Department of City and Regional Planning, University of North Carolina at Chapel Hill, New East Building, CB# 3140, 223 E Cameron Ave, NC, 27599, Chapel Hill, USA.
Community and Regional Planning Program, College of Architecture, University of Nebraska-Lincoln, 217 Architecture Hall, NE, 68588, Lincoln, USA.
BMC Public Health. 2022 Sep 20;22(1):1783. doi: 10.1186/s12889-022-14149-x.
Transportation problems are known barriers to health care and can result in late arrivals and delayed or missed care. Groups already prone to greater social and economic disadvantage, including low-income individuals and people with chronic conditions, encounter more transportation barriers and experience greater negative health care consequences. Addressing transportation barriers is important not only for mitigating adverse health care outcomes among patients, but also for avoiding additional costs to the health care system. In this study, we investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users.
A web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers.
Approximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18-64, people with disabilities, and people without a household vehicle were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one's ability to access and pay for transportation as well as to personal health.
To address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs.
交通问题是医疗保健的已知障碍，可能导致患者迟到、延迟或错过治疗。已经面临更大的社会和经济劣势的群体，包括低收入个人和患有慢性疾病的人，遇到更多的交通障碍，并经历更大的负面医疗保健后果。解决交通障碍不仅对于减轻患者不良医疗保健结果很重要，而且对于避免医疗保健系统的额外成本也很重要。在这项研究中，我们调查了在 COVID-19 大流行期间，高频率使用医疗保健服务的患者在获得医疗服务时遇到的交通障碍。
我们向 UNC 健康系统中年龄在 18 岁及以上的北卡罗来纳州居民进行了一项基于网络的调查，这些居民参加了医疗补助或医疗保险，并且在过去一年中有至少六次门诊医疗预约。分析了 323 份完整的回复，以调查报告因交通障碍而导致迟到、延迟或错过治疗的发生率，以及人口统计学和其他独立变量与交通障碍之间的关系。对文本回复数据进行了定性分析，以解释交通障碍。
大约 1/3 的受访者在 2020 年 6 月至 2021 年 6 月期间经历过医疗保健交通障碍。多变量逻辑回归表明，18-64 岁的个体、残疾人和没有家庭用车的人更有可能遇到交通障碍。旅行费用和缺乏司机或汽车可用性是主要的交通障碍；然而，受访者解释说，障碍往往很复杂，涉及到与个人获取和支付交通费用以及个人健康相关的环境问题。
为了解决交通障碍，我们建议交通和卫生专业人员之间进行更多的协调，并实施扩大医疗保健机动性服务的获取途径和提高患者意识的计划。我们还建议交通和卫生实体有针对性地分配资源，以公平地解决交通障碍问题，因为障碍不成比例地给年龄在 65 岁以下、参加公共保险计划的年轻成年人带来负担。
