title: Access to electroconvulsive therapy services in Canada.
abstract: OBJECTIVE
  We sought to determine factors governing access to electroconvulsive therapy (ECT) in Canada.
  
  
  METHODS
  We contacted all 1273 registered health care institutions in Canada and invited the 175 centers identified as providing ECT to complete a comprehensive questionnaire. To determine geographic access to ECT, we used a geographic information system, population density data, and road network data. Responses to 5 questions from the questionnaire were used to identify local barriers to access.
  
  
  RESULTS
  Approximately 84% of the population in the 10 Canadian provinces live within a 1-hour drive of an ECT center, but 5% live more than 5 hours' drive away. There was significant province-to-province variation, with all of the citizens of Prince Edward Island living within 2 hours of an ECT center but 12.5% of those in Newfoundland and Labrador living more than 5 hours' distance away. There are no ECT services at all in the 3 territories, which contain 3% of the Canadian population. Nongeographic barriers to access included inadequate human resources, particularly, a lack of anesthesiologists, in 59% of the centers; logistical impedances (52%); space limitations (45%); strictures on the hiring of adequate staff (29%); imposed limits to number of treatments or to operating or postanesthetic room time (28%); and a lack of funds to purchase up-to-date ECT or related anesthesiology equipment (14%).
  
  
  CONCLUSIONS
  Electroconvulsive therapy is geographically accessible for most Canadians. Even when geography is not a factor, however, there are significant barriers to access resulting from inadequate availability of qualified professional staff, treatment areas, and funding.
authors: Department of Psychiatry, Dalhousie University, Halifax, Canada. delvan@cdha.nshealth.ca
authors: Nicholas John
authors: NJ
authors: Delva
authors: Peter
authors: P
authors: Graf
authors: Simon
authors: S
authors: Patry
authors: Caroline
authors: C
authors: Gosselin
authors: Roumen
authors: R
authors: Milev
authors: Ian
authors: I
authors: Gilron
authors: Barry
authors: B
authors: Martin
authors: James Stuart
authors: JS
authors: Lawson
authors: Murray
authors: M
authors: Enns
authors: Mark
authors: M
authors: Jewell
authors: Peter
authors: P
authors: Chan
mesh_terms: D002170:Canada; D004565:Electroconvulsive Therapy / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D011795:Surveys and Questionnaires