Impact of Geographic Access to Primary Care provider on Pediatric Behavioral Health Screening

Abstract

Objective : To assess the impact of geographic access to primary care providers (PCPs) on the receipt of behavioral disorder screening among children and adolescents from different racial/ethnic groups. Data Sources/Study Setting: The primary data source was 2013-2016 administrative claims data from a large pediatric Medicaid Managed Care Plan linked to the US Census data and the National Provider Identifier (NPI) Registry. Study Design: The study was a retrospective cohort design which was conducted using data obtained from multiple sources. Data Collection/Extraction Methods : Geographic access was measured as one way travel distance to the nearest PCP estimated based on google map, and the PCP density per 10,000 population within a 10-mile travel radius from the population weighted centroid of each individual’s zip code. Multivariate logistic regression was conducted to examine the association between the geographic access measures and the likelihood of receiving behavioral disorder screening within each racial/ethnic group. Principal Findings : Behavioral disorder screening rate was 12.6% among 457,870 children and adolescents who met the inclusion criteria. Multivariable analyses revealed that the travel distance to the nearest PCP was negatively associated with the screening uptake among Hispanics (10-20 vs. 0-10 miles: OR=0.78, 95%CI [0.71-0.86]; 20-30 vs. 0-10 miles: OR=0.35, 95%CI [0.23-0.54]). Similar effects associated with the travel distance were not observed in Blacks and Whites. Among those having access to ≥1 PCP within 10 miles of travel distance, the increase in PCP density had a greater positive impact on the receipt of behavioral disorder screening in minorities than that in Whites. Conclusion : Minorities, especially Hispanics, were more sensitive than Whites to the geographic access barriers to PCPs for pediatric behavioral disorder screening.

Are Federally Qualified Health Centers Accessible to Pediatric Populations in Most Need throughout Detroit? A Visualization Using Proximity Analysis

“…Various studies have shown that increased distance to a health facility affects accessibility and tends to result in fewer primary care visits. [8][9][10] There is also evidence that the recent expansion of FQHCs nationwide has tended not to occur in areas with the highest rates of poverty. 11 In consideration of the issues associated with increased distance to care for children in poverty, the objective of this study was to determine if currently established FQHCs in Detroit are accessible to populations who require them, and to examine what areas in the city are most in need of the expansion of FQHCs.…”

The Role of Financial Drivers in the Regionalization of Pediatric Care

“…It is important to remember that even a small increase in distance to pediatric care can have a large impact on access for patients with few resources and lack of transportation. [19][20][21] The trend is clear: pediatric inpatient care is more regionalized and concentrated. Intensive care beds are increasingly used, and the reason for that may be partly a financial response to decreased reimbursement rather than increased need for intensive care services.…”