GeoGraphical approach for psychiatric healthcare utilization

Abstract

GeoGraphical approach for psychiatric healthcare utilization Psychiatric “sectorization”, territorial and demographic concept for organization of healthcare aimed, by establishing structures of care outside the hospital, to facilitate access to care. Its instructions were followed unevenly. Interest is then to be able to identify the factors of “roughness of space” that underlie the heterogeneity or inequality that affects the distribution of supply and use of healthcare. This involves identifying the links between the use of healthcare and geographical typology of municipalities (constructed by data analysis summarizing the demographic variables or variables measuring the distance to services), individual patient characteristics, covariates related to the structure... The use of care is the ratio between the number of patients residing in a municipality and an expected number of patients. This ratio then depends on covariates in a generalized additive model. Some variables are systematically included (spatial autocorrelation). This method is applied to a specialized healthcare provider, supporting 7,350 patients per year. Variations of access in healthcare are mainly explained by the pathology of patients, but little by the typology of municipalities, the density of general practitioners or psychiatrists. Current thinking on the aims of psychiatry shows the importance of rethinking the organization of healthcare delivery and to better take into account a global point of view. Our method seems to be useful but needs to be completed by some other analyses, notably in terms of territorial planning.