Accessibility to urgent and emergency care services in low-density territories: the case of Baixo Alentejo, Portugal

Ferreira, Rita; Costa, Nuno Marques da; Costa, Eduarda Marques da

doi:10.1590/1413-81232021266.1.40882020

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ARTICLE • Ciênc. Saúde Colet. 26 (suppl 1) • 2021 • https://doi.org/10.1590/1413-81232021266.1.40882020 copy

Accessibility to urgent and emergency care services in low-density territories: the case of Baixo Alentejo, Portugal

Acessibilidade à rede de serviços de urgência em territórios de baixa densidade: o caso do Baixo Alentejo, Portugal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Access to health care is a sensitive issue in low population density territories, as these areas tend to have a lower level of service provision. One dimension of access is accessibility. This paper focuses on measuring the accessibility to urgent and emergency care services in the Portuguese region of Baixo Alentejo, a territory characterized by low population density. Data for the calculation of accessibility is the road network, and the methodology considers the application of a two-level network analyst method: time-distance by own mean (car or taxi) to the urgent care services and the time distance to emergency services as a way to get assistance and to go to urgent care services. While urgent care accessibility meets the requirements stipulated in the Integrated Medical Emergency System’s current legislative framework, the simulation of different scenarios of potential accessibility shows intra-regional disparities. Some territories have a low level of accessibility. Older adults, the poorly educated, and low-income population, also have the lowest levels of accessibility, which translates into dually disadvantageous situation since the potential users of emergency services are most likely to belong to this group of citizens.

Key words:
Accessibility; Urgent care Services; Emergency Ambulance Service; Low-Density Areas

1^st Reception Level	2^nd Reception Level	3^rd Reception Level
Basic Urgent Care Service (BUS)	Medical-Surgical Urgent care Service (MSUS)	Multipurpose Urgent care Service (MUS)
Responding to more uncomplicated urgent care and emergencies. It assumes the patient’s initial stabilization for further referral to a more differentiated level of care in more complex situations.	It responds to situations requiring more differentiated care. Referral to higher-level services situations that require the support of specific medical specialties.	Responding to more complex situations and having most hospital valences. Some MUS have Trauma Centers designed to accommodate patients with more severe issues.
This service should be available, wherever deemed justified, to ensure the access of a given population within a maximum period of 60 minutes (in the absence of a higher-level urgent care service).	Ranging from 20 to 39 MSUS or according to a ratio of 2/3 per MUS. It should be located at least 60 minutes from another MSES or MSE, except for cases where the population covered by each hospital exceeds 200,000 inhabitants.	Ranging from 10 to 13 MUS or according to a ratio of 1 MUS for each 100 to 750,000 inhabitants.
Life support ambulance - LSA (ambulância de suporte imediato de vida - SIV) is available.	Emergency medical and resuscitation vehicle - EMRS (Viatura Médica de Emergência e Reanimação - VMER) is available.	Emergency medical and resuscitation vehicle - EMRS (Viatura Médica de Emergência e Reanimação - VMER) is available.

Emergency Ambulance Service	Description	Location
Emergency ambulance - EA (ambulância de Socorro - AS)	Ensures the rapid response of a team with training in emergency techniques to the scene. It acts in conjunction with other pre-hospital services.	Medical emergency points
Emergency medical Ambulance - EMA (ambulância de emergência médica - AEM)	Ensures the rapid response of a pre-hospital medical emergency team with training in emergency techniques to the scene.	NIME; MSUS; MUS
Immediate life support ambulance - LSA (ambulância de suporte imediato de vida - SIV)	Ensures more differentiated care, such as resuscitation maneuvers in a pre-hospital environment.	BUS
Emergency medical and resuscitation vehicle - EMRS (Viatura Médica de Emergência e Reanimação - VMER)	Ensures pre-hospital stabilization and medical follow-up during the transportation of accident victims.	MSUS and MUS

Accessibility intervals (time in minutes)	Young population (%)	Adult population (%)	Elderly population (%)
< 10	43	40	32
< 20	80	77	71
< 30	95	94	91
< 40	99	99	99
< 50	100	100	100

Accessibility intervals	1^st scenario Consider the time-distance from one of the 18 existing NIME ambulances to one of the three urgent care services		2^nd scenario Consider the time-distance from LSA and EMRS, NIME ambulances, to one of the three urgent care services		3^rd scenario Consider the time-distance from one of the 18 existing NIME ambulances to a medical-surgical urgent care service in Beja		4^th scenario Consider the time-distance from LSA and EMRS, NIME ambulances, to a medical-surgical urgent care service in Beja		5^th scenario Consider the time-distance from one of the 18 existing NIME ambulances to the nearest multipurpose urgent care service		6^th scenario Consider the time-distance from LSA and EMRS, NIME ambulances, to the nearest multipurpose urgent care service
	∑ Resident population (2011)		∑ Resident population (2011)		∑ P Resident population (2011)		∑ Resident population (2011)		∑ Resident population (2011)		∑ Resident population (2011)
	Nº	%	Nº	%	Nº	%	Nº	%	Nº	%	Nº	%
< 10	39 687	31	39 748	31	26 857	21	26 913	21	0	0	0	0
< 20	69 853	55	48 280	38	41 099	32	30 276	24	0	0	0	0
< 30	101 164	80	67 036	53	63 544	50	38 562	30	1177	1	0	0
< 40	120 576	95	95 568	75	90 931	72	68 678	54	6554	5	0	0
< 50	124 148	98	112 827	89	105 574	83	88 255	70	16742	13	0	0
< 60	126 404	100	118 746	94	118 101	93	103 906	82	66928	53	53 481	42
< 70	126 560	100	124 174	98	124 915	99	114 923	91	88981	70	70 577	56
< 80	126 670	100	125 518	99	126 021	99	121 185	96	114 542	90	90 117	71
< 90	126 692	100	126 682	100	126 458	100	123 547	98	124 179	98	106 290	84
< 100	-	-	126 692	100	126 571	100	124 642	98	126 183	100	119 018	94
< 110	-	-	-	-	126 675	100	126 586	100	126 688	100	124 070	98
< 120	-	-	-	-	126 692	100	126 686	100	126 692	100	125 518	99
< 130	-	-	-	-	-	-	126 692	100	-	-	126 692	100

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[1] Collaborations

Work conception and design: R Ferreira, NM Costa, EM Costa. Theoretical framework: R Ferreira, and EM Costa. Selection of variables, collecting data, selecting variables, and methodological implementation: R Ferreira and NM Costa. Discussion of results: R Ferreira, NM, Costa, and EM Costa. Conclusions: R Ferreira, NM, Costa, and EM Costa.