Comparison of general and cardiac care-specific indices of spatial access in Australia

Vincent Lawrence Versace; Neil T Coffee; Julie Franzon; Dorothy Turner; Jarrod Lange; Danielle Taylor; Robyn Clark

doi:10.1371/journal.pone.0219959

Comparison of general and cardiac care-specific indices of spatial access in Australia

PLoS One. 2019 Jul 25;14(7):e0219959. doi: 10.1371/journal.pone.0219959. eCollection 2019.

Authors

Vincent Lawrence Versace^{1

2

3}, Neil T Coffee^{3

4}, Julie Franzon³, Dorothy Turner⁵, Jarrod Lange⁶, Danielle Taylor⁷, Robyn Clark³

Affiliations

¹ Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia.
² National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria, Australia.
³ College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
⁴ Centre for Research and Action in Public Health (CeRAPH), University of Canberra, Canberra, ACT, Australia.
⁵ Spatial Sciences Group, School of Biological Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
⁶ Hugo Centre for Migration and Population Research, The University of Adelaide, Adelaide, South Australia, Australia.
⁷ Basil Hetzel Institute for Translational Health Research, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.

Abstract

Objective: To identity differences between a general access index (Accessibility/ Remoteness Index of Australia; ARIA+) and a specific acute and aftercare cardiac services access index (Cardiac ARIA).

Research design and methods: Exploratory descriptive design. ARIA+ (2011) and Cardiac ARIA (2010) were compared using cross-tabulations (chi-square test for independence) and map visualisations. All Australian locations with ARIA+ and Cardiac ARIA values were included in the analysis (n = 20,223). The unit of analysis was Australian locations.

Results: Of the 20,223 locations, 2757 (14% of total) had the highest level of acute cardiac access coupled with the highest level of general access. There were 1029 locations with the poorest access (5% of total). Approximately two thirds of locations in Australia were classed as having the highest level of cardiac aftercare. Locations in Major Cities, Inner Regional Australia, and Outer Regional Australia accounted for approximately 98% of this category. There were significant associations between ARIA+ and Cardiac ARIA acute (χ2 = 25250.73, df = 28, p<0.001, Cramer's V = 0.559, p<0.001) and Cardiac ARIA aftercare (χ2 = 17204.38, df = 16, Cramer's V = 0.461, p<0.001).

Conclusions: Although there were significant associations between the indices, ARIA+ and Cardiac ARIA are not interchangeable. Systematic differences were apparent which can be attributed largely to the underlying specificity of the Cardiac ARIA (a time critical index that uses distance to the service of interest) compared to general accessibility quantified by the ARIA+ model (an index that uses distance to population centre). It is where the differences are located geographically that have a tangible impact upon the communities in these locations-i.e. peri-urban areas of the major capital cities, and around the more remote regional centres. There is a strong case for specific access models to be developed and updated to assist with efficient deployment of resources and targeted service provision. The reasoning behind the differences highlighted will be generalisable to any comparison between general and service-specific access models.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Australia
Cardiology / standards*
Health Services Accessibility
Health Services Needs and Demand
Humans
Rural Health Services / standards*

Grants and funding

Professor Robyn A Clark is supported by a Heart Foundation Future Fellowship (App ID 100847). Associate Professor Vincent Versace is funded by the Rural Health Multidisciplinary Training (RHMT) program (Australian Government Department of Health). Dr Danielle Taylor is supported by a Hospital Research Foundation Mid-Career Research Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.