title: Spatial equity and realised access to healthcare - a geospatial analysis of general practitioner enrolments in Waikato, New Zealand

authors: Whitehead, Jesse

subjects: Science & Technology

abstract: Introduction:  Geographic measures of accessibility can quantify inequitable distributions of health care. Although closest distance measures are often used in Aotearoa New Zealand these may not reflect patient use of health care. This research examines patterns of patient enrolment in general practitioner (GP) services from a geospatial perspective.
Methods:  Patient enrolment records (n=137 596) from one primary health organisation were examined and geographic information systems used to determine whether patients enrolled with their closest GP service. A binomial logistic regression was performed to examine factors associated with the bypass of GP services closer to patients’ homes.
Results:  Overall 68.1% of patients in the sample bypassed the GP service closest to their home, while rates of GP bypass varied across the Waikato region and between rural and urban areas. A binary logistic regression analysis revealed that rurality of patient residence, patient ethnicity, patient age, area-level socioeconomic deprivation, sex, distance to the closest GP clinic, clinic after-hours availability, Māori service provider status, GP and nurse full time equivalent hours, and clinic fees were statistically significant predictors of increased closest-GP bypass. While residents of major urban areas had high rates of GP bypass, this was followed by patients living in rural areas – patients living more than 20 km from the closest GP service had exceptionally high rates of GP bypass.
Conclusion:  This study suggests that most patients in the Waikato region do not enrol with the GP service closest to their home and it outlines several factors, including rurality of residence, associated with the GP bypass. Closest distance accessibility measures may be inappropriate in mixed urban–rural settings, and researchers should consider other approaches to quantifying spatial equity. Health services should also be designed to better reflect the realities of the populations they serve.

text: Spatial equity and realised access to healthcare - a geospatial analysis of general practitioner enrolments in Waikato, New Zealand Introduction:  Geographic measures of accessibility can quantify inequitable distributions of health care. Although closest distance measures are often used in Aotearoa New Zealand these may not reflect patient use of health care. This research examines patterns of patient enrolment in general practitioner (GP) services from a geospatial perspective.
Methods:  Patient enrolment records (n=137 596) from one primary health organisation were examined and geographic information systems used to determine whether patients enrolled with their closest GP service. A binomial logistic regression was performed to examine factors associated with the bypass of GP services closer to patients’ homes.
Results:  Overall 68.1% of patients in the sample bypassed the GP service closest to their home, while rates of GP bypass varied across the Waikato region and between rural and urban areas. A binary logistic regression analysis revealed that rurality of patient residence, patient ethnicity, patient age, area-level socioeconomic deprivation, sex, distance to the closest GP clinic, clinic after-hours availability, Māori service provider status, GP and nurse full time equivalent hours, and clinic fees were statistically significant predictors of increased closest-GP bypass. While residents of major urban areas had high rates of GP bypass, this was followed by patients living in rural areas – patients living more than 20 km from the closest GP service had exceptionally high rates of GP bypass.
Conclusion:  This study suggests that most patients in the Waikato region do not enrol with the GP service closest to their home and it outlines several factors, including rurality of residence, associated with the GP bypass. Closest distance accessibility measures may be inappropriate in mixed urban–rural settings, and researchers should consider other approaches to quantifying spatial equity. Health services should also be designed to better reflect the realities of the populations they serve.

year: 2019

title: The relation between Preference and Price of different different amounts of food with hens

authors: Bicknell, Sinead Candice

subjects: Preference

abstract: In the first condition six hens responded on concurrent schedule with two variable interval 60-s schedules leading to 2 s of access to wheat.  This gave estimates of bias resulting from any uncontrolled differences between the two schedules (i.e., inherent bias). Then the same hens responded on concurrent chain schedules of reinforcement for two different durations of access to food: 2 s and 8 s. The initial links were both variable interval 60-s schedules and the terminal links were equal fixed ratio schedules. Over Conditions 2 to 8, the response requirement in the terminal links was varied over 1 to 128. Response and time ratios in the initial links showed responding and time allocation was greater on the key associated with the 8 s duration reinforcer, showing a preference for that terminal link, even when any inherent bias was removed. These preferences were generally greater the larger the response requirement. Preference followed the 8-s reinforcer when the key associated with that reinforcer was changed in Conditions 9 and 10, and was greater the larger the response requirement in these conditions. Thus increases in response requirement increased preference for the longer duration reinforcer. The terminal-link length increased equally for both food durations with increases in response requirement up to fixed ratio 32 for most hens. With fixed ratios of 64 and 128 there were some unequal length terminal links and these were associated with preference changes, with greater inequality between the terminal link lengths giving greater preference for the shorter terminal link. The study cannot separate out the effects of terminal link length and response requirement on preference, both most likely contributed to the preference changes. In the terminal links there were higher overall response rates and shorter post-entry pauses with the shorter duration of reinforcer (2 s) at the smaller fixed ratio values. These data follow the pattern seen in studies of fixed ratio performance, where less preferred reinforcers have given higher overall response rates and shorter post-reinforcement pauses at smaller fixed ratio values. These data indicate that differences in overall response rate in do not reflect the preference seen in the initial links.

text: The relation between Preference and Price of different different amounts of food with hens In the first condition six hens responded on concurrent schedule with two variable interval 60-s schedules leading to 2 s of access to wheat.  This gave estimates of bias resulting from any uncontrolled differences between the two schedules (i.e., inherent bias). Then the same hens responded on concurrent chain schedules of reinforcement for two different durations of access to food: 2 s and 8 s. The initial links were both variable interval 60-s schedules and the terminal links were equal fixed ratio schedules. Over Conditions 2 to 8, the response requirement in the terminal links was varied over 1 to 128. Response and time ratios in the initial links showed responding and time allocation was greater on the key associated with the 8 s duration reinforcer, showing a preference for that terminal link, even when any inherent bias was removed. These preferences were generally greater the larger the response requirement. Preference followed the 8-s reinforcer when the key associated with that reinforcer was changed in Conditions 9 and 10, and was greater the larger the response requirement in these conditions. Thus increases in response requirement increased preference for the longer duration reinforcer. The terminal-link length increased equally for both food durations with increases in response requirement up to fixed ratio 32 for most hens. With fixed ratios of 64 and 128 there were some unequal length terminal links and these were associated with preference changes, with greater inequality between the terminal link lengths giving greater preference for the shorter terminal link. The study cannot separate out the effects of terminal link length and response requirement on preference, both most likely contributed to the preference changes. In the terminal links there were higher overall response rates and shorter post-entry pauses with the shorter duration of reinforcer (2 s) at the smaller fixed ratio values. These data follow the pattern seen in studies of fixed ratio performance, where less preferred reinforcers have given higher overall response rates and shorter post-reinforcement pauses at smaller fixed ratio values. These data indicate that differences in overall response rate in do not reflect the preference seen in the initial links.

year: 2015

title: Indigenous people in Aotearoa New Zealand are overrepresented in cannabis convictions

authors: Rapana, Wetini

subjects: Cannabis

abstract: Background: Previous work has demonstrated that cannabis laws have had a disproportionate impact on Māori, the Indigenous people of Aotearoa New Zealand. In 2019, the New Zealand Government amended cannabis laws, providing police with the power to determine whether a therapeutic or health-centred approach would be more beneficial than a conviction. In the current study, we use population level data to assess whether this law change has ameliorated the bias in cannabis convictions for Māori. Methods: Data were drawn from the Integrated Data Infrastructure (IDI), a large government database hosted by Aotearoa New Zealand’s national statistics office. In the IDI, we selected individuals who (1) were between 18 and 65, (2) were Māori or Pākehā (New Zealanders of European descent) and, (3) had any cannabis charges that proceeded to the courts. Results: Māori ethnicity was a significant predictor of the odds of receiving a cannabis conviction for Māori males (Odds: 1.56), with a marginally significant effect for Māori females (Odds: 1.57). Further, for Māori, there was no reduction in the number of cannabis charges before vs. after the amendment to cannabis laws. Conclusion: The current study demonstrates that the bias in cannabis convictions for Māori remain. Given this, the New Zealand Government must follow other countries around the world and move forward on cannabis law reform.

text: Indigenous people in Aotearoa New Zealand are overrepresented in cannabis convictions Background: Previous work has demonstrated that cannabis laws have had a disproportionate impact on Māori, the Indigenous people of Aotearoa New Zealand. In 2019, the New Zealand Government amended cannabis laws, providing police with the power to determine whether a therapeutic or health-centred approach would be more beneficial than a conviction. In the current study, we use population level data to assess whether this law change has ameliorated the bias in cannabis convictions for Māori. Methods: Data were drawn from the Integrated Data Infrastructure (IDI), a large government database hosted by Aotearoa New Zealand’s national statistics office. In the IDI, we selected individuals who (1) were between 18 and 65, (2) were Māori or Pākehā (New Zealanders of European descent) and, (3) had any cannabis charges that proceeded to the courts. Results: Māori ethnicity was a significant predictor of the odds of receiving a cannabis conviction for Māori males (Odds: 1.56), with a marginally significant effect for Māori females (Odds: 1.57). Further, for Māori, there was no reduction in the number of cannabis charges before vs. after the amendment to cannabis laws. Conclusion: The current study demonstrates that the bias in cannabis convictions for Māori remain. Given this, the New Zealand Government must follow other countries around the world and move forward on cannabis law reform.

year: 2022