Identifying professional and territorial health communities by analyzing healthcare spatial realities

Introduction: Professional and Territorial Health Communities aim at organizing the coordination of health professionals of primary and specialty care, in order to better structure care pathways and improve healthcare access. The flow of patients to specialty care outlines territories whose scale and organization can serve as a basis to identify these communities' territories. Method: The analysis of patient flows to specialty care professionals in Centre-Val de Loire region in 2015 (SNIIRAMdata) made it possible to classify medical specialties according to their scale of attractiveness (i.e. regional, departmental and sub-departmental specialties). Among sub-departmental specialties, 5 have been merged to identify common poles of attraction. These empirical poles have been compared to health professionals' perception of territories where they practice in order to refine the territorial subdivision of the region. Patient flows to the General Hospitals (PMSI date) were then defined to compare them with the private practice patient poles. Results: In the region, twenty or so attraction poles can be identified in the six departments of the region. Local areas have been divided into 5 classes, according to their degree of attraction to a pole. Attraction poles seem to be consistent with health professionals' habits. The concordance with hospital patient poles reinforced the relevance of this division. Conclusion: Patients flows respond to a real territorial logic which, confronted to health professionals' real-life practices, draws territories relevant for a first approach of the Professional and Territorial Health Communities.