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Title: Equity of geographic access to specialist patient hospices within the United Kingdom
Author: Wood, David Justin
ISNI:       0000 0004 2717 0739
Awarding Body: Lancaster University
Current Institution: Lancaster University
Date of Award: 2010
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Aim: As adult specialist inpatient hospice provision in the United Kingdom has matured, interest in the question of 'access' to care has grown. The evidence base on geographic accessibility is limited. This study examines whether geographic and socio-demographic accessibility to, and utilisation of, specialist inpatient hospices is equitable. Methods: A selective literature review critically examines the evidence on access to specialist inpatient hospices and specialist palliative care services. Inequalities in the availability of specialist inpatient hospices across the United Kingdom are summarised, analysed and mapped using a geographic information system. The geographic supply of, and demand for, adult specialist inpatient hospices across England and Wales are mapped by small area, and related to levels of deprivation. Specialist inpatient hospice accessibility scores are derived using a Newtonian distance decay model that analyses drive times between 189 inpatient hospices and 34,378 small areas. Inequities in access to specialist inpatient hospices are mapped. The utilisation of specialist inpatient hospices, across England, is examined for a variety of patient groups. A multivariate binary logistic regression analysis, undertaken on 378,482 adult cancer death records, models whether access, deprivation, age, gender and region influence the likelihood of dying in a specialist inpatient hospice. Results: A complex interaction of geographic, socio-demographic, healthcare system, clinical need, personal, cultural, societal and political factors impacts on the accessibility and utilisation of specialist inpatient hospices. Widespread regional variations in the geographic availability of specialist inpatient hospices are revealed. The highest levels of geographic access to adult specialist inpatient hospices are found within major urban conurbations, where cancer patients may potentially access alternative hospices with high bed numbers. Local examples of inequitable access are observed within neighbourhoods of many cities and towns, and across rural fringe counties. Over 6% of adults live at least 30 minutes from a specialist inpatient hospice. Once effects attributable to other variables are accounted for, significant gradients are shown, nationally, by decile of accessibility, relative level of affluence or deprivation, and age, in the likelihood of dying in a specialist inpatient hospice. Notable geographical 'distance decay' effects are clear within the most inaccessible and accessible areas. For 80% of patients, a gradual gradient in utilisation, by decile of accessibility, is shown, though patients from the most accessible decile of areas are 2.79 times more likely to die in a specialist inpatient hospice than are those from least accessible areas. There is evidence of 'inverse care' effects, whereby patients with potentially greater levels of need, show lower utilisation ratios. Patients from the most affluent decile of areas are 1.38 times more likely to die in a specialist inpatient hospice than are those from the poorest areas. The youngest decile banding of patients are 3.86 times more likely to die in a specialist inpatient hospice than the most elderly banding. Implications: Inequitable geographic access has implications for the establishment of future specialist inpatient hospices and integrated models of specialist palliative care.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available