Measurement of the potential geographic accessibility from call to definitive care for patient with acute stroke

Abstract

BackgroundThe World Health Organization refers to stroke, the second most frequent cause of death in the world, in terms of pandemic. Present treatments are only effective within precise time windows. Only 10% of thrombolysis patients are eligible. Late assessment of the patient resulting from admission and lack of knowledge of the symptoms is the main explanation of lack of eligibility.MethodsThe aim is the measurement of the time of access to treatment facilities for stroke victims, using ambulances (firemen ambulances or EMS ambulances) and private car. The method proposed analyses the potential geographic accessibility of stroke care infrastructure in different scenarios. The study allows better considering of the issues inherent to an area: difficult weather conditions, traffic congestion and failure to respect the distance limits of emergency transport.ResultsDepending on the scenario, access times vary considerably within the same commune. For example, between the first and the second scenario for cities in the north of Rhône county, there is a 10 min difference to the nearest Primary Stroke Center (PSC). For the first scenario, 90% of the population is 20 min away of the PSC and 96% for the second scenario. Likewise, depending on the modal vector (fire brigade or emergency medical service), overall accessibility from the emergency call to admission to a Comprehensive Stroke Center (CSC) can vary by as much as 15 min.ConclusionsThe setting up of the various scenarios and modal comparison based on the calculation of overall accessibility makes this a new method for calculating potential access to care facilities. It is important to take into account the specific pathological features and the availability of care facilities for modelling. This method is innovative and recommendable for measuring accessibility in the field of health care. This study makes possible to highlight the patients’ extension of care delays. Thus, this can impact the improvement of patient care and rethink the healthcare organization. Stroke is addressed here but it is applicable to other pathologies.

Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

“…Fourth, our analyses focused on driving times based on posted speed limits; however, actual driving speeds will be higher than posted ones for emergency vehicles and lower during difficult weather conditions or heavy traffic. 45 Not all people have access to vehicles, and use of driving time as a surrogate for access may overestimate access to care, especially in subgroups of people with lower car ownership. 46,47 True transit time includes not only driving time but also emergency medical services activation time, response time, on-scene time, and "door-in door-out" times for those seen first at a local hospital and subsequently transferred to a stroke center.…”

Impact of Perception of Green Space for Health Promotion on Willingness to Use Parks and Actual Use among Young Urban Residents

“…Park physical features may also play a vital role in encouraging park use or physical activity among residents [ 65 ], especially for specific features, e.g., playgrounds [ 66 ], water features [ 67 ] and vegetation [ 68 ]. In contrast, other features, such as litter, vandalism and poor playground surface quality have been shown to have a negative impact on park use [ 69 , 70 ].…”

Mobile Exergaming in Adolescents’ Everyday Life—Contextual Design of Where, When, with Whom, and How: The SmartLife Case

“…The results indicated that moments when the adolescents are already engaging in technology-based activities to overcome boredom may be replaced with the active play of a mobile exergame. In addition, research shows that transportation stops or stations were often used by adolescents to wait for friends or public transportation [ 67 ]. Our study adds that during these timeframes, including waiting time and after-school hours, a mobile exergame may be interesting to play.…”