Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed Determining geographic accessibility of family physician and nurse practitioner services in relation to the distribution of seniors within two Canadian Prairie Provinces Tayyab Ikram Shah, Stephan Milosavljevic, Brenna Bath * University of Saskatchewan, Saskatoon, SK, Canada ARTICLE INFO Keywords: Health geography Spatial accessibility Primary health care Health services Rural and remote health ABSTRACT Equitable access and distribution of health care services for rural and remote populations is a substantial challenge for health workforce planners and policy makers. Geospatial examination of access to health care considers both need and supply dimensions together to determine spatial access scores which contribute to a greater understanding of potential inequity in accessibility. This geospatial investigation explores geographic variation in accessibility to primary health care services utilizing combined access scores for family physicians and nurse practitioner services in urban and rural communities in the Canadian Prairie provinces of Saskatchewan and Alberta. An index of access scores was developed using a floating catchment area framework and a census subdivision geographic unit. Information about family physician and nurse practitioner practice locations and spatial population data were obtained from the Canadian Institute for Health Information and Statistics Canada respectively. Alberta has a better overall provincial access score than Saskatchewan for family physicians and nurse practitioners combined (11.37 vs. 9.77). The results demonstrate that nurse practitioner services are likely addressing primary care access gaps due to reduced numbers of family physician services in certain geographical areas. Combined access scores reveal inequalities in the distribution of primary health care services relative to the proportion of population aged 65 + across both provinces, particularly in rural and remote communities. This study contributes to health services research by exploration of combined access scores for family physician and nurse practitioner services in relation to the distribution of seniors. These findings provide insight into which areas may be in need of increased primary health care services with a focus on both of these health professional groups. The findings of this research will serve as a foundational model for future expansion of the methods to other health care provider groups and to other population health need indicators provincially and nationally. 1. Introduction Equitable access and distribution of health care services for rural and remote communities is a substantial challenge for health workforce planners, managers and policy makers. Similar to other developed countries, Canada is continually updating health care strategies in an attempt to ensure that healthcare resources, particularly primary health care (PHC) services, are distributed and accessible according to popu- lation need across the full rural-urban spectrum – including urban areas and rural and remote communities (Government of Alberta, 2010; Government of Ontario, 2012). PHC is a term used to refer to the part of a health system that people interact with most of the time when they need health care (V. A. Crooks and Andrews, 2009; Health Canada, 2006). Access to PHC services is a considerable health delivery concern for all provincial/territorial jurisdictions in Canada. However, for jur- isdictions with dispersed and low population density, ensuring equi- table access and distribution of PHC services irrespective of location is a major challenge (Fucile, 2009; Matthew Richard McGrail and Humphreys, 2015; Ministry of Health and Long-Term Care, 2011). Accessibility to health care is classically characterized by the relation- ship between availability of health care providers and community- based demand for health care services. While access has a number of different dimensions, identifying the geospatial features of health care accessibility is considered critical across several countries. In Canada, the increasing interest in geographic access to health care services to determine under-served areas has focused almost ex- clusively on physician services (Bell et al., 2012, 2013; V. Crooks and Schuurman, 2012; Guagliardo et al., 2004; Ngui and Apparicio, 2011). http://dx.doi.org/10.1016/j.socscimed.2017.10.019 Received 9 May 2017; Received in revised form 30 August 2017; Accepted 17 October 2017 * Corresponding author. School of Physical Therapy, 104 Clinic Place, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada. E-mail address: brenna.bath@usask.ca (B. Bath). Social Science & Medicine 194 (2017) 96–104 Available online 19 October 2017 0277-9536/ © 2017 Elsevier Ltd. All rights reserved. T