title: Comparison of perceived and modelled geographical access to accident and emergency departments: a cross-sectional analysis from the Caerphilly Health and Social Needs Study.
abstract: BACKGROUND
  Assessment of the spatial accessibility of hospital accident and emergency departments as perceived by local residents has not previously been investigated. Perceived accessibility may affect where, when, and whether potential patients attend for treatment. Using data on 11,853 respondents to a population survey in Caerphilly county borough, Wales, UK, we present an analysis comparing the accessibility of accident and emergency departments as reported by local residents and drive-time to the nearest accident and emergency department modelled using a geographical information system (GIS).
  
  
  RESULTS
  Median drive-times were significantly shorter in the lowest perceived access category and longer in the best perceived access category (p < 0.001). The perceived access and GIS modelled drive-time variables were positively correlated (Spearman's rank correlation coefficient, r = 0.38, p < 0.01). The strongest correlation was found for respondents living in areas in which nearly all households had a car or van (r = 0.47, p < 0.01). Correlations were stronger among respondents reporting good access to public transport and among those reporting a recent accident and emergency attendance for injury treatment compared to other respondents. Correlation coefficients did not vary substantially by levels of household income. Drive-time, road distance and straight-line distance were highly inter-correlated and substituting road distance or straight-line distance as the GIS modelled spatial accessibility measure only marginally decreased the magnitude of the correlations between perceived and GIS modelled access.
  
  
  CONCLUSIONS
  This study provides evidence that the accessibility of hospital-based health care services as perceived by local residents is related to measures of spatial accessibility modelled using GIS. For studies that aim to model geographical separation in a way that correlates well with the perception of local residents, there may be minimal advantage in using sophisticated measures. Straight-line distance, which can be calculated without GIS, may be as good as GIS-modelled drive-time or distance for this purpose. These findings will be of importance to health policy makers and local planners who seek to obtain local information on access to services through focussed assessments of residents' concerns over accessibility and GIS modelling.
authors.affiliation: Department of Epidemiology, Statistics and Public Health, Centre for Health Sciences Research, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK. foned@cf.ac.uk
authors.forename: David L
authors.initials: DL
authors.lastname: Fone
authors.forename: Stephen
authors.initials: S
authors.lastname: Christie
authors.forename: Nathan
authors.initials: N
authors.lastname: Lester
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D040362:Geographic Information Systems; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors; D014186:Transportation; D014852:Wales