美国扩大视光师执业范围的州的医疗保险人口的眼科保健提供者的可及性。
Eye Care Provider Availability for the Medicare Population in U.S. States That Have Expanded Optometrist Scope of Practice.
机构信息
Marxe School of Public and International Affairs, Baruch College, City University of New York, New York, New York.
出版信息
Optom Vis Sci. 2020 Nov;97(11):929-935. doi: 10.1097/OPX.0000000000001599.
SIGNIFICANCE
Estimating a broader set of measures of local eye care provider availability than used in prior research offers information that is useful for policy decisions related to access to eye care.
PURPOSE
The purpose of this study was to examine whether policy-relevant information was gained when measures of local eye care provider availability in addition to the estimated travel time (ETT) to the closest provider were estimated for the population 65 years or older in Kentucky, New Mexico, and Oklahoma. These states have expanded surgical scope of practice for optometrists.
METHODS
This study used block group-level population data from the 2010 U.S. Decennial Census and eye care provider office address information from the 2016 Medicare Provider Utilization and Payment Data. Geographic information system analysis was used to calculate ETTs between individuals and eye care providers. Expanded measures of availability included the difference in ETT to an individual's second closest and closest ophthalmologist, the difference in ETT to an individual's closest ophthalmologist and closest optometrist, and whether only one ophthalmologist at the closest office accepted Medicare. Descriptive statistics were calculated for each state and by urbanicity.
RESULTS
Of the population 65 years or older in each state, between 10.8 (Kentucky) and 16.6% (Oklahoma) had a one-way ETT to the second closest ophthalmologist >15 minutes longer than to the closest ophthalmologist, between 21.1 (Kentucky) and 27.6% (Oklahoma) had a one-way ETT to the closest ophthalmologist >15 minutes longer than to the closest optometrist, and between 56.4 (Kentucky) and 70.0% (Oklahoma) had only one ophthalmologist at the closest office who accepted Medicare. Findings differed substantially by urbanicity.
CONCLUSIONS
Using a portfolio of travel time-based measures enhances the understanding of local eye care provider availability.
意义
相较于先前的研究，评估更广泛的当地眼科医疗服务提供者供给衡量标准提供了与获得眼科护理相关的政策决策有用的信息。
目的
本研究旨在检验在肯塔基州、新墨西哥州和俄克拉荷马州，对 65 岁及以上人群除了估计到最近提供者的出行时间（ETT）外，还对当地眼科医疗服务提供者的供给情况进行评估，是否能获取到与政策相关的信息。这三个州都扩大了视光师的手术范围。
方法
本研究使用了 2010 年美国十年普查的街区组级人口数据和 2016 年医疗保险提供者使用和支付数据中的眼科医疗服务提供者办公地址信息。地理信息系统分析用于计算个人与眼科医疗服务提供者之间的 ETT。扩大的供给衡量标准包括个体与第二位最近的眼科医生之间 ETT 的差值、个体与最近的眼科医生和最近的视光师之间 ETT 的差值，以及最近的办公室是否只有一位眼科医生接受医疗保险。计算了每个州和城市人口密度的描述性统计数据。
结果
在每个州的 65 岁及以上人群中，10.8%（肯塔基州）至 16.6%（俄克拉荷马州）的人到第二位最近的眼科医生的 ETT 单向超过 15 分钟，比到最近的眼科医生的 ETT 单向长；21.1%（肯塔基州）至 27.6%（俄克拉荷马州）的人到最近的眼科医生的 ETT 单向超过 15 分钟，比到最近的视光师的 ETT 单向长；56.4%（肯塔基州）至 70.0%（俄克拉荷马州）的人在最近的办公室只有一位接受医疗保险的眼科医生。发现结果在城市人口密度上有很大差异。
结论
使用基于出行时间的衡量标准组合可增强对当地眼科医疗服务提供者供给情况的理解。
Zotero 插件