GEOGRAPHIC ACCESS AND SERVICE USE IN RURAL DEPRESSION

我们建议：1）研究地理可达性对 在农村地区利用精神卫生服务; 2）发展和 测试寻求治疗行为的预测空间模型。分析 将使用先前编制的基于人口的 470名受试者的纵向数据集，这些受试者目前有 萧条地理可达性被定义为道路旅行 从每个病人到初级保健和专业心理健康的距离 护理提供者。为了实现这一结构，我们将收集 研究区域内每个医疗保健提供者的位置信息。 我们假设，居住在离供应商较远的地方的个人 不太可能因抑郁症状而寻求治疗。为个人 在初级保健环境中治疗不成功，我们假设， 那些地理上难以获得专业精神卫生服务的人 提供者将不太可能被他们的初级保健转介 专业精神卫生部门的医生。这些假设将是 使用寻求治疗行为的模型进行测试， 患者的易感性、使能性和需求特征，以及提供者 实践属性，尤其是位置。本研究设计 这是对先前研究的重大改进， 地理上的可达性，简单的农村/城市二分法 解释变量为测试这些数据而创建的统计模型 假设将用于开发一个综合模型系统， 根据普查数据预测总体利用模式。这些预测 模型将通过比较预测值和实际值进行外部验证 在不同的基于治疗的患者样本中的利用率， 在整个阿肯色州的农村地区执业的初级保健医生。的 建议的研究是一个与医疗保健改革政策相关的研究课题 因为精神卫生保健服务的地理分布可能 修改公共政策。这里开发的预测模型可以 理论上可用于预测总利用率的变化 在精神卫生保健提供者的空间重新分配之后， 设施地理可达性作为一种 治疗障碍可能会增加，如果其他方面的准入， 由于缺乏保险覆盖，在健康保险的赞助下， 护理改革。

We propose to 1) examine the effects of geographical accessibility on the utilization of mental health services in rural areas and 2) to develop and test predictive spatial models of treatment seeking behavior. Analyses will be conducted using a previously compiled population-based longitudinal dataset of 470 subjects with current substantial symptoms of depression. Geographical accessibility is defined as the road travel distance from each patient to primary care and specialty mental health care providers. To operationalize this construct we will collect locational information for every health care provider in the study area. We hypothesize that individuals living further away from providers will be less likely to seek care for their symptoms of depression. For individuals unsuccessfully treated in the primary care setting, we hypothesize that those with poor geographical accessibility to specialty mental health providers will be less likely to be referred by their primary care physician to the specialty mental health sector. These hypotheses will be tested using models of treatment seeking behavior that are a function of patient predisposing, enabling and need characteristics, and provider practice attributes especially location. This proposed research design constitutes a major improvement over prior studies which have approximated geographical accessibility with a simple rural/urban dichotomous explanatory variable. The statistical models created to test these hypotheses will be used to develop a system of integrated models able to predict aggregate utilization patterns from census data. These predictive models will be externally validated by comparing predicted and actual utilization in a different treatment-based sample of patients seen by ten primary care physicians practicing in rural areas throughout Arkansas. The proposed study is a policy relevant research topic for health care reform because the geographic distribution of mental health care services can be modified by public policy. The predictive models developed here could theoretically be used to forecast changes in aggregate utilization following a spatial redistribution of mental health care providers and facilities. The relative importance of geographical accessibility as a treatment barrier is likely to increase if other aspects of access, such as lack of insurance coverage, are reduced under the auspices of health care reform.