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Hauschild MH, Wren TAL, Chavez M, Omar H, Goldstein RY. Transportation Barriers in Pediatric Orthopaedic Clinic Visits. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202409000-00004. [PMID: 39254588 PMCID: PMC11387042 DOI: 10.5435/jaaosglobal-d-24-00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVES To identify what transportation barriers pediatric patients face when traveling to a major metropolitan orthopaedic center, how these barriers affect care, and what changes can be made to address this issue. STUDY DESIGN A cross-sectional transportation survey was administered to 107 caregivers of patients being seen in the orthopaedic clinic at a tertiary children's hospital in a large metropolitan area. Using logistic regression analysis, we compared socioeconomic characteristics, transportation methods, and scheduling practices among caregivers who reported missing at least one visit in the past and those who reported never missing a visit. RESULTS 13% (14/108) of caregivers reported missing one or more past visits due to late arrival or transportation issues. Families that traveled more than 45 minutes to clinic (P = 0.04), waited more than one week to schedule a visit (P = 0.002), or reported difficulty scheduling a visit (P = 0.02) were significantly more likely to have a history of nonattendance. In addition, patients who were nonambulatory (P = 0.007), used a mobility device (P = 0.007), or were non-White (P < 0.05) were significantly more likely to have missed a visit. CONCLUSION Travel time, difficult or delayed scheduling, and patient ambulatory status were all associated with missing orthopaedic clinic visits although other socioeconomic factors were not related. Interventions to improve orthopaedic clinic attendance should focus on promoting accessibility for patients with mobility limitations and encouraging simple and timely scheduling practices.
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Affiliation(s)
- Maia H Hauschild
- From the Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA
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Schweiberger K, Hoberman A, Iagnemma J, Schoemer P, White GE, Wolfson D, Ray KN. Pediatric Primary Care Clinicians' Perspectives on Telemedicine Use, 2020 Versus 2021. Telemed J E Health 2024; 30:e1927-e1934. [PMID: 38621152 DOI: 10.1089/tmj.2023.0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Objective: We examined the change in pediatric primary care clinician attitudes and perceptions about telemedicine after one year of telemedicine use. Methods: We administered a survey to pediatric primary care clinicians across 50 primary care practices in Pennsylvania in 2020 and 2021. Surveys were linked using a combination of deterministic and probabilistic matching. We used McNemar's test to compare change in responses from 2020 to 2021. Results: Among pediatric primary care clinicians surveyed in 2020 and 2021 (n = 101), clinicians agreed that telemedicine could always or usually deliver high-quality care for mental health (80% in 2020 and 78% in 2021), care coordination (77% in 2020 and 70% in 2021), acute care (33% in 2020 and 34% in 2021), or preventive care (25% in 2020 and 18% in 2021) and this did not significantly change. Clinician perceptions of usability, while high, declined over time with fewer endorsing ease of use (93% in 2020 and 80% in 2021) and reliability (14% in 2020 and 0% in 2021) over time. Despite this, 62% of clinicians agreed that they were satisfied with their use of telemedicine at both time points. Respondents anticipated positive impact on equity and timeliness of care from telemedicine use but did not anticipate positive impact across child health, health care delivery, or clinician experience. Perceptions across these domains did not change over time. Conclusions: With one year of telemedicine experience, primary care clinicians maintained beliefs that telemedicine could deliver high-quality care for specific clinical needs but had worsening perceptions of usability over time.
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Affiliation(s)
- Kelsey Schweiberger
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alejandro Hoberman
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Children's Community Pediatrics, Wexford, Pennsylvania, USA
| | | | - Pamela Schoemer
- UPMC Children's Community Pediatrics, Wexford, Pennsylvania, USA
| | - Gretchen E White
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David Wolfson
- UPMC Children's Community Pediatrics, Wexford, Pennsylvania, USA
| | - Kristin N Ray
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Children's Community Pediatrics, Wexford, Pennsylvania, USA
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Volerman A, Carlson B, Wan W, Murugesan M, Asfour N, Bolton J, Chin MH, Sripipatana A, Nocon RS. Utilization, quality, and spending for pediatric Medicaid enrollees with primary care in health centers vs non-health centers. BMC Pediatr 2024; 24:100. [PMID: 38331758 PMCID: PMC10851548 DOI: 10.1186/s12887-024-04547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Limited research has explored the performance of health centers (HCs) compared to other primary care settings among children in the United States. We evaluated utilization, quality, and expenditures for pediatric Medicaid enrollees receiving care in HCs versus non-HCs. METHODS This national cross-sectional study utilized 2012 Medicaid Analytic eXtract (MAX) claims to examine children 0-17 years with a primary care visit, stratified by whether majority (> 50%) of primary care visits were at HCs or non-HCs. Outcome measures include utilization (primary care visits, non-primary care outpatient visits, prescription claims, Emergency Department (ED) visits, hospitalizations) and quality (well-child visits, avoidable ED visits, avoidable hospitalizations). For children enrolled in fee-for-service Medicaid, we also measured expenditures. Propensity score-based overlap weighting was used to balance covariates. RESULTS A total of 2,383,270 Medicaid-enrolled children received the majority of their primary care at HCs, while 18,540,743 did at non-HCs. In adjusted analyses, HC patients had 20% more primary care visits, 15% less non-primary care outpatient visits, and 21% less prescription claims than non-HC patients. ED visits were similar across the two groups, while HC patients had 7% lower chance of hospitalization than non-HC. Quality of care outcomes favored HC patients in main analyses, but results were less robust when excluding managed care beneficiaries. Total expenditures among the fee-for-service subpopulation were lower by $239 (8%) for HC patients. CONCLUSIONS In this study of nationwide claims data to evaluate healthcare utilization, quality, and spending among Medicaid-enrolled children who receive primary care at HCs versus non-HCs, findings suggest primary care delivery in HCs may be associated with a more cost-effective model of healthcare for children.
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Affiliation(s)
- Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Bradley Carlson
- University of Chicago Pritzker School of Medicine, 924 E 57th St, Chicago, IL, 60637, USA
| | - Wen Wan
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Manoradhan Murugesan
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Nour Asfour
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Joshua Bolton
- Health Resources and Services Administration (Affiliation at Time Research Conducted), 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Marshall H Chin
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Alek Sripipatana
- Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Robert S Nocon
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA, 91101, USA
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Labban M, Chen CR, Frego N, Nguyen DD, Lipsitz SR, Reich AJ, Rebbeck TR, Choueiri TK, Kibel AS, Iyer HS, Trinh QD. Disparities in Travel-Related Barriers to Accessing Health Care From the 2017 National Household Travel Survey. JAMA Netw Open 2023; 6:e2325291. [PMID: 37498602 PMCID: PMC10375305 DOI: 10.1001/jamanetworkopen.2023.25291] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Importance Geographic access, including mode of transportation, to health care facilities remains understudied. Objective To identify sociodemographic factors associated with public vs private transportation use to access health care and identify the respondent, trip, and community factors associated with longer distance and time traveled for health care visits. Design, Setting, and Participants This cross-sectional study used data from the 2017 National Household Travel Survey, including 16 760 trips or a nationally weighted estimate of 5 550 527 364 trips to seek care in the United States. Households that completed the recruitment and retrieval survey for all members aged 5 years and older were included. Data were analyzed between June and August 2022. Exposures Mode of transportation (private vs public transportation) used to seek care. Main Outcomes and Measures Survey-weighted multivariable logistic regression models were used to identify factors associated with public vs private transportation and self-reported distance and travel time. Then, for each income category, an interaction term of race and ethnicity with type of transportation was used to estimate the specific increase in travel burden associated with using public transportation compared a private vehicle for each race category. Results The sample included 12 092 households and 15 063 respondents (8500 respondents [56.4%] aged 51-75 years; 8930 [59.3%] females) who had trips for medical care, of whom 1028 respondents (6.9%) were Hispanic, 1164 respondents (7.8%) were non-Hispanic Black, and 11 957 respondents (79.7%) were non-Hispanic White. Factors associated with public transportation use included non-Hispanic Black race (compared with non-Hispanic White: adjusted odds ratio [aOR], 3.54 [95% CI, 1.90-6.61]; P < .001) and household income less than $25 000 (compared with ≥$100 000: aOR, 7.16 [95% CI, 3.50-14.68]; P < .001). The additional travel time associated with use of public transportation compared with private vehicle use varied by race and household income, with non-Hispanic Black respondents with income of $25 000 to $49 999 experiencing higher burden associated with public transportation (mean difference, 81.9 [95% CI, 48.5-115.3] minutes) than non-Hispanic White respondents with similar income (mean difference, 25.5 [95% CI, 17.5-33.5] minutes; P < .001). Conclusions and Relevance These findings suggest that certain racial, ethnic, and socioeconomically disadvantaged populations rely on public transportation to seek health care and that reducing delays associated with public transportation could improve care for these patients.
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Affiliation(s)
- Muhieddine Labban
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Nicola Frego
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - David-Dan Nguyen
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amanda J Reich
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Rebbeck
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Epidemiology and Zhu Family Center for Global Cancer Prevention, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hari S Iyer
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Maness P, Tumin D, Cholera R, Collier DN, Bonilla-Hernandez L, Lazorick S. Ethnicity and trends in pediatric specialty care clinic attendance at an academic medical center in the rural southeastern US. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001816. [PMID: 37053141 PMCID: PMC10101378 DOI: 10.1371/journal.pgph.0001816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
Following the 2016 US Presidential election, immigration enforcement became more aggressive, with variation by state and region depending on local policies and sentiment. Increases in enforcement created an environment of risk for decreased use of health care services among especially among Latino families. of Hispanic ethnicity and/or from Latin American origin (as a group subsequently referred to as Latino). For Latino children with chronic health conditions, avoidance of routine health care can result in significant negative health consequences such as disease progression, avoidable use of acute health care services, and overall increased costs of care. To investigate for changes in visit attendance during the periods before and since increased immigration enforcement, we extracted data on children followed by subspecialty clinics of one healthcare system in the US state of North Carolina during 2015-2019. For each patient, we calculated the proportion of cancelled visits and no-show visits out of all scheduled visits during the 2016-2019 follow-up period. We compared patient characteristics (at the 2015 baseline) according to whether they cancelled or did not show to any visits in subsequent years by clinic and patient factors, including ethnicity. Data were analyzed using multinomial logistic regression of attendance at each visit, including an interaction between visit year and patient ethnicity. Among 852 children 1 to 17 years of age (111 of Latino ethnicity), visit no-show was more common among Latino patients, compared to non-Latino White patients; while visit cancellation was more common among non-Latino White patients, compared to Latino patients. There was no significant interaction between ethnicity and trends in visit no-show or cancellation. Although differences in pediatric specialty clinic visit attendance by patient ethnicity were seen at study baseline, changing immigration policy and negative rhetoric did not appear to impact use of pediatric subspecialty care.
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Affiliation(s)
- Philip Maness
- Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
| | - Rushina Cholera
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - David N. Collier
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
| | - Luisa Bonilla-Hernandez
- Pediatrics Residency Program, Vidant Medical Center and East Carolina University, Greenville, North Carolina, United States of America
| | - Suzanne Lazorick
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
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Schweiberger K, Verma R, Faulds S, Jonassaint CR, White GE, Ray KN. Scheduled and attended pediatric primary care telemedicine appointments during COVID-19. Pediatr Res 2023:10.1038/s41390-023-02481-w. [PMID: 36690746 PMCID: PMC9869302 DOI: 10.1038/s41390-023-02481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND The aim of this study was to examine pediatric primary care telemedicine visit scheduling and attendance during the first year of telemedicine. METHODS Using electronic health record data from two academic pediatric primary care practices between April 2020-March 2021, we used Pearson χ2 tests and logistic regression models to identify child-, family-, and appointment-level characteristics associated with scheduled and attended telemedicine appointments. RESULTS Among 5178 primary care telemedicine appointments scheduled during the 12-month period, the proportion of appointments scheduled differed over time for children in families with a language preference other than English or Spanish (4% quarter 1 vs. 6% in quarter 4, p = 0.01) and residing in ZIP codes with the lowest household technology access (24% in quarter 1 vs. 19% in quarter 3 (p = 0.01). Four thousand one hundred and forty-eight of 5178 scheduled telemedicine appointments were attended. Likelihood of attending a telemedicine appointment was highest for children in families with a language preference other than English or Spanish (90%, 95% CI 86-94% compared to Spanish 74%, 95% CI 65-84%), and same-day appointments (86%, 95% CI 85-87%). Attendance among families preferring Spanish language was higher in later months compared to earlier months. CONCLUSIONS We found disparities in scheduling and attending telemedicine appointments, but signs of greater language equity over time.
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Affiliation(s)
- Kelsey Schweiberger
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Avenue, CHOB 1st Floor, Pittsburgh, PA, 15213, USA.
| | - Rhea Verma
- grid.21925.3d0000 0004 1936 9000Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Avenue, CHOB 1st Floor, Pittsburgh, PA 15213 USA
| | - Samantha Faulds
- grid.21925.3d0000 0004 1936 9000Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Avenue, CHOB 1st Floor, Pittsburgh, PA 15213 USA
| | - Charles R. Jonassaint
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213 USA
| | - Gretchen E. White
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213 USA
| | - Kristin N. Ray
- grid.21925.3d0000 0004 1936 9000Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Avenue, CHOB 1st Floor, Pittsburgh, PA 15213 USA
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Response to Comment on: "The Influence of Timing of Reporting and Clinic Presentation on Concussion Recovery Outcomes: A Systematic Review and Meta-Analysis". Sports Med 2021; 52:429-430. [PMID: 34609714 DOI: 10.1007/s40279-021-01554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
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Which patients miss appointments with general practice and the reasons why: a systematic review. Br J Gen Pract 2021; 71:e406-e412. [PMID: 33606660 PMCID: PMC8103926 DOI: 10.3399/bjgp.2020.1017] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Missed GP appointments have considerable time and cost implications for healthcare services. Aim This systematic review aims to explore the rate of missed primary care appointments, what the reported reasons are for appointments being missed, and which patients are more likely to miss appointments. Design and setting This study reports the findings of a systematic review. The included studies report the rate or reasons of missed appointments in a primary care setting. Method Databases were searched using a pre-defined search strategy. Eligible studies were selected for inclusion based on detailed inclusion criteria through title, abstract, and full text screening. Quality was assessed on all included studies, and findings were synthesised to answer the research questions. Results A total of 26 studies met the inclusion criteria for the review. Of these, 19 reported a rate of missed appointments. The mean rate of missed appointments was 15.2%, with a median of 12.9%. Twelve studies reported a reason that appointments were missed, with work or family/childcare commitments, forgetting the appointment, and transportation difficulties most commonly reported. In all, 20 studies reported characteristics of people likely to miss appointments. Patients who were likely to miss appointments were those from minority ethnicity, low sociodemographic status, and younger patients (<21 years). Conclusion Findings from this review have potential implications for targeted interventions to address missed appointments in primary care. This is the first step for clinicians to be able to target interventions to reduce the rate of missed appointments.
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Kroshus E, Qu P, Chrisman SP, Schwien C, Herring SA, Rivara FP. Parental concern about concussion risk for their children. Soc Sci Med 2019; 222:359-366. [DOI: 10.1016/j.socscimed.2018.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/12/2018] [Accepted: 12/24/2018] [Indexed: 01/07/2023]
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Cooper MT, Campbell J, Dileki N, Darden P. Access to Care for Children under five in Oklahoma: a Geographic Imputation Application. THE JOURNAL OF THE OKLAHOMA STATE MEDICAL ASSOCIATION 2018; 111:784-789. [PMID: 31289409 PMCID: PMC6615749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Geographic access to primary care can be a barrier to receiving appropriate preventative services. Oklahoma has been identified as having relatively few primary care providers per capita to care for its population compared to the US. The goal of this analysis was to identify the areas in Oklahoma with significant concentrations of children under five, no pediatrician within reasonable driving distance, and whether other primary care providers are present. METHODS The 2016 American Community Survey was used to estimate the total population of children under five years of age for each Census Block Group in Oklahoma. Access was defined as a thirty-minute drive time radius computed around each child's imputed location. The National Provider Identifier database was used to identify and locate pediatricians, family medicine physicians, and mid-level providers in Oklahoma. Areas of high concentrations of children with no pediatrician access were identified and non-pediatrician provider locations were superimposed. RESULTS Of the estimated 265,818 children under five in Oklahoma, approximately 7% were outside of a thirty-minute drive from a pediatrician. These children are concentrated in northwestern and southeastern Oklahoma, with several smaller additional groupings. There are multiple non-pediatrician primary care providers operating in many of these areas. CONCLUSION There are areas in the state where a paucity of pediatricians and high concentrations of young children lend themselves to collaborations using technology and education to improve the care of children.
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Affiliation(s)
- M. Townsend Cooper
- University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, OK USA
| | - Janis Campbell
- University of Oklahoma Health Sciences Center, Department of Biostatics and Epidemiology, Oklahoma City, OK USA
| | - Naci Dileki
- Center for Spatial Analysis, University of Oklahoma, Department of Geography and Environmental Sustainability, Norman, OK USA
| | - Paul Darden
- University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, OK USA
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Boozary AS, Shojania KG. Pathology of poverty: the need for quality improvement efforts to address social determinants of health. BMJ Qual Saf 2018; 27:421-424. [PMID: 29511090 DOI: 10.1136/bmjqs-2017-007552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Andrew S Boozary
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Kaveh G Shojania
- Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada
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