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Oluwoye O, Amiri S, Kordas G, Fraser E, Stokes B, Daughtry R, Langton J, McDonell MG. Geographic Disparities in Access to Specialty Care Programs for Early Psychosis in Washington State. Adm Policy Ment Health 2021; 49:5-12. [PMID: 33877475 DOI: 10.1007/s10488-021-01137-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Supported by the 10% set-aside funds in the Community Mental Health Block grant, distributed at the state level, coordinated specialty care (CSC) have been widely disseminated throughout the U.S. This study explores variations in the geographical accessibility of CSC programs by neighborhood level characteristics in Washington State. CSC locations were geocoded. Socioeconomic neighborhood deprivation (i.e., Area deprivation index) and rurality (i.e., Rural-Urban Commuting Area codes) were neighborhood level characteristics extracted from the 2018 American Community Survey. Geographic accessibility of CSC was assessed using a two-step floating catchment area technique and multilevel linear models were used to examine the association between specific neighborhood characteristics and geographic accessibility. The association between access and socioeconomically deprived neighborhoods varied differentially by neighborhood rurality (an interaction effect). Model estimates indicated that the least deprived, metropolitan neighborhoods had the best access (M = 0.38; CI: 0.34, 0.42) and rural neighborhoods in the second most deprived quartile had the worst access (M = 0.16; CI: 0.11, 0.21) to CSC. There was a clear decrease in accessibility for more rural neighborhoods, regardless of other neighborhood characteristics. In conclusions, findings provide important insight into how resource distribution contributes to geographic disparities in access to CSC. The use of spatial analytic techniques has the potential to identify specific neighborhoods and populations where there is a need to expand and increase availability of CSC to ensure access to rural and socioeconomically deprived neighborhoods.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA. .,Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA.
| | - Solmaz Amiri
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Institute for Research and Education To Advance Community Health (IREACH), Seattle, USA
| | - Gordon Kordas
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Elizabeth Fraser
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA
| | - Bryony Stokes
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA
| | - Rebecca Daughtry
- Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA.,Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia, WA, USA
| | - Jared Langton
- Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA.,Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia, WA, USA
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA
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Abstract
BACKGROUND Obesity causes substantial morbidity and mortality in the United States. Evidence shows that primary care physician (PCP) supply correlates positively with improved health, but its association with obesity in the United States as not been adequately characterized. Our purpose was to characterize the association between PCP supply in US counties and adult obesity. METHODS We performed a multivariate logistic regression analysis to examine the relationship between county-level PCP supply and individual obesity status. We controlled for individual variables, including sex, race, marital status, income, and insurance status, and county-level variables, including rurality and poverty. RESULTS Higher county-level PCP supply was associated with lower adult obesity after controlling for common confounders. Individuals living in counties with the most robust PCP supply were about 20% less likely to be obese (P ≤ .01) than those living in counties with the lowest PCP supply. CONCLUSIONS While the observed association between the supply of PCPs and lower rates of obesity may not be causal, the association warrants further investigation. This may have important implications for restructuring the physician workforce in the context of the current PCP shortage and implementation of the Affordable Care Act and the patient-centered medical home.
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