Mapping Rural and Urban Veterans’ Spatial Access to Primary Care Following the MISSION Act

Sullivan, Eliana; Zahnd, Whitney E.; Zhu, Jane M.; Kenzie, Erin S.; Patzel, Mary; Davis, Melinda M.

doi:10.1007/s11606-021-07229-y

Cited by 9 publications

(4 citation statements)

References 30 publications

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“…Finally, we add to a growing literature in health services research, suggesting that more nuanced geospatial methods, like the E2SFCA approach, 32,58 can enhance traditional time and distance measures of access to care. Our results suggested differences between these approaches in highlighting areas with poor access to mental health care.…”

Section: Discussionmentioning

confidence: 98%

Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid

Charlesworth

Nagy

Drake

et al. 2023

The Journal of Rural Health

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ObjectiveMedicaid enrollees in rural and frontier areas face inadequate access to mental health services, but the extent to which access varies for different provider types is unknown. We assessed access to Medicaid‐participating prescribing and nonprescribing mental health clinicians, focusing on Oregon, which has a substantial rural population.MethodsUsing 2018 Medicaid claims data, we identified enrollees aged 18‐64 with psychiatric diagnoses and specialty mental health providers who billed Medicaid at least once during the study period. We measured both 30‐ and 60‐minute drive time to a mental health provider, and a spatial access score derived from the enhanced 2‐step floating catchment area (E2SFCA) approach at the level of Zip Code Tabulation Areas (ZCTAs). Results were stratified for prescribers and nonprescribers, across urban, rural, and frontier areas.ResultsOverall, a majority of ZCTAs (68.6%) had at least 1 mental health prescriber and nonprescriber within a 30‐minute drive. E2SFCA measures demonstrated that while frontier ZCTAs had the lowest access to prescribers (84.3% in the lowest quintile of access) compared to other regions, some frontier ZCTAs had relatively high access to nonprescribers (34.3% in the third and fourth quartiles of access).ConclusionsSome frontier areas with relatively poor access to Medicaid‐participating mental health prescribers demonstrated relatively high access to nonprescribers, suggesting reliance on nonprescribing clinicians for mental health care delivery amid rural workforce constraints. Efforts to monitor network adequacy should consider differential access to different provider types, and incorporate methods, such as E2SFCA, to better account for service demand and supply.

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Section: Discussionmentioning

confidence: 98%

Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid

Charlesworth

Nagy

Drake

et al. 2023

The Journal of Rural Health

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“…A convenience sample of participants were recruited from the listserv of the Oregon Rural Practice-based Research Network (ORPRN). ORPRN is an established practice-based research network of 296 clinics (nearly half of Oregon primary care clinics) [ 33 ] that conducts research, education and quality improvement projects with clinics and communities across the state in both rural and urban areas [ 34 , 35 ]. An email to the ORPRN listserv invited primary care clinicians and staff to participate in a brief electronic survey regarding the impacts of the recent vaccination mandate on their clinic.…”

Section: Methodsmentioning

confidence: 99%

Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making

et al. 2023

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Introduction Little is known about the impact of mandated vaccination policies on the primary care clinic workforce in the United States or differences between rural and urban settings, especially for COVID-19. With the continued pandemic and an anticipated increase in novel disease outbreaks and emerging vaccines, healthcare systems need additional information on how vaccine mandates impact the healthcare workforce to aid in future decision-making. Methods We conducted a cross-sectional survey of Oregon primary care clinic staff between October 28, 2021– November 18, 2021, following implementation of a COVID-19 vaccination mandate for healthcare personnel. The survey consisted of 19 questions that assessed the clinic-level impacts of the vaccination mandate. Outcomes included job loss among staff, receipt of an approved vaccination waiver, new vaccination among staff, and the perceived significance of the policy on clinic staffing. We used univariable descriptive statistics to compare outcomes between rural and urban clinics. The survey also included three open-ended questions that were analyzed using a template analysis approach. Results Staff from 80 clinics across 28 counties completed surveys, representing 38 rural and 42 urban clinics. Clinics reported job loss (46%), use of vaccination waivers (51%), and newly vaccinated staff (60%). Significantly more rural clinics (compared to urban) utilized medical and/or religious vaccination waivers (71% vs 33%, p = 0.04) and reported significant impact on clinic staffing (45% vs 21%, p = 0.048). There was also a non-significant trend toward more job loss for rural compared to urban clinics (53% vs. 41%, p = 0.547). Qualitative analysis highlighted a decline in clinic morale, small but meaningful detriments to patient care, and mixed opinions of the vaccination mandate. Conclusions Oregon’s COVID-19 vaccination mandate increased healthcare personnel vaccination rates, yet amplified staffing challenges with disproportionate impacts in rural areas. Staffing impacts in primary care clinics were greater than reported previously in hospital settings and with other vaccination mandates. Mitigating primary care staffing impacts, particularly in rural areas, will be critical in response to the continued pandemic and novel viruses in the future.

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“…Any clinic in Oregon providing primary care to adult patients is eligible for the study. Prior work by our team identified approximately 750 primary care clinics in Oregon that meet eligibility criteria; we aim to engage approximately 20% of potentially eligible sites [ 35 ]. ANTECEDENT uses a rolling recruitment process to capitalize on changing capacity and interest in clinics, health systems, and CCOs over time.…”

Section: Methodsmentioning

confidence: 99%

Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: Protocol of the ANTECEDENT study

Singh

Sánchez²,

Kenzie³

et al. 2022

PLoS ONE

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Background Unhealthy alcohol use (UAU) is a leading cause of morbidity and mortality in the United States, contributing to 95,000 deaths annually. When offered in primary care, screening, brief intervention, referral to treatment (SBIRT), and medication-assisted treatment for alcohol use disorder (MAUD) can effectively address UAU. However, these interventions are not yet routine in primary care clinics. Therefore, our study evaluates tailored implementation support to increase SBIRT and MAUD in primary care. Methods ANTECEDENT is a pragmatic implementation study designed to support 150 primary care clinics in Oregon adopting and optimizing SBIRT and MAUD workflows to address UAU. The study is a partnership between the Oregon Health Authority Transformation Center—state leaders in Medicaid health system transformation—SBIRT Oregon and the Oregon Rural Practice-based Research Network. We recruited clinics providing primary care in Oregon and prioritized reaching clinics that were small to medium in size (<10 providers). All participating clinics receive foundational support (i.e., a baseline assessment, exit assessment, and access to the online SBIRT Oregon materials) and may opt to receive tailored implementation support delivered by a practice facilitator over 12 months. Tailored implementation support is designed to address identified needs and may include health information technology support, peer-to-peer learning, workflow mapping, or expert consultation via academic detailing. The study aims are to 1) engage, recruit, and conduct needs assessments with 150 primary care clinics and their regional Medicaid health plans called Coordinated Care Organizations within the state of Oregon, 2) implement and evaluate the impact of foundational and supplemental implementation support on clinic change in SBIRT and MAUD, and 3) describe how practice facilitators tailor implementation support based on context and personal expertise. Our convergent parallel mixed-methods analysis uses RE-AIM (reach, effectiveness, adoption, implementation, maintenance). It is informed by a hybrid of the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) and the Dynamic Sustainability Framework. Discussion This study will explore how primary care clinics implement SBIRT and MAUD in routine practice and how practice facilitators vary implementation support across diverse clinic settings. Findings will inform how to effectively align implementation support to context, advance our understanding of practice facilitator skill development over time, and ultimately improve detection and treatment of UAU across diverse primary care clinics.

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Mapping Rural and Urban Veterans’ Spatial Access to Primary Care Following the MISSION Act

Cited by 9 publications

References 30 publications

Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid

Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid

Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making

Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: Protocol of the ANTECEDENT study

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