Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores.
Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores.
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DOI：
10.1016/j.pmedr.2017.12.001
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发表时间：
2018-03
影响因子：
2.8
通讯作者：
Grande D
中科院分区：
文献类型：
--
作者：
Chaiyachati KH;Hom JK;Hubbard RA;Wong C;Grande D
生活在贫困中的人的健康状况较差，部分原因是医疗保险率较低和获得护理的障碍。由于《负担得起的医疗法案》减少了财政障碍，因此确定妨碍获得医疗保健的持续障碍仍然很重要。我们研究了步行得分™（衡量邻里资源的步行能力）和交通得分™（衡量交通可达性）所反映的建筑环境是否与新加入医疗补助计划的低收入成年人的常规护理来源有关。我们收到了来自费城（一个人口稠密的大城市）1000名医疗补助新参保者中的312人的回复，他们在2015年至2016年期间接受了调查，以确定他们是否确定了门诊初级保健的常规来源。居住在低步行评分（< 70）地址的受访者拥有常规护理来源的几率低84% （OR 0.16, 95% CI 0.04-0.61）。交通评分与常规护理来源无关。步行评分可以作为政策制定者和医疗服务提供者的一种工具，以确定有较差的初级保健获得风险的人群。步行和交通评分与初级保健之间的关系进行了测试。这些评分是免费的，可用于识别难以获得医疗服务的人群。步行评分确定了在获得医疗保健方面存在持续障碍的患者。
Worse health outcomes among those living in poverty are due in part to lower rates of health insurance and barriers to care. As the Affordable Care Act reduced financial barriers, identifying persistent barriers to accessible health care continues to be important. We examined whether the built environment as reflected by Walk Score™ (a measure of walkability to neighborhood resources) and Transit Score™ (a measure of transit access) is associated with having a usual source of care among low-income adults, newly enrolled in Medicaid. We received responses from 312 out of 1000 new Medicaid enrollees in Philadelphia, a large, densely populated urban area, who were surveyed between 2015 and 2016 to determine if they had identified a usual source of outpatient primary care. Respondents living at an address with a low Walk Scores (< 70) had 84% lower odds of having a usual source of care (OR 0.16, 95% CI 0.04–0.61). Transit scores were not associated with having a usual source of care. Walk Score may be a tool for policy makers and providers of care to identify populations at risk for worse primary care access. The association between Walk and Transit Scores and having primary care was tested. These Scores are free and could be used to identify populations with poor access. Walk Scores identified patients with persistent barriers to accessing healthcare.