WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington.
MEDEX Northwest, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington.
J Rural Health. 2021 Sep;37(4):692-699. doi: 10.1111/jrh.12504. Epub 2020 Aug 18.
To describe the mix of health professionals who care for rural and urban seniors suffering from mood and/or anxiety disorders, the quantity of services they receive, and to understand where beneficiaries receive care for mood and/or anxiety disorders and the distance and time they travel for care.
We used 2014 Medicare administrative claims data to examine access to health care for fee-for-service Medicare beneficiaries aged ≥ 65 years who received outpatient services for mood and anxiety disorders. We classified providers into 9 categories: (1) family physicians/general practice, (2) internists, (3) nurse practitioners (NPs) and physician assistants (PAs), (4) psychiatrists, (5) psychologists, (6) clinical social workers, (7) emergency medicine physicians, (8) other physicians, and (9) other providers. We calculated the 1-way driving distance and travel time between the beneficiary residence and provider location. We classified beneficiaries into 1 of 4 geographic categories based on their residence ZIP Code.
Urban beneficiaries had an average of 2.7 visits for mood and anxiety disorders, while rural beneficiaries had 2.4. Generalist physicians and NPs/PAs provided 50.8% of all visits. Urban beneficiaries saw more behavioral health specialists (34.3%) than rural beneficiaries (16.1%). NPs and PAs provided more than twice as much of the care for rural beneficiaries (14.8%) as for urban beneficiaries (6.4%). Rural beneficiaries travelled about twice as far as urban beneficiaries.
Rural and urban Medicare beneficiaries received care for mood/anxiety disorders from different mixes of health care providers, and ensuring access for rural populations will require innovative solutions.
描述为患有情绪和/或焦虑障碍的农村和城市老年人提供护理的卫生专业人员的混合情况、他们接受的服务数量，并了解受益人接受情绪和/或焦虑障碍治疗的地点以及他们为获得治疗而旅行的距离和时间。
我们使用 2014 年医疗保险管理索赔数据，检查了接受门诊服务治疗情绪和焦虑障碍的 65 岁及以上医疗保险受益人获得医疗保健的机会。我们将提供者分为 9 类：（1）家庭医生/全科医生，（2）内科医生，（3）执业护士（NP）和医师助理（PA），（4）精神科医生，（5）心理学家，（6）临床社会工作者，（7）急诊医师，（8）其他医生，和（9）其他提供者。我们计算了受益人与提供者位置之间的单程驾驶距离和旅行时间。我们根据受益人的居住邮政编码将受益人分为 4 个地理类别之一。
城市受益人的情绪和焦虑障碍就诊平均为 2.7 次，而农村受益人为 2.4 次。全科医生和 NP/PA 提供了所有就诊的 50.8%。城市受益人的行为健康专家（34.3%）比农村受益人的（16.1%）多。NP 和 PA 为农村受益人提供的护理量是城市受益人的两倍多（农村受益人 14.8%，城市受益人 6.4%）。农村受益人的旅行距离大约是城市受益人的两倍。
农村和城市的医疗保险受益人接受情绪/焦虑障碍治疗的医疗服务提供者组合不同，确保农村人口获得治疗需要创新的解决方案。
