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primary care.1 Accessibility consists of four perspec- tives: geographic ... However, a databank of community health care, in which GIS is available, has.
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.