Department of Defense Management, Naval Postgraduate School, Monterey, California.
National Bureau of Economic Research, Cambridge, Massachusetts.
JAMA Netw Open. 2023 Jan 3;6(1):e2249314. doi: 10.1001/jamanetworkopen.2022.49314.
Military service members and their families have greater mental health care needs compared with their civilian counterparts. Some communities have inadequate access to psychiatrists for this population.
To identify geographic variations in the availability of military and civilian psychiatrists within a 30-minute driving time of TRICARE (the US military's health care program) beneficiaries' communities and compare the likelihood of living in areas with inadequate access to psychiatrists for historically underserved and other communities.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of all zip code communities in the continental US, Hawaii, and Alaska with at least one TRICARE beneficiary between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census to estimate a logistic regression to compare differences between communities with and without a psychiatrist shortage. Data were analyzed from September 2021 to November 2022.
A community's likelihood of having a shortage of military and civilian psychiatrists within a 30-minute driving time and a community's likelihood of having no psychiatrists. Odds ratios were calculated to estimate likelihood of the outcomes.
This study includes 39 487 unique communities where 13% of the population is Black and 14% of the population is Hispanic. During the study period, 35% of TRICARE beneficiaries lived in communities with a shortage of both military and civilian psychiatrists, and 6% lived in communities with no access to military or civilian psychiatrists. Low-income communities with high income inequality were 1.64 (95% CI, 1.30-2.07) times more likely to have inadequate access to psychiatrists and 2.59 (95% CI, 1.82-3.69) times more likely to have no access to psychiatrists, compared with reference communities (average income without high income inequality); low-income communities without high income inequality were 1.37 (95% CI, 1.05-1.78) times more likely to have inadequate access to psychiatrists and 1.93 (95% CI, 1.28-2.89) times more likely to have no access to psychiatrists. Rural communities were 6.65 (95% CI, 5.09-8.69) times more likely to have inadequate access to psychiatrists than urban communities.
In this cohort study of US communities, 35% of TRICARE beneficiaries lived in communities with inadequate access to psychiatrists. Psychiatric capacity was structurally inequitable along 2 separate dimensions: the income gradient and rurality. Developing targeted strategies for these shortage areas could alleviate disparities.
与平民相比，军人及其家属有更大的心理健康护理需求。一些社区缺乏为这一人群服务的精神科医生。
确定在距离 TRICARE（美国军方的医疗保健计划）受益人家园 30 分钟车程内，军人和民用精神科医生的可用性在地理上的差异，并比较历史上服务不足和其他社区生活在缺乏精神科医生的地区的可能性。
设计、地点和参与者：这项对美国大陆、夏威夷和阿拉斯加所有邮政编码社区的回顾性队列研究，纳入了 2016 年 1 月 1 日至 2020 年 9 月 30 日期间至少有一名 TRICARE 受益人的社区，该研究结合了国防卫生局、国家计划和提供者登记系统以及美国人口普查的数据，以估计逻辑回归来比较有和没有精神科医生短缺的社区之间的差异。数据于 2021 年 9 月至 2022 年 11 月进行分析。
社区在 30 分钟车程内出现精神科医生短缺的可能性，以及社区没有精神科医生的可能性。计算比值比来估计结果的可能性。
这项研究包括 39487 个独特的社区，其中 13%的人口是黑人，14%的人口是西班牙裔。在研究期间，35%的 TRICARE 受益人生活在军人和民用精神科医生都短缺的社区，6%的受益人生活在没有军人或民用精神科医生的社区。收入不平等程度高的低收入社区获得精神科医生服务不足的可能性是参照社区（无高收入不平等的平均收入）的 1.64 倍（95%CI，1.30-2.07），没有精神科医生服务的可能性是参照社区的 2.59 倍（95%CI，1.82-3.69）；低收入、无高收入不平等的社区获得精神科医生服务不足的可能性是参照社区的 1.37 倍（95%CI，1.05-1.78），没有精神科医生服务的可能性是参照社区的 1.93 倍（95%CI，1.28-2.89）。农村社区获得精神科医生服务不足的可能性是城市社区的 6.65 倍（95%CI，5.09-8.69）。
在这项对美国社区的队列研究中，35%的 TRICARE 受益人生活在精神科医生服务不足的社区。精神科能力在收入梯度和农村地区存在着结构性的不平等。针对这些短缺地区制定有针对性的战略，可以缓解差距。
