General Medicine
2012, vol. 13, no. 1, p. 3-4.
Editorial
Primary Care, Accessibility, and Use of the Geographic Information System Masanobu Okayama, MD, PhD Editor, General Medicine
Accessibility is one of the basic principals of 1
primary care. Accessibility consists of four perspec-
an indispensable component for proposals of appropriate distributions of physicians. 3
tives: geographic, economic, temporal, and psychologi-
In the second, Harada M, et al. explore the disparity
cal. These perspectives lie just beneath the current
of spatial accessibility to inpatient care among 2,688
topics in health care delivery systems concerning the
census mesh blocks in Tochigi prefecture. In this
reconsolidation of public hospitals, numbers of physi-
paper, it is suggested that a Gini coefficient is useful to
cians and their distribution, and the behavior of
estimate geographical distribution. The Gini coeffi-
visiting clinics and hospitals. If we would like to obtain
cient measures inequality among values of a frequen-
satisfactory resolution of these important issues for all
cy distribution. Commonly used as an index of
stakeholders, we should evaluate and ensure health
inequality of income or wealth, a Gini coefficient is
care accessibility.
expressed between zero（perfect equality）and one
Two studies concerning accessibility are reported 2−3
（maximal inequality). Using this index, accessibility
One focuses on the
can be evaluated objectively and compared accurately
influence of practice location on the reasons for visits
among various regions. This approach offers us one
to a clinic, and the other focuses on regional inequality
tool for handling accessibility.
in this issue of General Medicine.
of spatial accessibility to inpatient care.
Information technology has been rapidly develop-
2
In the first, Morita Y, et al. reported that physicians
ing these days, and electronic health record systems
working at a clinic on an isolated island need to be able
are already used in most medical institutes, especially
to control lifestyle related diseases and provide initial
hospitals. Thus, information on many aspects of
treatment for musculoskeletal or skin diseases. It may
clinical practice can be easily obtained in the form of
be reasonable that differences in practice location
electric information. By collecting data on health
make differences in the requirements of practice for a
insurance claims and health check-ups though health
physician in a clinic. However, these finding suggest
insurance systems, municipalities, the national health
that primary care physicians in rural areas require
insurance system, and so on, the Japanese
more clinical skills and knowledge than in cities.
Government has generated a national database of data
Geographical accessibility probably plays a critical
and attempted to evaluate the quality of health care
role in developing a physicianʼs adaptation to a
and develop benchmarks. The spread of information
community setting. In this way, accessibility influen-
technology has created an environment in which it is
ces medical education, especially in a clinical training
convenient to examine the contents of clinical practice
program, and presumably ought to be considered as
much more quickly than before.
Author for corresponding : Masanobu Okayama, MD, PhD Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University 3311-1 Yakushiji, Shimotsuke-city, Tochigi, Japan
e-mail:
[email protected]
― 3 ―
General Medicine
2012, vol. 13, no. 1
In addition, high technology allows us to perform
to simply consider location and scale as key issues
geographic information system（GIS）analysis. GIS
related to reconsolidation of public hospitals. They will
integrates hardware, software, and data for capturing,
probably not able to reach consensus on these issues,
managing, analyzing, and displaying all forms of
unless geographical accessibility is evaluated in
geographically referenced information. GIS lets us
communities. Renewal planning will need to be based
visualize, question, analyze, interpret, and understand
on research evidence concerning the requirements of
data to reveal relationships, patterns, and trends.
health care and accessibility.
However, this system places extraordinary demands
In conclusion, accessibility is one of several essential
on a computing system and high-power computers
elements for generating a health care delivery system
are essential for using GIS. Fortunately, in the last few
that is satisfactory for all people in a community. In
years, high-power personal computers have become
the field of primary care research, it is essential to
easier to use and continue to become dramatically
promote research concerning accessibility using
cheaper. Thus, through the use of GIS it has become
health care databases and GIS.
much easier to examine geographical accessibility to health care resources.
References
In spite of recent developments of GIS, research
1
Japan Primary Care Association. What is primary
focusing on geographical accessibility and the associa-
care?
http:／／www.primary-care.or.jp／paramedic／ ／／ ／ ／
tion between accessibility and health indicators
pc.html. Accessed 2012-05-07)
remains rare in Japan. However, a databank of
2
community health care, in which GIS is available, has
reasons for visits a clinic on an isolated island. Gen
been established and includes not only data of health
Med. 2012. vol. 13, no. 1, p. 30-36.
insurance claims but prescribed medication and
3
Morita Y, Kuroki S, Lefor A, KajiiE. Analysis of the
Harada M, Okayama M, Ae R, Kojo T, Aihara M,
4
anonymous personal data. In one review concerning
Kajii E. A study on regional disparities in access to
concepts and measurements of spatial accessibility to
inpatient care, using the Gini coefficient. Gen Med.
primary care, several researches presented examples
2012 vol. 13, no. 1, p. 25-29.
5
of promising work using GIS. Therefore it is expected
4
that research using GIS will make progress in Japan.
care. White paper of community health care 3
It is also worth noting that local governments in
Aihara M. The databank of community health rd
ed.
Jichi Medical University. 2012, p. 131-137
Japan will soon be undertaking renewal planning of
5
community health care delivery systems, partially
care: concepts, methods and challenges. Int J Health
supported by funding from the central government.
Geogr. 2004, vol. 3, p. 3
As part of this planning, the members of the
6
committee are likely to discuss Japanʼs shortage of
Association between increases in number of physi-
physicians. However, it is reported that increases in
cians and the standard mortality ratio in medical
the number of physicians per capita might not lead to
administrative districts in Japan. J Jpn Primary Care.
improved health indicators in medical administrative
2011, vol. 34, no. 3, p. 188-194.
6
districts. In the meetings of the committee, they tend
― 4 ―
Guagliardo M. F, Spatial accessibility of primary
Nakamura T, Okayama M, Sekine S, Kajii E.
