Investigating the impact of bank branch closures on access to financial services in the early stages of the COVID-19 pandemic.

There is a longstanding policy interest in understanding the impacts of changes in access to public and private services in rural areas. To date much of the empirical analysis concerning changing patterns of accessibility has been predicated on assumptions regarding the mode of transport used to access such facilities. The availability of new and open sources of data, and the increasing sophistication of spatial analytical tools, has enabled alternative transportation modes to be included when investigating the impact of service changes. In this study a nationwide analysis of changes in public transport provision and bank closures has enabled the identification of those parts of Wales that were disproportionally impacted by the loss of financial services during the early years of the COVID-19 pandemic. Drawing on local scenarios which show the combined impact of such changes, the findings demonstrate how temporal variations in accessibility can be used to examine potential patterns of exclusion that arise from the loss of key services. We conclude by suggesting that any assessment of changes in accessibility needs a holistic approach that considers changes in the transport infrastructure alongside other facets of service provision to understand the full impact of such closures on rural communities.

Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches.

Suggestions of the existence of so-called 'social care deserts' in England in the years leading up to the COVID-19 pandemic drew attention to the potential impact of geographical inequalities on the availability of residential, nursing and domiciliary care. To date, much of this analysis has been conducted at spatially aggregated scales such as that of local authorities or postcode sector. Hidden within such aggregate-level analysis however are geographical differences in the local provision of care services. In this paper, we draw attention to geographical modelling techniques that can be used to examine local trends in the supply of social care services in relation to potential demand. These spatial models can be used to examine variations in the number of facilities (or choice) within reasonable drive times/distances. Drawing on a national database of residential and nursing care beds in Wales for March 2020, we illustrate the potential of such techniques to provide an insight into current patterns in access to care homes, and to monitor future changes in the fall-out from the effects of the COVID-19 pandemic on the care home sector. The concentration of care home sites in metropolitan areas and in the heavily populated post-industrial valleys in the south-east is identified, but significant demand present in these areas ameliorates scores towards mid-range ratios. We conclude by suggesting that the types of techniques used in this study enable disparities in provision within localised areas to be better explored, thereby helping planners and policy makers to address potential inequalities in provision.

Using machine learning tools to investigate factors associated with trends in 'no-shows' in outpatient appointments.

Missed appointments are estimated to cost the UK National Health Service (NHS) approximately £1 billion annually. Research that leads to a fuller understanding of the types of factors influencing spatial and temporal patterns of these so-called "Did-Not-Attends" (DNAs) is therefore timely. This research articulates the results of a study that uses machine learning approaches to investigate whether these factors are consistent across a range of medical specialities. A predictive model was used to determine the risk-increasing and risk-mitigating factors associated with missing appointments, which were then used to assign a risk score to patients on an appointment-by-appointment basis for each speciality. Results show that the best predictors of DNAs include the patient's age, appointment history, and the deprivation rank of their area of residence. Findings have been analysed at both a geographical and medical speciality level, and the factors associated with DNAs have been shown to differ in terms of both importance and association. This research has demonstrated how machine learning techniques have real value in informing future intervention policies related to DNAs that can help reduce the burden on the NHS and improve patient care and well-being.

Using Geographic Information Systems to investigate variations in accessibility to 'extended hours' primary healthcare provision.

There are ongoing policy concerns surrounding the difficulty in obtaining timely appointments to primary healthcare services and the potential impact on, for example, attendance at accident and emergency services and potential health outcomes. Using the case study of potential access to primary healthcare services in Wales, Geographic Information System (GIS)-based tools that permit a consideration of population-to-provider ratios over space are used to examine variations in geographical accessibility to general practitioner (GP) surgeries offering appointment times outside of 'core' operating hours. Correlation analysis is used to explore the association of accessibility scores with potential demand for such services using UK Population Census data. Unlike the situation in England, there is a tendency for accessibility to those surgeries offering 'extended' hours of appointment times to be better for more deprived census areas in Wales. However, accessibility to surgeries offering appointments in the evening was associated with lower levels of working age population classed as 'economically active'; that is, those who could be targeted beneficiaries of policies geared towards 'extended' appointment hours provision. Such models have the potential to identify spatial mismatches of different facets of primary healthcare, such as 'extended' hours provision available at GP surgeries, and are worthy of further investigation, especially in relation to policies targeted at particular demographic groups.

An exploratory analysis of spatial variations in organ donation registration rates in Wales prior to the implementation of the Human Transplantation (Wales) Act 2013.

Spatial variations in rates of registered organ donors have not been studied in the UK at detailed spatial scales despite some evidence of national and regional differences. By drawing on the findings from the existing literature, this study examines associations between small-area variations in rates of new registrants to the UK organ donor register (ODR) within Wales and key demographic factors. Using map-based visualisations and statistical regression methods, spatial patterns in new registrants to the ODR are identified within Wales, a country which moved to an opt-out system of consent for organ donation following the Human Transplantation (Wales) Act 2013. By identifying the underlying factors associated with trends in rates of new ODR sign-up, this study aims to highlight the types of approaches that could be used to help to inform future targeted interventions aimed at improving registration rates.

Multi-modal two-step floating catchment area analysis of primary health care accessibility.

Two-step floating catchment area (2SFCA) techniques are popular for measuring potential geographical accessibility to health care services. This paper proposes methodological enhancements to increase the sophistication of the 2SFCA methodology by incorporating both public and private transport modes using dedicated network datasets. The proposed model yields separate accessibility scores for each modal group at each demand point to better reflect the differential accessibility levels experienced by each cohort. An empirical study of primary health care facilities in South Wales, UK, is used to illustrate the approach. Outcomes suggest the bus-riding cohort of each census tract experience much lower accessibility levels than those estimated by an undifferentiated (car-only) model. Car drivers' accessibility may also be misrepresented in an undifferentiated model because they potentially profit from the lower demand placed upon service provision points by bus riders. The ability to specify independent catchment sizes for each cohort in the multi-modal model allows aspects of preparedness to travel to be investigated.

Aerosol optical depth as a measure of particulate exposure using imputed censored data, and relationship with childhood asthma hospital admissions for 2004 in athens, Greece.

An understanding of human health implications from atmosphere exposure is a priority in both the geographic and the public health domains. The unique properties of geographic tools for remote sensing of the atmosphere offer a distinct ability to characterize and model aerosols in the urban atmosphere for evaluation of impacts on health. Asthma, as a manifestation of upper respiratory disease prevalence, is a good example of the potential interface of geographic and public health interests. The current study focused on Athens, Greece during the year of 2004 and (1) demonstrates a systemized process for aligning data obtained from satellite aerosol optical depth (AOD) with geographic location and time, (2) evaluates the ability to apply imputation methods to censored data, and (3) explores whether AOD data can be used satisfactorily to investigate the association between AOD and health impacts using an example of hospital admission for childhood asthma. This work demonstrates the ability to apply remote sensing data in the evaluation of health outcomes, that the alignment process for remote sensing data is readily feasible, and that missing data can be imputed with a sufficient degree of reliability to develop complete datasets. Individual variables demonstrated small but significant effect levels on hospital admission of children for AOD, nitrogen oxides (NOx), relative humidity (rH), temperature, smoke, and inversely for ozone. However, when applying a multivari-able model, an association with asthma hospital admissions and air quality could not be demonstrated. This work is promising and will be expanded to include additional years.

Distance from home to hospital and thrombolytic utilization for acute ischemic stroke.

Treatment of acute stroke with thrombolytic therapy has been limited because of the narrow treatment window. Distance from home to hospital may affect arrival time and likelihood of receiving thrombolytic therapy for acute stroke. The present study included stroke subjects seen at Barnes Jewish Hospital in 2006-2007, residing in St Louis City/County, who were at home at the time of the stroke (n = 416). A network distance was calculated by mapping the best route from each subject's home to the hospital on a street network grid. Patients were grouped by distance into quintiles, and the group living the closest (group A, first quintile) was compared with the remainder of the cohort (group B). Outcomes of interest were rate of arrival within 3 hours of stroke onset (timely arrival) and rate of thrombolytic administration. The relative rate (RR) of each outcome was calculated for group A versus group B. A multivariate model of thrombolytic administration was created correcting for potential confounders. There was no difference in timely arrival between groups. The rate of thrombolytic administration was 13/100 for group B and 23/100 for group A, for an RR 0.55 (95% confidence interval [CI], 0.31-0.097) for group B versus group A. In the multivariate model, only National Institutes of Health Stroke Scale score was a significant confounder. The adjusted RR of thrombolytic treatment was 0.59 (95% CI, 0.34-0.99) for group B versus group A. Our data indicate that patients living in close proximity to the hospital are more likely to receive thrombolytic therapy for stroke compared with those living farther away. This finding cannot be explained by earlier arrival time.

An audit of smoking behaviours among patients attending two general dental practices in South Wales: an awareness-raising exercise for the dental team and patients.

AIMS: This audit aimed to quantify the number of smokers attending two general dental practices. It also aimed to establish the demographic characteristics of these smokers in terms of age, gender and deprivation status, and to raise the awareness of practice staff about smoking cessation. METHODS: Data were collected from consecutive patients (aged over 16 years) attending two general dental practices over a period of one month. The information collected included smoking status, number of cigarettes smoked, age, gender, and postcode. A deprivation score (derived from the Welsh Index of Multiple Deprivation [WIMD] for 2008) was appended to each patient record in order to provide a measure of deprivation based on the postcode of the patient. Staff at both practices were involved in the audit. Staff were given a brief pre- and post-audit questionnaire to test their knowledge on smoking cessation. The audit standard was that no more than 29% of patients should be smokers. Where relevant, data were statistically tested using the chi-square test. RESULTS: Five hundred and sixty-one patients provided data on their smoking habits. It was found that 159 (28.3%) were smokers, smoking on average 12 cigarettes per day. The average age of the sample was 46 years and 242 (43.1%) were male. Forty-eight per cent of the sample was shown to be resident in a postcode considered to be deprived. Older patients were more likely to be nonsmokers (P=0.0001). Following the final audit meeting, correct answers among staff for knowledge of the National Institute for Health and Clinical Excellence guidelines regarding effective smoking-cessation practices improved from 6% to 71%. CONCLUSION: The issue of smoking cessation has been highlighted for two dental teams. Whether the audit will result in the delivery of smoking-cessation procedures within the dental practice settings cannot be established. It is clear that the desired smoking-cessation behaviours can now be contemplated by the dental teams. Further monitoring is required to establish outcomes as a result of the actions of the teams.

An audit of dental general anaesthetic referral from a general dental practice in South Wales.

AIMS: The aim of this audit was to quantify the number of patients that received a dental general anaesthetic (DGA) between 1999 and 2007 following referral from a general dental practice. It also aimed to establish the deprivation status of those referred and to investigate further dental treatment pathways of these patients. METHODS: Data were collected from all patient records held by the practice. The information collected included: postcode, gender, age at the close of the study, age at time of DGA, reason for DGA, number of teeth extracted, and details of further ongoing care. In the absence of individual level socioeconomic data, a deprivation score (derived from the Welsh Index of Multiple Deprivation [WIMD]) was appended to each record in order to provide a measure of deprivation based on the postcode of the patient. RESULTS: Two hundred and eighty-seven patients were referred for DGA during the nine-year period. Their mean age was 9.4 years (95% confidence interval [CI] = 8.4, 10.4) and 30.7% were children aged five years or younger. The most common reason for DGA was dental caries. The mean number of teeth extracted was 4.5 (95% CI = 4.1, 4.9). Patients living in deprived areas were more likely to be referred for DGA. Of the 87 who did not subsequently attend for continuing care, 72 were from deprived areas compared with 15 from more affluent areas (P=0.003). CONCLUSIONS: In proportion to the number of patients registered at a practice, the number of referrals for DGAs was relatively low. Patients categorised as deprived (based on their residential postcode) received more referrals for DGAs than those from more affluent areas. Patients from deprived locations were significantly more likely not to attend for continuing care after their DGA than those from more affluent areas.

Positional accuracy and geographic bias of four methods of geocoding in epidemiologic research.

PURPOSE: We examined the geographic bias of four methods of geocoding addresses using ArcGIS, commercial firm, SAS/GIS, and aerial photography. We compared "point-in-polygon" (ArcGIS, commercial firm, and aerial photography) and the "look-up table" method (SAS/GIS) to allocate addresses to census geography, particularly as it relates to census-based poverty rates. METHODS: We randomly selected 299 addresses of children treated for asthma at an urban emergency department (1999-2001). The coordinates of the building address side door were obtained by constant offset based on ArcGIS and a commercial firm and true ground location based on aerial photography. RESULTS: Coordinates were available for 261 addresses across all methods. For 24% to 30% of geocoded road/door coordinates the positional error was 51 meters or greater, which was similar across geocoding methods. The mean bearing was -26.8 degrees for the vector of coordinates based on aerial photography and ArcGIS and 8.5 degrees for the vector based on aerial photography and the commercial firm (p < 0.0001). ArcGIS and the commercial firm performed very well relative to SAS/GIS in terms of allocation to census geography. For 20%, the door location based on aerial photography was assigned to a different block group compared to SAS/GIS. The block group poverty rate varied at least two standard deviations for 6% to 7% of addresses. CONCLUSION: We found important differences in distance and bearing between geocoding relative to aerial photography. Allocation of locations based on aerial photography to census-based geographic areas could lead to substantial errors.

The geography of genetics: an analysis of referral patterns to a cancer genetics service.

This study uses a geographical information system (GIS) and statistical analysis to look for patterns in referrals to a British cancer genetics service. In this case, familial cancers are taken to be those that can develop when an individual inherits DNA mutations that cause an increased risk of cancer. Between 1998 and 2006 the Cancer Genetics Service for Wales received nearly 11,000 referrals for patients resident in Wales and it is the service database recording those referrals which is the subject of this secondary analysis. Using postcodes to match referred patients to areas, deprivation scores were assigned. Referral rates per 10,000 head of population across the 8-year study period by unitary authority are presented, as is information on referrals from primary and secondary care sources by year. Each patient referred has their family history of cancer recorded and is assigned to a risk category; high, medium or average. There are correlations between number of GPs (General Practitioners) in a practice, number of patients referred from a practice, and deprivation as measured by the overall Welsh Index of Multiple Deprivation 2005, such that the two former factors increase as deprivation decreases. Over time there were changes in referral sources, with referrals from primary care overtaking those from secondary care in percentage and absolute terms. There were also changes in the types of cancer referred, risk categories seen and to which centre referrals were made. Referral patterns reveal an inverse relationship between deprivation and health service availability and use.

Integrating multi-criteria techniques with geographical information systems in waste facility location to enhance public participation.

Despite recent U.K. Government commitments' to encourage public participation in environmental decision making, those exercises conducted to date have been largely confined to 'traditional' modes of participation such as the dissemination of information and in encouraging feedback on proposals through, for example, questionnaires or surveys. It is the premise of this paper that participative approaches that use IT-based methods, based on combined geographical information systems (GIS) and multi-criteria evaluation techniques that could involve the public in the decision-making process, have the potential to build consensus and reduce disputes and conflicts such as those arising from the siting of different types of waste facilities. The potential of these techniques are documented through a review of the existing literature in order to highlight the opportunities and challenges facing decision makers in increasing the involvement of the public at different stages of the waste facility management process. It is concluded that there are important lessons to be learned by researchers, consultants, managers and decision makers if barriers hindering the wider use of such techniques are to be overcome.

Risk of congenital anomalies after the opening of landfill sites.

Concern that living near a particular landfill site in Wales caused increased risk of births with congenital malformations led us to examine whether residents living close to 24 landfill sites in Wales experienced increased rates of congenital anomalies after the landfills opened compared with before they opened. We carried out a small-area study in which expected rates of congenital anomalies in births to mothers living within 2 km of the sites, before and after opening of the sites, were estimated from a logistic regression model fitted to all births in residents living at least 4 km away from these sites and hence not likely to be subject to contamination from a landfill, adjusting for hospital catchment area, year of birth, sex, maternal age, and socioeconomic deprivation score. We investigated all births from 1983 through 1997 with at least one recorded congenital anomaly [International Classification of Diseases, Ninth Revision (ICD-9), codes 7400-7599; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), codes Q000-Q999]. The ratio of the observed to expected rates of congenital anomalies before landfills opened was 0.87 [95% confidence interval (CI), 0.75-1.00], and this increased to 1.21 (95% CI, 1.04-1.40) after opening, giving a standardized risk ratio of 1.39 (95% CI, 1.12-1.72). Enhanced congenital malformation surveillance data collected from 1998 through 2000 showed a standardized risk ratio of 1.04 (95% CI, 0.88-1.21). Causal inferences are difficult because of possible biases from incomplete case ascertainment, lack of data on individual-level exposures, and other socioeconomic and lifestyle factors that may confound a relationship with area of residence. However, the increase in risk after the sites opened requires continued enhanced surveillance of congenital anomalies, and site-specific chemical exposure studies. Key words: congenital malformations, epidemiology, landfill, small-area health statistics.

A pilot study of spatial patterns in referrals to a multicentre cancer genetics service.

OBJECTIVES: To analyse spatial and temporal patterns in patients referred to a cancer genetics service in order to monitor service utilization and accessibility. METHODS: Postcodes of patients during a 4-year period were used to examine spatial patterns using a Geographical Information System (GIS). Referral rates were compared visually and statistically to explore yearly variation for administrative areas in Wales. RESULTS: There has been a four-fold increase in actual referrals to the service over the period of study. The variance between unitary authority referral rates has decreased from the inception of the service from an almost ten-fold difference between lowest and highest in year 1 to less than a three-fold difference in year 4. CONCLUSIONS: This study shows the potential of GIS to highlight spatial variations in referral rates across Wales. Although the disparity in referral rates has decreased, trends in referral rates are not consistent. Ongoing research will examine those referral and referrer characteristics affecting uptake.

Findings from a survey on GIS use in the UK National Health Service: organisational challenges and opportunities.

The use of geographical information systems (GIS) in a variety of application areas points to an increasing interest in the spatial aspects of health policies. Despite the fact that most public sector organisations in the United Kingdom (UK) have access to such software tools, there has not been a comprehensive review of take-up within the health sector. In this paper, we report on a recently completed mixed-method research project that has examined the current levels of GIS use in the UK National Health Service, and focus our discussion on health authorities (HAs). Couched within the context of previous studies that have been concerned with outlining the types of factors influencing IT implementation in the health sector, we illuminate the importance of behavioural, cultural and organisational factors on the diffusion of GIS in the UK National Health Service. It is noted that very few organisations had a GIS strategy and we contend that if GIS is to play a wider role in addressing issues surrounding 'joined-up' government, more advice and guidance is needed on policies promoting the exchange of geographical data between agencies concerned with tackling health issues. We conclude by drawing attention to the perceived lack of national guidance on GIS matters, more generally, within the UK health sector.

Evaluating the utility and accuracy of a reverse telephone directory to identify the location of survey respondents.

PURPOSE: To investigate the utility and positional accuracy of a reverse telephone directory to enhance geocoding using self-reported street addresses. METHODS: This cross-sectional study used 2001 self-reported survey data from 2636 participants in three Missouri areas. When available, street addresses were appended to participant telephone numbers using a reverse telephone directory. The odds of finding a telephone number in the reverse directory and the positional accuracy between self-reported addresses and those obtained from the reverse directory were calculated. We also determined the quality of self-reported address information and that obtained by means of the reverse telephone directory. RESULTS: Rural respondents, younger respondents, women, African Americans, and respondents with less than a high school education were less likely to have their telephone number present in the reverse directory. Using the reverse directory increased the overall percentage of respondents whose addresses were geocoded from 51.5% to 72.0%. Eighty-one percent of addresses were geocoded to the same US Census Block Group and 89% were geocoded to the same Census Tract as the self-reported addresses. CONCLUSIONS: The street address of survey participants obtained through the reverse directory can be used to augment the unknown location of telephone survey respondents but specific groups of people are less likely to be found in the directory.

Analysing spatial trends in referral patterns to cancer genetics services: a preliminary investigation of regional variations in Wales.

This paper discusses spatial trends in referral patterns to a cancer genetics service. It presents a literature review outlining the paucity of existing research, a preliminary analysis at the Unitary Authority level in Wales and advances a programme of further research to be conducted at a more detailed spatial level. The preliminary analysis shows a weak negative relationship between referral rates from primary care and social deprivation by Unitary Authority (Spearman rank correlation coefficient, sigma = -0.38). There is also a weak positive relationship between average settlement size and referral rates (sigma = +0.28), which taken together may indicate that primary care practices in affluent urban areas are more likely to refer than those in poorer rural areas. Future research will be conducted at a finer spatial scale, and will take into account characteristics of primary care practices and the patients being referred, amongst other variables.

Morbidity, deprivation and drug prescribing: factors affecting variations in prescribing between doctors' practices.

Analyses are reported of the prescribing quality and behaviour of 131 doctors' practices in a South Wales health authority during the first quarter of 1997. Prescribing of specific groups of drugs are examined, namely antidepressants; bronchodilators and inhaled corticosteroids for treating asthma; and oral antidiabetics and insulin for diabetes. It is hypothesised that the volumes and costs of prescriptions are determined by the characteristics of both doctors/practices (number and age of doctors; training and fundholding status of practices; single-handed practices and doctors per patient) and their patients (age; gender; ethnicity; deprivation). The health authority's population is characterised by substantial inequalities in wealth and health. Statistical analyses reveal the consistent influence of deprivation on prescribing costs and volumes, with the exception of items of insulin. Supply factors exert more selective influences. Thus, the number of doctors per practice and per patient has a positive influence on antidepressant prescribing; fundholding status is associated with lower costs for bronchodilator prescribing; and older doctors tend to prescribe more bronchodilators and oral antidiabetics. Residuals from the statistical analyses suggest further systematic influences, notably advice from hospital consultants, as well as more localised and less consistent effects.