Geographic access to palliative care
A blog post written by Dr Deborah van Gaans, Research Associate, CareSearch, College of Nursing and Health Sciences, Flinders University
Inequality of access to palliative care is one of the largest disparities in global health care. [1] Within Australia the national Australian government has long recognised the importance of providing high quality palliative care, both as a matter of equity but also of efficiency. [2] Yet geographic access to palliative care services within Australia is still a significant issue.
Palliative Care Australia has established a Palliative Care Support and Service Directory which enables greater visibility and awareness of existing services. Directory users can find the following information:
- name and type of service
- location and contact details
- description of service
- availability of after-hours support.
Contact details and a link to each of the services website is also provided. Therefore, providing users with the availability of palliative care services, should they require them and providing comfort to patients through knowing that they exist.
The directory allows users to search for services by category (specialist palliative care, generalist palliative care, specialist paediatric palliative care, and other), service type (allied health, age care provider, community nursing, general practice), distance (set at 25km intervals), and after-hours support. Users can not only find their nearest service providers they can locate services which may meet specific individual needs.
Location mapping enables users to see palliative care services which are geographically located nearby. The “Get Direction” button redirects users to a map highlighting the route that can be taken from their current location. This includes options for travel by private car and public transport. This once again takes into consideration the user’s location and therefore makes it easy for the user to potentially travel to the palliative care services.
While the Directory is an important first resource to support awareness and possible use of services, it offers only a narrow view of accessibility to palliative care services. Accessibility theories such as the dimensions of accessibility developed by Penchansky and Thomas (1981) describe accessibility as the following 5 dimensions:
Availability as the relationship between the volume and type of existing services (and resources) and the clients’ volume and types of needs. Availability refers to the adequacy of the supply of physicians, dentists, and other providers or facilities, such as clinics and hospitals and of specialised programs and services, such as mental health and emergency care;
Accessibility as the relationship between the location of supply and the location of clients, taking account of client transportation resources and travel time, distance, and cost;
Accommodation as the relationship between the manner in which the supply resources are organised to accept clients (including appointment systems, hours of operation, walk-in facilities, telephone services) and the clients’ ability to accommodate these factors;
Affordability as the relationship between the prices of services and providers’ insurance or deposit requirements and the client’s income, ability to pay and existing health insurance. Client perception of worth relative to total cost may be a concern, as is clients’ knowledge of prices, total cost, and possible credit arrangements;
Acceptability as the relationship, between clients’ attitudes about personal and practice characteristics of existing providers including age, sex, location and type of facility or religious affiliation of the provider or facility, as well as provider attitudes about acceptable personal characteristics of clients, including ethnicity and source of payment. [3]
Penchansky and Thomas’ theory of accessibility highlights not only the geographic but also the socio-economic aspects of the relationship between health services and the population that they serve. Incorporating some of these dimensions of accessibility into the Palliative Care Support and Service Directory, would provide a better resource for improving the accessibility of palliative care services.
However, the availability information from the directory could be used to underpin further research to understand the accessibility of palliative care services to the population that they serve. As in reality, people trade off geographical and non-geographical factors in making decisions about health service use. [4] Further research could identify which dimensions of accessibility other than availability affect accessibility of palliative care services. Generating models of accessibility from the directory information could also identify areas where accessibility to palliative care services could be improved and where new services or models of delivery should be established to enhance accessibility in areas that are currently poorly served.
References
- Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, et al. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet. 2018 Apr 7;391(10128):1391-1454. doi: 10.1016/S0140-6736(17)32513-8. Epub 2017 Oct 12. Erratum in: Lancet. 2018 Mar 9
- Mitchell GK. Palliative Care in Australia. Ochsner J. 2011 Winter;11(4):334-7.
- Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981 Feb;19(2):127-40. doi: 10.1097/00005650-198102000-00001.
- Cromley EK, McLafferty SL. GIS and Public Health. 2nd ed. New York: The Guilford Press; 2020
Dr Deborah van Gaans, Research Associate, CareSearch, College of Nursing and Health Sciences, Flinders University