Disparities in Alcohol, Drug Use, and Mental Health Condition Prevalence and Access to Care in Rural, Isolated, and Reservation Areas: Findings From the South Dakota Health Survey
Disparities in Alcohol, Drug Use, and Mental Health Condition Prevalence and Access to Care in Rural, Isolated, and Reservation Areas: Findings From the South Dakota Health Survey
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DOI：
10.1111/jrh.12157
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发表时间：
2016-06-01
影响因子：
4.9
通讯作者：
McConnell, K. John
中科院分区：
文献类型：
--
作者：
Davis, Melinda M.;Spurlock, Margaret;McConnell, K. John
研究目的酒精、药物使用和精神健康（ADM）状况的城乡差异是不一致的。本研究介绍了ADM条件的患病率和获得照顾在不同的地理位置在一个主要的农村state.MethodsMultimodal横断面调查在南达科他州从2013年11月至2014年10月，在农村地区和美国印第安人保留地过抽样。措施评估人口统计学特征，ADM条件的患病率使用临床筛查和参与者自我报告，认为需要治疗，卫生服务的使用，并获得护理的障碍。我们测试了城市，农村，孤立和保留的地理区域之间的差异，控制参与者的年龄和gender.FindingsWe分析了7，675调查（48%的响应率）。一般来说，ADM疾病的患病率在不同地区之间没有显著差异。然而，偏远地区和保留区的受访者获得初级保健的可能性要小得多。在偏远地区，对治疗方案的了解明显较低，在保留区的个人报告接受所有必要护理的几率明显较低。在整个样本中，ADM临床筛查和参与者自我报告的需求之间存在实质性的不一致; 98.1%的酒精或药物滥用筛查阳性的受访者和63.8%的精神健康状况筛查阳性的受访者认为不需要护理。ADM条件的地理差异与获得的差异有关，而不是流行率，特别是对于孤立和保留区的个人。关于ADM状况特征的教育干预可能与改善获得护理的机会一样重要。
PurposeResearch on urban/rural disparities in alcohol, drug use, and mental health (ADM) conditions is inconsistent. This study describes ADM condition prevalence and access to care across diverse geographies in a predominantly rural state.MethodsMultimodal cross-sectional survey in South Dakota from November 2013 to October 2014, with oversampling in rural areas and American Indian reservations. Measures assessed demographic characteristics, ADM condition prevalence using clinical screenings and participant self-report, perceived need for treatment, health service usage, and barriers to obtaining care. We tested for differences among urban, rural, isolated, and reservation geographic areas, controlling for participant age and gender.FindingsWe analyzed 7,675 surveys (48% response rate). Generally, ADM condition prevalence rates were not significantly different across geographies. However, respondents in isolated and reservation areas were significantly less likely to have access to primary care. Knowledge of treatment options was significantly lower in isolated regions and individuals in reservation areas had significantly lower odds of reporting receipt of all needed care. Across the sample there was substantial discordance between ADM clinical screenings and participant self-reported need; 98.1% of respondents who screened positive for alcohol or drug misuse and 63.8% of respondents who screened positive for a mental health condition did not perceive a need for care.ConclusionIn a predominantly rural state, geographic disparities in ADM conditions are related to differences in access as opposed to prevalence, particularly for individuals in isolated and reservation areas. Educational interventions about ADM condition characteristics may be as important as improving access to care.