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Refining small area estimates for the health workforce in rural areas using floating catchments

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Refining small area estimates for the health workforce in rural areas using floating catchments

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    1. This study builds on workforce planning previously published by the WA Centre for Rural and Remote Medicine (WACRRM) – the “Rural General Practice Workforce Report, 2003” This project uses the same dataset, the Rural GP survey, but applies a GIS Based Methodology for the first time.This study builds on workforce planning previously published by the WA Centre for Rural and Remote Medicine (WACRRM) – the “Rural General Practice Workforce Report, 2003” This project uses the same dataset, the Rural GP survey, but applies a GIS Based Methodology for the first time.

    7. National Average GP Supply Primary Care GPs* = 20,852 Australia’s Population = 20 Million GP : Population ratio = 1:864 *1998 (AMWAC) How is workforce supply described? Quick GP head count in Australia….. Serving 20 million….gives a GP to population ratio of 1:864 However, Of course neither GPs or population is distributed evenly across Australia. And so, Variations in the GP to Population ratio are bound to occur. Rural GP Supply Recognised shortage of General Practitioners (GPs) in Rural and Remote regions of Australia. These shortages likely to increase, given the difficulty of recruiting and retating GPs to rural and remote areas. There is increasing demand for medical services due to an ageing and expanding popultion. Workforce planning Medical workforce planning is an activity which seeks to ensure that all Australians have access to quality medical services appropriate to their needs. How is workforce supply described? Quick GP head count in Australia….. Serving 20 million….gives a GP to population ratio of 1:864 However, Of course neither GPs or population is distributed evenly across Australia. And so, Variations in the GP to Population ratio are bound to occur. Rural GP Supply Recognised shortage of General Practitioners (GPs) in Rural and Remote regions of Australia. These shortages likely to increase, given the difficulty of recruiting and retating GPs to rural and remote areas. There is increasing demand for medical services due to an ageing and expanding popultion. Workforce planning Medical workforce planning is an activity which seeks to ensure that all Australians have access to quality medical services appropriate to their needs.

    8. Current methods of estimating workforce shortages How is workforce shortage identified? WACRRM uses the Local Government Area (LGA) as the smallest geographical unit for workforce analysis. GP numbers are added up for each LGA, and then divided by the total population for that LGA. The population standardised ratios are aggregated up to a regional level, such as Division of General Practice. The GP to population ratio can then be compared to a predetermined benchmark. Advantages: This method is relatively easy to apply. It doesn’t require GIS, Can be calculated on existing administrative boundaries such as the Local Government Area, for which data is available. The location of the GPs is only needed at the level of LGA.How is workforce shortage identified? WACRRM uses the Local Government Area (LGA) as the smallest geographical unit for workforce analysis. GP numbers are added up for each LGA, and then divided by the total population for that LGA. The population standardised ratios are aggregated up to a regional level, such as Division of General Practice. The GP to population ratio can then be compared to a predetermined benchmark. Advantages: This method is relatively easy to apply. It doesn’t require GIS, Can be calculated on existing administrative boundaries such as the Local Government Area, for which data is available. The location of the GPs is only needed at the level of LGA.

    13. CD & GP workforce location GP workforce data Medical workforce data for WA was supplied by the WACRRM Annual GP Survey (November 2003). The GP Survey contains information on the location and work practices of all GPs working in non-metropolitan WA. A measure of workload is included based on the number of clinical sessions worked per week per GP. Full Time Equivalent (FTE) workload was calculated for each GP based on the number of reported sessions worked. In order to focus on the primary health care workforce, all Department of Health salaried doctors including registrars and Royal Flying Doctors were removed from the workforce data in all Divisions except the Kimberley. In the Kimberley, half of the working hours of Dept of Health salaried GPs were retained in Kununurra, Derby, Halls Ck and Fitzroy Crossing, in recognition of the primary health care consultations conducted by salaried GPs in those areas. In all Divisions, private resident GPs and AMS GP sessions were retained in the database in full. The GP practice locations were geocoded to exact street address within ArcView GIS. GP workforce data Medical workforce data for WA was supplied by the WACRRM Annual GP Survey (November 2003). The GP Survey contains information on the location and work practices of all GPs working in non-metropolitan WA. A measure of workload is included based on the number of clinical sessions worked per week per GP. Full Time Equivalent (FTE) workload was calculated for each GP based on the number of reported sessions worked. In order to focus on the primary health care workforce, all Department of Health salaried doctors including registrars and Royal Flying Doctors were removed from the workforce data in all Divisions except the Kimberley. In the Kimberley, half of the working hours of Dept of Health salaried GPs were retained in Kununurra, Derby, Halls Ck and Fitzroy Crossing, in recognition of the primary health care consultations conducted by salaried GPs in those areas. In all Divisions, private resident GPs and AMS GP sessions were retained in the database in full. The GP practice locations were geocoded to exact street address within ArcView GIS.

    17. Our hypothesis has been proven. There are regions – divisions of general practice – in which the aggregate model gives the impression of similar levels of access but a small area approach shows a very different pattern.Our hypothesis has been proven. There are regions – divisions of general practice – in which the aggregate model gives the impression of similar levels of access but a small area approach shows a very different pattern.

    18. Sth West Here is an example of this variation. This Map shows the South Western Districts at larger scale. Using the Great Southern Division of General Practice as an example : There are some areas of adequate workforce and some areas of shortage There are no red areas, that is no population which is located further than 100km from a GP. Here is an example of this variation. This Map shows the South Western Districts at larger scale. Using the Great Southern Division of General Practice as an example : There are some areas of adequate workforce and some areas of shortage There are no red areas, that is no population which is located further than 100km from a GP.

    20. One of the problems we encountered in applying this method was a visual one. Understandably our colleagues in the rural workforce agency did not like the idea that we show most of Western Australia without GP access. While there are large parts of WA in which this is true, this map is also an artifact of the application of this methods to the cds that we have.One of the problems we encountered in applying this method was a visual one. Understandably our colleagues in the rural workforce agency did not like the idea that we show most of Western Australia without GP access. While there are large parts of WA in which this is true, this map is also an artifact of the application of this methods to the cds that we have.

    21. This maps demonstrates how important the location of the centroid is to the calculation of GP access. The large CD to the south has adequate GP access because its centroid is within 100 kms of Carnarvon were there are GPs. This maps demonstrates how important the location of the centroid is to the calculation of GP access. The large CD to the south has adequate GP access because its centroid is within 100 kms of Carnarvon were there are GPs.

    25. Aggregation to areal units

    26. Aggregation to areal units

    27. Aggregation to areal units

    28. Aggregation to areal units

    31. Note the different effects of a weighted centroid. For the northern CD the centroid is moved south, so the 100 km radius no longer includes the GP living to the east. For the southern CD, a small shift in the centroid to the southwest means that two GPs who were out of range previously are now within range.Note the different effects of a weighted centroid. For the northern CD the centroid is moved south, so the 100 km radius no longer includes the GP living to the east. For the southern CD, a small shift in the centroid to the southwest means that two GPs who were out of range previously are now within range.

    32. While there are differences for individual CDs, the overall map looks very similar.While there are differences for individual CDs, the overall map looks very similar.

    39. Although clients come from throughout the region, the majority (92%) reside within the Geraldton statistical subdivision.Although clients come from throughout the region, the majority (92%) reside within the Geraldton statistical subdivision.

    40. One possible explanation for the difference in the proportion of clients is the distance to the surgery. We would expect that the further a person lives from UMP, the less likely it is that he or she would become a client. For each CD we calculated the kilometres between the centre of the CD and surgery and produced a scatter plot. CDs shown in red are located in the urban area and CDs in green are located in the outlying rural areas. The relationship between distance and the proportion of population who had enrolled as a client shows a familiar decay function, that is, the proportion of clients declines exponentially with distance. But there are some outliers, especially in the rural areas, of areas that have larger proportion of clients than we would expect considering how far they are from the surgery.One possible explanation for the difference in the proportion of clients is the distance to the surgery. We would expect that the further a person lives from UMP, the less likely it is that he or she would become a client. For each CD we calculated the kilometres between the centre of the CD and surgery and produced a scatter plot. CDs shown in red are located in the urban area and CDs in green are located in the outlying rural areas. The relationship between distance and the proportion of population who had enrolled as a client shows a familiar decay function, that is, the proportion of clients declines exponentially with distance. But there are some outliers, especially in the rural areas, of areas that have larger proportion of clients than we would expect considering how far they are from the surgery.

    42. Over all, the gravity model has to show LESS access because of the frictional effect of distance. In this slide we see MORE variation because the middle CDs do not have the competing population from the larger CDs included. However, since this model looks only at the population within the CD, CDs with large populations have better access than those with smaller populations. Over all, the gravity model has to show LESS access because of the frictional effect of distance. In this slide we see MORE variation because the middle CDs do not have the competing population from the larger CDs included. However, since this model looks only at the population within the CD, CDs with large populations have better access than those with smaller populations.

    43. A model that had a patient perspective would recognise that rural CDs close to a regional centre with GPs still may not have good access because there may not be enough GPs for that regional centre.A model that had a patient perspective would recognise that rural CDs close to a regional centre with GPs still may not have good access because there may not be enough GPs for that regional centre.

    45. Numbers of patients hospitalised, data source – hospital morbidity data setNumbers of patients hospitalised, data source – hospital morbidity data set

    46. Current frequency of service by a Diabetes Educator, data provided by Meg Risk for the Pilbara Chronic Disease project.Current frequency of service by a Diabetes Educator, data provided by Meg Risk for the Pilbara Chronic Disease project.

    47. This is why we want to have a robust measure of access to primary medical care, because we want to explore why hospitalisations for largely avoidable complications to diabetes is so high in some places.This is why we want to have a robust measure of access to primary medical care, because we want to explore why hospitalisations for largely avoidable complications to diabetes is so high in some places.

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