title: Accessibility of general practitioners and selected specialist physicians by car and by public transport in a rural region of Germany.
abstract: The accessibility of medical care facilities in sparsely populated rural regions is relevant especially for elderly people which often represent a large segment of the population in such regions. Elderly people have higher morbidity risks and a higher demand for medical care. Although travelling with private cars is the dominating traffic mode in rural regions, accessibility by public transport is increasingly important especially because of limited mobility of elderly people. The aim of this study was to determine accessibility both by car and public transport to general practitioners (GP) and selected specialist physicians for a whole region and to detect areas with poor to no access in the county Vorpommern-Greifswald, which is a rural and sparsely populated region in the very northeast of Germany.
  
  
  
  Accessibility of medical care facilities by car was calculated on the basis of a network analysis within a geographic information system (GIS) with routable street data. Accessibility by public transport was calculated using GIS and a network analysis based on the implementation of Dijkstra's algorithm.
  
  
  
  The travelling time to general practitioners (GP) by car in the study region ranges from 0.1 to 22.9 min. This is a significant difference compared to other physician groups. Traveling times to specialist physicians are 0.4 to 42.9 min. A minority of 80 % of the inhabitants reach the specialist physicians within 20 min. The accessibility of specialist physicians by public transport is poor. The travel time (round trip) to GPs averages 99.3 min, to internists 143.0, to ophthalmologists 129.3 and to urologists 159.9 min. These differences were significant. Assumed was a one hour appointment on a Tuesday at 11 am. 8,973 inhabitants (3.8 %) have no connection to a GP by public transport. 15,455 inhabitants (6.5 %) have no connection to specialist internists.
  
  
  
  Good accessibility by public transport is not a question of distance but of transport connections. GIS analyses can detect areas with imminent or manifest deficits in the accessibility of health care providers. Accessibility analyses should be established instruments in planning issues.
authors.affiliation: Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany. ulrike.stentzel@uni-greifswald.de.
authors.forename: Ulrike
authors.identifier: 0000-0002-9723-8677
authors.initials: U
authors.lastname: Stentzel
authors.affiliation: Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Piegsa
authors.affiliation: Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fredrich
authors.affiliation: Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
authors.affiliation: Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany.
authors.forename: Neeltje
authors.initials: N
authors.lastname: van den Berg
mesh_terms: D000368:Aged; D005260:Female; D058005:General Practitioners; D040362:Geographic Information Systems; D005858:Germany; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D012424:Rural Population; D013038:Specialization; D014186:Transportation / Q000379:methods*
keywords: Accessibility; Car travel; GIS; General practitioners; Health care providers; Network analysis; Public transport