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.
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农村和边境获得心理健康处方者和非处方者的机会：俄勒冈州医疗补助的地理空间分析。
DOI：
10.1111/jrh.12761
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Zhu,JaneM
中科院分区：
文献类型：
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作者：
Charlesworth,ChristinaJ;Nagy,Dylan;Drake,Coleman;Manibusan,Brynna;Zhu,JaneM
农村和边境地区的医疗补助计划参与者面临着获得心理健康服务的机会不足，但不同类型的提供者获得服务的程度不同尚不清楚。我们评估了医疗补助参与处方和非处方精神卫生临床医生的访问，重点是俄勒冈州，其中有大量的农村人口。MethodsUsing 2018年Medicaid索赔数据，我们确定了18 - 64岁的登记者，精神病诊断和专业精神卫生提供者在研究期间至少一次向Medicaid收费。我们测量了到精神卫生提供者的30分钟和60分钟车程，以及在邮政编码列表区（ZCTAs）水平上从增强的两步浮动集水区（E2 SFCA）方法获得的空间访问评分。结果分层处方和nonprescribers，在城市，农村和边疆areas.ResultsOverall，大多数ZCTA（68.6%）有至少1个心理健康处方和nonprescriber在30分钟的车程。E2 SFCA措施表明，虽然前沿ZCTA对处方者的可及性最低，与其他地区相比，一些前沿ZCTA对非处方者的可及性相对较高（最低五分位数为84.3%）（34.3%在第三和第四四个四分位数的访问）。结论一些边境地区与医疗补助参与精神卫生处方相对较差，表现出相对较高的访问非处方，这表明在农村劳动力有限的情况下，精神卫生保健服务依赖于非处方临床医生。监测网络充分性的工作应考虑对不同提供商类型的不同接入，并采用E2 SFCA等方法，以更好地说明服务需求和供应。
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.