A comparative analysis of potential spatio-temporal access to palliative care services in two Canadian provinces

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.