Quantifying the impact of the cluster clinic model on geographic service accessibility

BackgroundTravel distance is a barrier to accessing care, especially in large areas with low population density. The cluster clinic model is designed to provide paediatric scheduled care in the community setting within NHS Grampian. Here, we have quantified the effect on overall travel distance and equality of access. MethodsThree models were compared: All clinics delivered at Royal Aberdeen Childrens Hospital, all clinics delivered at cluster clinics, and clinics at both hospital and cluster clinics. Shortest drivable distance from home to clinic in each model was calculated for all children in Aberdeen City and Aberdeenshire. Equality of distribution was assessed using a Gini coefficient, with values closer to 0 representing better equality, and 1 representing worse equality. ResultsIn model A, median travel distance was 8.64miles (Q1: 2.96miles, Q3: 25.7miles) with a Gini coefficient of 0.491. For model B, median travel distance was 3.14miles (Q1: 1.46miles, Q3: 9.07miles) with a Gini coefficient of 0.480. In model C, median travel distance was 3.13miles (Q1: 1.35miles, Q3: 9.07miles), with a Gini coefficient of 0.490. ConclusionsThe cluster clinic model significantly reduces travel distance, whilst simultaneously improving access equality. This methodology should be considered to prospectively evaluate implementation of similar models elsewhere.