Is there an association between spatial accessibility of outpatient care and utilization? Analysis of gynecological and general care.

Background: In rural regions with a low population density, distances to health care providers as well as insufficient public transport may be barriers for the accessibility of health care. In this analysis it was examined whether the accessibility of gynecologists and GPs, measured as travel time both by car and public transport has an influence on the utilization of health care in the rural region of Western Pomerania in Northern Germany.

Methods: Utilization data was obtained from the population based Study of Health in Pomerania (SHIP). Utilization was operationalized by the parameter "at least one physician visit during the last 12 months". To determine travel times by car and by public transport, network analyses were conducted in a Geographic Information System (GIS). Multivariate logistic regression models were calculated to identify determinants for the utilization of gynecologists and GPs.

Results: There is no significant association between the accessibility by car or public transport and the utilization of gynecologists and GPs. Significant predictors for the utilization of gynecologists in the regression model including public transport are age (OR 0.960, 95% CI 0.950-0.971, p < 0.0001), social class (OR 1.137, 95% CI 1.084-1.193, p < 0.0001) and having persons ≥18 years in the household (OR 2.315, 95% CI 1.116-4.800, p = 0.0241).

Conclusions: In the examined region less utilization of gynecologists is not explainable with long travel times by car or public transport.