Lombardi Brianna, de Saxe Zerden Lisa, Jensen Todd, Galloway Evan, Gaiser Maria
School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB #3550, Chapel Hill, NC, 27599-3550, USA.
Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, 725 Martin Luther King Blvd, Chapel Hill, NC, 27599, USA.
J Behav Health Serv Res. 2025 Jan;52(1):168-179. doi: 10.1007/s11414-024-09897-0. Epub 2024 Jul 25.
This study sought to understand the geographic distribution of three behavioral health clinician (BHC) types in disadvantaged communities in the U.S. across a standardized index of area disadvantage. CMS National Plan and Provider Enumeration System's data were used to identify BHC practice addresses. Addresses were geocoded and mapped to census block groups across Area Disadvantage Index (ADI) scores. Differences in the proportion of BHCs per 100k people in a block group by ADI, clinician type, and rurality were compared. Zero-inflated negative binomial models assessed associations between ADI score with any amount, and expected count, of BHC type in a block group. The sample included 836,780 BHCs (51.5% counselors, 34.5% social workers, 14.0% psychologists). Results indicated there were fewer BHCs in areas of high disadvantage with 351 BHCs in the lowest need versus 267 BHCs in highest need areas, per 100k people. BHC type was differently associated with the rate of clinicians per 100k by ADI and block groups that were both rural and high ADI had the least BHCs located. Findings suggest the maldistribution of BHCs by ADI underscores how some BHCs may be better positioned to meet the needs of vulnerable communities. Increasing access to behavioral health care requires a workforce equitably positioned in high-need areas. Reforms to payment and practice regulations may support BHCs to deliver services in socially disadvantaged neighborhoods.
本研究旨在了解美国弱势社区中三种行为健康临床医生（BHC）类型在标准化地区劣势指数上的地理分布情况。利用医疗保险和医疗补助服务中心（CMS）的国家计划与提供者枚举系统的数据来确定BHC的执业地址。对地址进行地理编码，并根据地区劣势指数（ADI）得分映射到人口普查街区组。比较了按ADI、临床医生类型和农村地区划分的街区组中每10万人中BHC的比例差异。零膨胀负二项式模型评估了ADI得分与街区组中BHC类型的任何数量和预期计数之间的关联。样本包括836,780名BHC（51.5%为咨询师，34.5%为社会工作者，14.0%为心理学家）。结果表明，在劣势程度高的地区，BHC的数量较少，每10万人中，需求最低地区有351名BHC，而需求最高地区有267名BHC。BHC类型与每10万人中临床医生的比例因ADI而存在不同关联，且农村且ADI高的街区组中BHC的数量最少。研究结果表明，BHC按ADI分布不均凸显了一些BHC可能更有能力满足弱势社区的需求。增加行为健康护理的可及性需要一支在高需求地区公平配置的劳动力队伍。支付和执业法规的改革可能会支持BHC在社会弱势社区提供服务。
