Spatial analysis of SS population coverage based on emergency regional healthcare
Authors: Morvan Esra , Bernadou Anne , Gautier Ludivine , Silue Yassungo , Jeannel Dominique 
Published: May 2017

ObjectiveTo analyse population coverage of syndromic surveillance(SS)based on emergency care data by studying i)the attractiveness ofrespectively SOS Médecins (Emergency care general practitioners)and Hospital emergency departments in the Centre-Val de Loireregion and ii) the contribution of ecological deprivation factors inemergency access to healthcare.IntroductionSOS Médecins France (SOS Med) is the first private and permanentnetwork of general practitioners providing emergency care in France.Besides Hospital emergency departments (HED), SOS Med istherefore a major source of data for detecting and measuring near-real-time health phenomena. The emergency services provided by theSOS Med have been subject to important changes in the recent years.Their services are enriched by a medical consultation center togetherwith extended working hours. Besides, the south of the region ismarkedly affected by a declining number of medical practitionersThis study was conducted to analyze the regional population coverageof emergency healthcare data provided by HED and SOS Med tothe French syndromic surveillance system (SurSaUD®) takinginto account distance, health care offer, demographic factors andecological deprivation factors.MethodsAn analysis of the activities and geographic attraction was carriedout based on the data respectively provided by the three regional SOSMed and three HED (Bourges, Orléans and Tours). Quasi-Poissonregression modelling was used to identify the factors influencing theattractiveness of each organization. Next, the findings were refinedthrough spatial analysis of the attractiveness of HED and SOS Medand analysis of the contribution of deprivation based on socio-economical and healthcare facilities ecological indexes.ResultsIn terms of age group, children under 2 years required the largestservice consultations as well as seniors over 75 who sought moreemergency visits at home. The SOS Med were almost always active inurban areas and at least once in two due to continuity of care. So theyare an efficient source of general medical care given present workhours. Distance as an influential factor may explain the differencesin attraction to the support type. The extent of the attraction appearsin 36% SOS Med Bourges and 14% for SOS Med Orleans. Addthe extent of attraction for SOS, remote consultation for SOS Medassociations are a good use of care in general practice in present workhours scheme.In terms of monitoring of epidemics, we note that the SOSMédecins associations are most active in winter, particularly duringthe seasonal epidemics of influenza. This can be explained by the factof patient referrals during calls. The most serious cases are redirectedto the ED and cases of general medicine to the SOS Médecins.It is also important to note that the attraction of ED ofCHR Orléanscovers more or less important a large part of the regional territory,which is not visible to the ED ofCH Bourges. It should neverthelessbe noted that theCHR Orleansa larger bed capacity than theCH Bourges.ConclusionsThis research has analysed the changes taking place in the SOSmédecins associations in the Centre-Val de Loire region. Findingsshows that these associations help ensure access to general medicalcare in a context of strongly reduced medical demography althoughwith an uneven, primarily urban, geographical coverage. Withbetter knowledge of the geographic span and sources and types ofemergency care provision, further research can be undertaken tofurther refine and interpret the data.