3.4 Mobile services, community services and telemedicine
In analysing the provision of health services using GIS, we often think in terms of facilities that are at fixed geographical locations – general practitioners’ surgeries, hospital accident and emergency units, birthing units, and so on. However, within most health services, there are forms of healthcare provision that are not tied to a particular location and these pose particular problems for spatial representation within a GIS. We focus on such mobile and community-based forms of health provision here.
Community-based health provision
There are many health professionals whose work is based not at recognised health centres, but through home visits to clients. Examples include community psychiatric nurses, who may provide healthcare and support to mental health patients via home visits. Similarly, community midwives provide pre- and post-natal support to mothers and new babies by visiting them in their homes, rather than at health centres. Clearly, such services are as much a part of the healthcare system as those that are based at fixed delivery points such as clinics and hospitals.
Activity 1
Q. How might we represent this form of service delivery spatially in a GIS?
Answer 1
Potentially, there are two ways of doing this – by mapping out visit patterns either at area level or for individual patients. In theory, it is possible to take the postal or zip codes of the patients seen by a given community health visitor and match these up with address locations through a geocoding exercise. This then maps out in detail the uptake at an individual level of these community-based services. In practice, in many countries, confidentiality and data protection legislation may prevent clinical records being used in this way. There may also be insufficient computerised records of visits for such geocoding to be possible. Another, more approximate alternative is to take the total number of visits made by a community health service team and combine this with an estimate of the team’s catchment area (the geographical area over which it operates).
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Mobile facilities
Other forms of healthcare make use of mobile facilities that can visit different communities on a regular timetable. In the developing world, where transport is limited and healthcare from hospitals and clinics is difficult to access, mobile outreach services are sometimes used to provide healthcare to more remote communities (Doerner, Focke and Gutjahr, 2007). In developed countries, such mobile services are sometimes a useful means of increasing population coverage when screening for disease. For example, in the UK, a mobile diabetes testing service has been used to detect diabetes among those unaware that they have this condition.
As with community-based services, it is possible to represent such mobile services within a GIS, provided that there are records of the schedule of visits made to different areas and, ideally, of the numbers of clients seen at each location.
Telemedicine
Also growing in popularity is the concept of telemedicine. Telemedicine involves the use of audio, video or other forms of telecommunication for diagnosis and patient care, when medical staff and patients are separated by distance. Clearly, for certain types of consultation, telemedicine breaks down GIS-derived, distance-based measures of healthcare accessibility.
However, even with this form of healthcare delivery, GIS can be a useful tool in understanding access patterns. Cooper et al (2005), for example, looked at the uptake of a new government-sponsored medical helpline in the UK. The post (zip) codes of callers were geocoded and mapped, so as to assess geographical patterns amongst those accessing this telephone-based service.
Activity 2
Download the zip file and undertake the activity described in the pdf file, which involves mapping out patterns of access to healthcare in an area of Zimbabwe, where an immunisation outreach programme is operating.
References (Essential reading for this learning object indicated by *)
Doerner K, Focke A, and Gutjahr W (2007): ‘Multicriteria tour planning for mobile healthcare facilities in a developing country’. European Journal of Operational Research 179 (3): 1078-1096. http://www.sciencedirect.com/science/article/pii/S0377221706000774
Cooper D, Arnold E, Smith G, Hollyoak V, Chinemana F, Baker M, O’Brien S (2005): ‘The effect of deprivation, age and sex on NHS Direct call rates’. British Journal of General Practice 55 (513): 287-291. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1463131