Using geographical information systems to plan dialysis facility provision.

Using geographical information systems to plan dialysis facility provision Sir, We read Toubiana et al.s' article on geographical information systems (GIS) with interest [1]. They suggest that GIS may be used to plan healthcare delivery, and we can confirm that. In Scotland, the government provides funding for universal healthcare to 15 National Health Service (NHS) Boards, with the level of funding based on population, deprivation and rurality. These Boards are responsible both for the strategic planning and the delivery of all healthcare. The Scottish government has set a target that all patients should be able to access a haemodialysis unit within 30 minutes of their home, 'within the constraints of population density and geography' [2]. Previous research has confirmed that travelling times in excess of 37 minutes impact on take-on rates and thus presumably patient survival [3]. Furthermore, a Scottish Renal Association patient survey identified travelling time as the single greatest concern for patients (B.J.R. Junor, personal communication). Scotland has one of the most challenging geographical situations in Europe for the provision of dialysis, with a low population density of 65 people/km 2 (ranging from 8 to 1560 people/km 2 in the fifteen NHS Boards), and 99 638 people (2% of the population) living on 55 islands [4], with frequently difficult weather conditions. NHS Dumfries and Galloway is one of the more rural NHS Boards with a population of 147 210 and a population density of 23 people/km 2 [4]. Currently, there is only one dialysis unit, in the main town of Dumfries. As a result the Board fails the government target badly, with 45% of renal replacement therapy (RRT) patients living >30 minutes from a dialysis facility (compared to a Scottish average of 10%). A previous study showed that 19% of Dumfries patients travelled in excess of 100 miles per dialysis day (15 000 miles per year) solely for the purpose of dialysis, compared to 2% elsewhere in Scotland (P<0.001) [5]. The Board plan to open a satellite dialysis unit to solve this problem. We used ArcGIS 8.3 and ProTerritory 1.0.591 with Bartholomew's 100 m road grid, to analyse the travelling time to the current and proposed dialysis facilities, for all RRT patients resident in the health board. We included all patients started on RRT between 1982 and 2002; all RRT patients potentially require hospital-based dialysis at some point in their life; a 21 year period was used to …