Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA.
Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA.
J Affect Disord. 2019 Jun 15;253:162-170. doi: 10.1016/j.jad.2019.04.091. Epub 2019 Apr 22.
To examine the association of geographic access to providers with racial/ethnic variations in treatment quality among youth with depression.
The geographic access to providers who initiated the depression treatment was measured using the travel distance estimated based on Google Maps® and the provider density within a 5-mile radius of each patient residence. Depression treatment quality was measured as treatment engagement, defined as having ≥2 prescriptions or psychotherapy with 2-month following a new depression diagnosis, and treatment completion defined as having ≥8 sessions of psychotherapy within 12 weeks or received ≥84 days of continuous treatment with antidepressants within 114 days following the treatment initiation.
The results of multivariate logistic regression analysis have demonstrated that the travel distance to provider was only negatively associated with the treatment engagement of Hispanics (5.0 - 14.9 vs ≤ 4.9 miles: OR=0.74, 95% CI [0.54-0.88]; ≥15 vs ≤ 4.9 miles: OR=0.82, 95% CI [0.56-0.97]), while a higher mental health specialist density was only positively associated with the treatment engagement of Blacks (1.00-1.99 vs < 1.00: OR=1.63, 95% CI [1.03-4.51]; 2.00-4.99 vs < 1.0: OR=2.28, 95% CI [1.21-7.11]). Among those who have engaged in the treatment, travel distance was associated with a lower likelihood of treatment completion in all racial/ethnic groups.
The study did not account for types of transportation used by patients.
Geographic access barriers had a negative association with treatment quality of pediatric depression. Minority children were more sensitive to the barriers than Whites.
探讨医疗服务提供者地理可及性与青少年抑郁症治疗质量的种族/民族差异的关系。
利用谷歌地图®估算的出行距离和患者居住地 5 英里范围内的提供者密度来衡量医疗服务提供者的地理可达性。以治疗参与度（定义为新诊断出抑郁症后 2 个月内至少开具 2 种处方或接受 2 次心理治疗）和治疗完成度（定义为在治疗开始后 12 周内接受至少 8 次心理治疗或在 114 天内接受至少 84 天连续抗抑郁药物治疗）作为衡量抑郁症治疗质量的指标。
多变量逻辑回归分析结果表明，就诊距离仅与西班牙裔青少年的治疗参与度呈负相关（5.0-14.9 英里比≤4.9 英里：比值比（OR）=0.74，95%置信区间[0.54-0.88]；≥15 英里比≤4.9 英里：OR=0.82，95%置信区间[0.56-0.97]），而精神科专家密度较高仅与黑人的治疗参与度呈正相关（1.00-1.99 英里比<1.00 英里：OR=1.63，95%置信区间[1.03-4.51]；2.00-4.99 英里比<1.0 英里：OR=2.28，95%置信区间[1.21-7.11]）。在已经接受治疗的患者中，无论种族/民族如何，就诊距离均与治疗完成率较低相关。
本研究未考虑患者使用的交通方式类型。
地理可达性障碍与儿科抑郁症的治疗质量呈负相关。少数民族儿童比白人儿童对障碍更为敏感。
