Geography of patients in the federal ENT hospital before and after the COVID-19 pandemic: changing spatial patterns and characteristics

Abstract

Introduction. During the COVID-19 pandemic, access to elective specialized healthcare has decreased significantly. In addition to economic, social, cultural, organizational and language factors, access to healthcare also includes geographic factors. In our country, geographical barriers are an important negative factor hampering access to healthcare for patients living far from regional and federal centres.Aim. This analysis provides an indirect view of the change in the availability of specialized medical otorhinolaryngological care. Describe the procedure for conducting a spatial analysis of the geographic accessibility of medical care.Materials and methods. The study analyzed changes in the spatial characteristics of the place of residence of patients admitted for inpatient treatment at the St Petersburg Research Institute of Ear, Nose and Speech Throat before and after the onset of the COVID-19 pandemic. The study materials used anonymized data of 32,304 patients who were treated in a 24-hour hospital at the St Petersburg Research Institute of Ear, Nose and Throat and Speech from January 2016 to December 2022. Descriptive statistics, spatial statistics, non-parametric methods for testing hypotheses (Wilcoxon criterion for independent samples), odds ratio for binary factors and outcomes processed in the R software environment, built on the basis of OpenStreetMap cartography with QGIS geocoding, were used as research methods.Results and discussion. In the study, geographic patterns of places of residence (locations) of inpatients before and after COVID-19 were obtained, and a visual assessment of their changes was made. The distances between the place of residence of patients and the place of provision of ENT care were calculated, and hypotheses were tested on the equality of the average geographical distance to the places of residence of patients before and after the pandemic. A count of patients and areas of zones of nuclear assessment of the probability density of patient locations in the country before and after the pandemic was made. The design of the study was an observational analytical retrospective study of the spatial characteristics of inpatients, in which the event of the onset of the COVID-19 pandemic acted as a factor.Conclusion. In general, after the resumption of planned inpatient otorhinolaryngological care, its availability, which can indirectly be assessed using a spatial statistical analysis of the places of residence of patients of a federal budgetary institution, has not changed.