergency call to hospital arrival) are in areas with very high MDI (18.8% in high MDI, 13.3% in medium MDI, 4.7% in low MDI, 0% in very low MDI). Kruskal-Wallis ANOVA confirms discrepancies in access times between better-off and poorer areas. Conclusion Poorer areas experience worse geographical access to EMS and hospital emergency units. More research is needed to explore the quality of services and their outcomes, and to refine the analysis by focusing on specific vulnerable groups. |
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Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological studydeprivation; emergency department; geographical access; medical emergency service; spatial justiceAdultChildCross-Sectional StudiesEmergency Service, HospitalGeographyHumansPortugalEmergency Medical ServicesObjectives Studies have suggested that material deprivation is strongly associated with negative health outcomes, and lower usage of various levels of healthcare. We aim to analyse geographical access to emergency medical services (EMSs) and hospital emergency units by EMS in relation to deprivation in the Lisbon Metropolitan Area (LMA), Portugal. Design This study estimates road network-based access times from the centroids of statistical sections (census block groups equivalent) to locations of EMS and hospital emergency services. Each statistical section has been linked to a Material Deprivation Index (MDI). A non-parametric analysis of variance (ANOVA) was undertaken to compare MDI-linked statistical sections in terms of access to emergency care. Geographical access analysis was conducted for 2018. Primary outcome measure Road network-based access time (in minutes) for EMSs to statistical sections and then on to emergency units in hospitals. Results Overall, 82.4% of the LMA population is located less than a 10 min drive from an EMS without transport, and 99.1% from an EMS with transport. Travel time from EMS with transport to hospital is potentially less than 20 min for 95.2% of the population. However, 63.1% of residents living beyond a 30 min threshold (total time from emergency call to hospital arrival) are in areas with very high MDI (18.8% in high MDI, 13.3% in medium MDI, 4.7% in low MDI, 0% in very low MDI). Kruskal-Wallis ANOVA confirms discrepancies in access times between better-off and poorer areas. Conclusion Poorer areas experience worse geographical access to EMS and hospital emergency units. More research is needed to explore the quality of services and their outcomes, and to refine the analysis by focusing on specific vulnerable groups.BMJ Publishing Group2020-11-06info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/105837http://hdl.handle.net/10316/105837https://doi.org/10.1136/bmjopen-2019-033777eng2044-60552044-6055Silva, Katielle Susane do NascimentoPadeiro, Miguelinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T21:34:12Zoai:estudogeral.uc.pt:10316/105837Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:22:20.200619Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study |
title |
Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study |
spellingShingle |
Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study Silva, Katielle Susane do Nascimento deprivation; emergency department; geographical access; medical emergency service; spatial justice Adult Child Cross-Sectional Studies Emergency Service, Hospital Geography Humans Portugal Emergency Medical Services |
title_short |
Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study |
title_full |
Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study |
title_fullStr |
Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study |
title_full_unstemmed |
Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study |
title_sort |
Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study |
author |
Silva, Katielle Susane do Nascimento |
author_facet |
Silva, Katielle Susane do Nascimento Padeiro, Miguel |
author_role |
author |
author2 |
Padeiro, Miguel |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Silva, Katielle Susane do Nascimento Padeiro, Miguel |
dc.subject.por.fl_str_mv |
deprivation; emergency department; geographical access; medical emergency service; spatial justice Adult Child Cross-Sectional Studies Emergency Service, Hospital Geography Humans Portugal Emergency Medical Services |
topic |
deprivation; emergency department; geographical access; medical emergency service; spatial justice Adult Child Cross-Sectional Studies Emergency Service, Hospital Geography Humans Portugal Emergency Medical Services |
description |
Objectives Studies have suggested that material deprivation is strongly associated with negative health outcomes, and lower usage of various levels of healthcare. We aim to analyse geographical access to emergency medical services (EMSs) and hospital emergency units by EMS in relation to deprivation in the Lisbon Metropolitan Area (LMA), Portugal. Design This study estimates road network-based access times from the centroids of statistical sections (census block groups equivalent) to locations of EMS and hospital emergency services. Each statistical section has been linked to a Material Deprivation Index (MDI). A non-parametric analysis of variance (ANOVA) was undertaken to compare MDI-linked statistical sections in terms of access to emergency care. Geographical access analysis was conducted for 2018. Primary outcome measure Road network-based access time (in minutes) for EMSs to statistical sections and then on to emergency units in hospitals. Results Overall, 82.4% of the LMA population is located less than a 10 min drive from an EMS without transport, and 99.1% from an EMS with transport. Travel time from EMS with transport to hospital is potentially less than 20 min for 95.2% of the population. However, 63.1% of residents living beyond a 30 min threshold (total time from emergency call to hospital arrival) are in areas with very high MDI (18.8% in high MDI, 13.3% in medium MDI, 4.7% in low MDI, 0% in very low MDI). Kruskal-Wallis ANOVA confirms discrepancies in access times between better-off and poorer areas. Conclusion Poorer areas experience worse geographical access to EMS and hospital emergency units. More research is needed to explore the quality of services and their outcomes, and to refine the analysis by focusing on specific vulnerable groups. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-11-06 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10316/105837 http://hdl.handle.net/10316/105837 https://doi.org/10.1136/bmjopen-2019-033777 |
url |
http://hdl.handle.net/10316/105837 https://doi.org/10.1136/bmjopen-2019-033777 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
2044-6055 2044-6055 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
BMJ Publishing Group |
publisher.none.fl_str_mv |
BMJ Publishing Group |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
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1799134112860078080 |