四川省急救医疗服务空间可及性研究
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摘要
目的了解急救医疗服务的空间可及性特征,为有限急救医疗资源的优化配置等提供依据。方法纳入四川省内2017年所有提供急救医疗服务的医疗卫生机构为供方,四川省内所有人口为需方。采用最短路径法计算所有需求点到最近急救医疗服务设施点的最短就医时间。结果总体而言,四川省的急救医疗服务的空间可及性较好,但四川省内急救医疗服务可及性也存在着较大的差异。与四川省东部地区相比,位于川西地区的阿坝藏族羌族自治州、甘孜藏族自治州和凉山彝族自治州的急救医疗服务可及性稍差。结论医疗资源多较集中地分布在人口密度较大、经济发展较好、自然条件等较优越的地方。通过最短就医时间分析,可以较全面地了解医疗资源的空间配置状况。对于急救医疗资源空间可及性较差的地区,除了新建/增设急救医疗机构外,可以通过增强居民自救技能等综合的策略改善急救医疗服务可及性,弥补由于有限条件导致的急救医疗服务空间可及性差的情况,有助于维护和促进人民健康。
Objective The aim of this study was to assess the spatial accessibility of emergency care in Sichuan province, and to give some suggestions for the location and allocation of the limited emergency care resources. Methods All facilities provided emergency care in 2017 were taken into account. The shortest travel time was calculated for the whole population by the nearest neighbor method. Results In general, the spatial accessibility of emergency care in Sichuan province was good.However, disparities still existed within regions. Compared with eastern areas, spatial accessibility was poorer in some western regions of Sichuan, including Ganzi, Aba, and Liangshan. Conclusion Health care resources were tending to concentrate in well-developed areas with high population density. Analyzing the shortest travel time contributed to a comprehensive understanding of the spatial distribution of health care resources. For those areas with poorer spatial accessibility, on the one hand, building new emergency care facilities will help a lot; on the other hand, other comprehensive measures should be conducted to improve spatial accessibility, regardless of the poor circumstance.
Objective The aim of this study was to assess the spatial accessibility of emergency care in Sichuan province, and to give some suggestions for the location and allocation of the limited emergency care resources. Methods All facilities provided emergency care in 2017 were taken into account. The shortest travel time was calculated for the whole population by the nearest neighbor method. Results In general, the spatial accessibility of emergency care in Sichuan province was good.However, disparities still existed within regions. Compared with eastern areas, spatial accessibility was poorer in some western regions of Sichuan, including Ganzi, Aba, and Liangshan. Conclusion Health care resources were tending to concentrate in well-developed areas with high population density. Analyzing the shortest travel time contributed to a comprehensive understanding of the spatial distribution of health care resources. For those areas with poorer spatial accessibility, on the one hand, building new emergency care facilities will help a lot; on the other hand, other comprehensive measures should be conducted to improve spatial accessibility, regardless of the poor circumstance.
引文
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[13]蒋祎,刘亚兰,李西同,等.公益性视角下重庆市急救医疗服务可及性城乡对比分析[J].中国全科医学,2014(35):4230-4233.
[14]丁士祥,钟明良,杨谱芸,等.乡镇卫生院急救服务能力与空间可及性实证研究-以四川省富顺县农药中毒急救服务为例[J].中国卫生政策研究,2018,11(2):69-73.
[15]陈海乐,朱勤忠,李婉莹,等.院前急救服务地理可及性指标计算与可视化表达研究[J].中国医院管理,2013,33(2):31-33.
[16] Bhaduri B, Bright E, Coleman PR, et al. LandScan:Locating peopleis what matters[J]. Geoinformatics, 2002, 5(2):34-37.
[17] Meara JG, Leather AJ, Hagander L, et al. Global surgery 2030:evi-dence and solutions for achieving health, welfare, and economic de-velopment[J]. Surgery, 2015, 158(1):3-6.
[18]张爱华,陶红,桂莉.国内外急救医疗服务体系发展的回顾与展望[J].护理管理杂志,2004,4(4):23-25.
[19] Mathison DJ, Chamberlain JM, Cowan NM, et al. Primary care spatialdensity and nonurgent emergency department utilization:a newmethodology for evaluating access to care[J]. Academic Pediatrics,2013, 13(3):278-285.
[20] Wang XL, Yang HZ, Duan ZQ, et al. Spatial accessibility of primaryhealth care in China:A case study in Sichuan Province[J]. SocialScience&Medicine, 2018, 209:14-24.
[21]何忠杰,姚卫海,张志成,等.“急救白金十分钟-全国自救互救日”部分地区大众急救现状横断面调查[J].解放军医学杂志,2015,40(10):841-845.
[2]岳茂兴.重视和加强外科危重症的基础研究与临床救治[J].中华急诊医学杂志,2005,14(10):5-7.
[3] Richard B, Ray B. Pre hospital medical services and paramedic en-gagement in Australian health care‐improving the pathways of carethrough collaborative action[J]. Family Medicine and CommunityHealth, 2014, 2(4):1-12.
[4] Kobusingye OC, Hyder AA, Bishai D, et al. Emergency medical ser-vices[M]//Jamison DT, Breman JG, Measham AR, et al. Disease con-trol priorities in developing countries. 2nd ed. New York:Oxford U-niversity Press, 2006:1261-1279.
[5] Gao Y, Zhou H, Singh NS, et al. Progress and challenges in maternalhealth in western China:a Countdown to 2015 National case study[J].The Lancet. Global Health, 2017, 5(5):e523-e536.
[6] Pan J, Liu HR, Wang XL, et al. Assessing the spatial accessibility ofhospital care in Sichuan Province, China[J]. Geospatial Health, 2015,10(2):261-270.
[7] Pan J, Shallcross D. Geographic distribution of hospital bedsthroughout China:a county-level econometric analysis[J]. Interna-tional Journal for Equity in Health, 2016, 15(1):179.
[8]国家卫生和计划生育委员会.中国卫生和计划生育统计年鉴2016[M].北京:中国协和医科大学出版社,2016.
[9]钟仕锟,刘子锋,张玲玲,等.广州市中心城区院前急救反应时间影响因素实证研究-基于分位数回归方法[J].中国医院管理,2016,36(11):59-61.
[10]齐腾飞,景军.中国1996-2015年城市院前急救反应时间分析[J].中国公共卫生,2017,32(10):1466-1468.
[11]杨丽娟,糜庆,鲁玲玲.珠海市院前急救反应时间影响因素的研究[J].中外医学研究,2012,10(5):143-144.
[12]周亮,肖水源,刘志宏,等.湖南省两县市乡级医疗机构中毒急救服务能力和可及性的研究[J].中国社会医学杂志,2008,25(2):114-116.
[13]蒋祎,刘亚兰,李西同,等.公益性视角下重庆市急救医疗服务可及性城乡对比分析[J].中国全科医学,2014(35):4230-4233.
[14]丁士祥,钟明良,杨谱芸,等.乡镇卫生院急救服务能力与空间可及性实证研究-以四川省富顺县农药中毒急救服务为例[J].中国卫生政策研究,2018,11(2):69-73.
[15]陈海乐,朱勤忠,李婉莹,等.院前急救服务地理可及性指标计算与可视化表达研究[J].中国医院管理,2013,33(2):31-33.
[16] Bhaduri B, Bright E, Coleman PR, et al. LandScan:Locating peopleis what matters[J]. Geoinformatics, 2002, 5(2):34-37.
[17] Meara JG, Leather AJ, Hagander L, et al. Global surgery 2030:evi-dence and solutions for achieving health, welfare, and economic de-velopment[J]. Surgery, 2015, 158(1):3-6.
[18]张爱华,陶红,桂莉.国内外急救医疗服务体系发展的回顾与展望[J].护理管理杂志,2004,4(4):23-25.
[19] Mathison DJ, Chamberlain JM, Cowan NM, et al. Primary care spatialdensity and nonurgent emergency department utilization:a newmethodology for evaluating access to care[J]. Academic Pediatrics,2013, 13(3):278-285.
[20] Wang XL, Yang HZ, Duan ZQ, et al. Spatial accessibility of primaryhealth care in China:A case study in Sichuan Province[J]. SocialScience&Medicine, 2018, 209:14-24.
[21]何忠杰,姚卫海,张志成,等.“急救白金十分钟-全国自救互救日”部分地区大众急救现状横断面调查[J].解放军医学杂志,2015,40(10):841-845.