Investigating the role of healthcare centre accessibility on the decision to attend for screening for gestational diabetes mellitus in Ireland [presentation]

Hdl Handle:
http://hdl.handle.net/10147/221338
Title:
Investigating the role of healthcare centre accessibility on the decision to attend for screening for gestational diabetes mellitus in Ireland [presentation]
Other Titles:
Presented at the International Health Economics Association 2011
Authors:
Cullinan, John; Dunne, F; Gillespie, Paddy; Owens, Lisa
Affiliation:
John Cullinan (National University of Ireland, Galway. School of Economics), Paddy Gillespie (National University of Ireland, Galway. School of Economics), Lisa Owens (National University of Ireland, Galway. School of Medicine) and Fidelma Dunne (National University of Ireland, Galway. School of Medicine)
Issue Date:
2011
URI:
http://hdl.handle.net/10147/221338
Abstract:
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and is associated with several serious maternal and neonatal complications and conditions. Screening practices for GDM vary within and across European countries, with some offering universal screening to all pregnant women and others only to selective high risk groups. In Ireland, no single policy with respect to GDM screening is implemented nationally and a debate exists as to what form such a policy should take. Within this context, the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network was established in 2005 to provide robust information on pregnancy outcomes for women with diabetes. The network includes five healthcare centres along the Atlantic seaboard and provides testing for all pregnant women at 24-28 weeks using a 75g Oral Glucose Tolerance Test. The centres are linked using a clinical information system which allows for data to be captured within a central database, containing a comprehensive range of data on screening uptake rates, maternal characteristics, outcomes for mothers and infants, healthcare resource usage over the course of pregnancy, as well as the postal address of each individual. At present it contains observations on 9,043 pregnant women offered the screening, 5,218 (58%) of whom participated in testing. This paper uses the ATLANTIC DIP dataset to investigate the role of healthcare centre accessibility on the decision to attend for screening, employing geographic information systems (GIS), econometric and simulation techniques. In particular, we focus on the extent to which ‘travel distance to screening site’ impacts upon the individual’s screen uptake decision, whether significant geographic inequalities exist in relation to accessibility to screening, and the likely impact on uptake rates of providing screening services at a local level. In order to do so, the postal addresses contained within the ATLANTIC DIP dataset are first ‘geocoded’, in order to provide precise spatial (x,y) coordinates for patients’ residential locations. This facilitates GIS-based route analysis of travel distances for each individual to their nearest screening site. We then model the decision to attend for screening, where control variables include travel distance to screening site, a range of other site accessibility-related variables, as well as a number of individual-level variables relating to personal, socio-economic, clinical and lifestyle characteristics. Overall, our model suggests that after controlling for these different factors, the probability of attending for screening is reduced by 1.8% [95% CI: 1.3% to 2.3%] for every additional 10kms required to travel for screening (p=0.000). We also find significant variation in uptake rates across hospitals after controlling for travel distance and other factors, suggesting that accessibility and quality-of-service are also important determinants of overall uptake rates. The uptake model allows us to also estimate ‘two-part’ and ‘bivariate probit with sample selection’ models of the risk factors associated with GDM, which provide strong evidence of a socio-economic gradient in the prevalence of GDM in Ireland. Altogether, the findings have important implications for the provision of GDM screening services in Ireland.
Item Type:
Conference Presentation
Language:
en
Keywords:
SCREENING; CONSUMER; DIABETES MELLITUS

Full metadata record

DC FieldValue Language
dc.contributor.authorCullinan, Johnen_GB
dc.contributor.authorDunne, Fen_GB
dc.contributor.authorGillespie, Paddyen_GB
dc.contributor.authorOwens, Lisaen_GB
dc.date.accessioned2012-05-01T11:44:09Z-
dc.date.available2012-05-01T11:44:09Z-
dc.date.issued2011-
dc.identifier.urihttp://hdl.handle.net/10147/221338-
dc.description.abstractGestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and is associated with several serious maternal and neonatal complications and conditions. Screening practices for GDM vary within and across European countries, with some offering universal screening to all pregnant women and others only to selective high risk groups. In Ireland, no single policy with respect to GDM screening is implemented nationally and a debate exists as to what form such a policy should take. Within this context, the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network was established in 2005 to provide robust information on pregnancy outcomes for women with diabetes. The network includes five healthcare centres along the Atlantic seaboard and provides testing for all pregnant women at 24-28 weeks using a 75g Oral Glucose Tolerance Test. The centres are linked using a clinical information system which allows for data to be captured within a central database, containing a comprehensive range of data on screening uptake rates, maternal characteristics, outcomes for mothers and infants, healthcare resource usage over the course of pregnancy, as well as the postal address of each individual. At present it contains observations on 9,043 pregnant women offered the screening, 5,218 (58%) of whom participated in testing. This paper uses the ATLANTIC DIP dataset to investigate the role of healthcare centre accessibility on the decision to attend for screening, employing geographic information systems (GIS), econometric and simulation techniques. In particular, we focus on the extent to which ‘travel distance to screening site’ impacts upon the individual’s screen uptake decision, whether significant geographic inequalities exist in relation to accessibility to screening, and the likely impact on uptake rates of providing screening services at a local level. In order to do so, the postal addresses contained within the ATLANTIC DIP dataset are first ‘geocoded’, in order to provide precise spatial (x,y) coordinates for patients’ residential locations. This facilitates GIS-based route analysis of travel distances for each individual to their nearest screening site. We then model the decision to attend for screening, where control variables include travel distance to screening site, a range of other site accessibility-related variables, as well as a number of individual-level variables relating to personal, socio-economic, clinical and lifestyle characteristics. Overall, our model suggests that after controlling for these different factors, the probability of attending for screening is reduced by 1.8% [95% CI: 1.3% to 2.3%] for every additional 10kms required to travel for screening (p=0.000). We also find significant variation in uptake rates across hospitals after controlling for travel distance and other factors, suggesting that accessibility and quality-of-service are also important determinants of overall uptake rates. The uptake model allows us to also estimate ‘two-part’ and ‘bivariate probit with sample selection’ models of the risk factors associated with GDM, which provide strong evidence of a socio-economic gradient in the prevalence of GDM in Ireland. Altogether, the findings have important implications for the provision of GDM screening services in Ireland.en_GB
dc.language.isoenen
dc.subjectSCREENINGen_GB
dc.subjectCONSUMERen_GB
dc.subjectDIABETES MELLITUSen_GB
dc.titleInvestigating the role of healthcare centre accessibility on the decision to attend for screening for gestational diabetes mellitus in Ireland [presentation]en_GB
dc.title.alternativePresented at the International Health Economics Association 2011en_GB
dc.typeConference Presentationen
dc.contributor.departmentJohn Cullinan (National University of Ireland, Galway. School of Economics), Paddy Gillespie (National University of Ireland, Galway. School of Economics), Lisa Owens (National University of Ireland, Galway. School of Medicine) and Fidelma Dunne (National University of Ireland, Galway. School of Medicine)en_GB
dc.description.provinceConnachten
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