title: A comparative analysis of potential spatio-temporal access to palliative care services in two Canadian provinces.
abstract: BACKGROUND
  Access to health services such as palliative care is determined not only by health policy but a number of legacies linked to geography and settlement patterns. We use GIS to calculate potential spatio-temporal access to palliative care services. In addition, we combine qualitative data with spatial analysis to develop a unique mixed-methods approach.
  
  
  METHODS
  Inpatient health care facilities with dedicated palliative care beds were sampled in two Canadian provinces: Newfoundland and Saskatchewan. We then calculated one-hour travel time catchments to palliative health services and extended the spatial model to integrate available beds as well as documented wait times.
  
  
  RESULTS
  26 facilities with dedicated palliative care beds in Newfoundland and 69 in Saskatchewan were identified. Spatial analysis of one-hour travel times and palliative beds per 100,000 population in each province showed distinctly different geographical patterns. In Saskatchewan, 96.7% of the population living within a-1 h of drive to a designated palliative care bed. In Newfoundland, 93.2% of the population aged 65+ were living within a-1 h of drive to a designated palliative care bed. However, when the relationship between wait time and bed availability was examined for each facility within these two provinces, the relationship was found to be weak in Newfoundland (R(2) = 0.26) and virtually nonexistent in Saskatchewan (R(2) = 0.01).
  
  
  CONCLUSIONS
  Our spatial analysis shows that when wait times are incorporated as a way to understand potential spatio-temporal access to dedicated palliative care beds, as opposed to spatial access alone, the picture of access changes.
authors.affiliation: Department of Geography, Simon Fraser University, Burnaby, Canada. nadine@sfu.ca.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schuurman
authors.affiliation: Department of Geography, Simon Fraser University, Burnaby, Canada.
authors.forename: Ofer
authors.initials: O
authors.lastname: Amram
authors.affiliation: Department of Geography, Simon Fraser University, Burnaby, Canada.
authors.forename: Valorie A
authors.initials: VA
authors.lastname: Crooks
authors.affiliation: Department of Geography, Simon Fraser University, Burnaby, Canada.
authors.forename: Rory
authors.initials: R
authors.lastname: Johnston
authors.affiliation: School of Geography and Earth Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
mesh_terms: D006268:Health Facilities; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D009523:Newfoundland and Labrador; D010166:Palliative Care; D019035:Rural Health Services; D012525:Saskatchewan; D062211:Spatio-Temporal Analysis