Distance to hospital and utilization of surgical services in Haiti: do children, delivering mothers, and patients with emergent surgical conditions experience greater geographical barriers to surgical care?. (31st August 2012)

• Record Type: Journal Article
• Authors: Friedman, James M.; Hagander, Lars; Hughes, Christopher D.; Nash, Katherine A.; Linden, Allison F.; Blossom, Jeff; Meara, John G.
• Is Part Of: International journal of health planning and management. Volume 28:Number 3(2013)
• Page Start: 248
• Page End: 256
• Publication Date: 2012-08-31
• Subjects: Geographic Information Systems -- barriers to care -- Haiti -- surgical utilization -- geographic accessibility; Health planning -- Periodicals; Health services administration -- Periodicals; Santé publique -- Planification -- Périodiques; Santé, Services de -- Administration -- Périodiques; 362.1068
• DOI: 10.1002/hpm.2134
• Languages: English
• ISSNs: 0749-6753

Abstract

SUMMARY: Background: An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti. Methods: We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care. Results: The highest annual surgical utilization rate was 184 operations/100 000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital ( r s = −0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults ( p < 0.01), and distance from residence to hospital was not significantly different between men and women ( p = 0.25). Patients who received obstetric or gynecologic surgery originated 7.8% closer to the hospital than patients seeking other operations ( p < 0.01), and patients who received emergent surgical care originated 24.8% closer to the hospital than patients who received elective surgery ( p < 0.01). Conclusions: Utilization of surgical services was low and inversely related to distance from residence to hospital in rural areas of central Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care. Copyright © 2012 John Wiley & Sons, Ltd.