Addressing transportation barriers to health care during the COVID-19 pandemic: Perspectives of care coordinators

Oluyede, Lindsay; Cochran, Abigail L.; Wolfe, Mary; Prunkl, Lauren; McDonald, Noreen C.

doi:10.1016/j.tra.2022.03.010

Cited by 46 publications

(31 citation statements)

References 19 publications

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“…However, some patients use public transportation, which may take longer or shorter. 38 , 39 Thus, travel time that accounts for mode of transportation would be a better measure of access to care. However, drive time is more easily captured and can be calculated using administrative data, while capturing travel time data would require surveying patients about modes of transportation and time required.…”

Section: Discussionmentioning

confidence: 99%

Drive Time and Receipt of Guideline-Recommended Screening, Diagnosis, and Treatment

et al. 2022

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ImportanceMany patients do not receive recommended services. Drive time to health care services may affect receipt of guideline-recommended care, but this has not been comprehensively studied.ObjectiveTo assess associations between drive time to care and receipt of guideline-recommended screening, diagnosis, and treatment interventions.Design, Setting, and ParticipantsThis cohort study used administrative data from the National Veterans Health Administration (VA) data merged with Medicare data. Eligible participants were patients using VA services between January 2016 and December 2019. Women ages 65 years or older without underlying bone disease were assessed for osteoporosis screening. Patients with new diagnosis of chronic obstructive pulmonary disease (COPD) indicated by at least 2 encounter codes for COPD or at least 1 COPD-related hospitalization were assessed for receipt of diagnostic spirometry. Patients hospitalized for ischemic heart disease were assessed for cardiac rehabilitation treatment.ExposuresDrive time from each patient’s residential address to the closest VA facility where the service was available, measured using geocoded addresses.Main Outcomes and MeasuresBinary outcome at the patient level for receipt of osteoporosis screening, spirometry, and cardiac rehabilitation. Multivariable logistic regression models were used to assess associations between drive time and receipt of services.ResultsOf 110 780 eligible women analyzed, 36 431 (32.9%) had osteoporosis screening (mean [SD] age, 66.7 [5.4] years; 19 422 [17.5%] Black, 63 403 [57.2%] White). Of 281 130 patients with new COPD diagnosis, 145 249 (51.7%) had spirometry (mean [SD] age, 68.2 [11.5] years; 268 999 [95.7%] men; 37 834 [13.5%] Black, 217 608 [77.4%] White). Of 73 146 patients hospitalized for ischemic heart disease, 11 171 (15.3%) had cardiac rehabilitation (mean [SD] age, 70.0 [10.8] years; 71 217 [97.4%] men; 15 213 [20.8%] Black, 52 144 [71.3%] White). The odds of receiving recommended services declined as drive times increased. Compared with patients with a drive time of 30 minutes or less, patients with a drive time of 61 to 90 minutes had lower odds of receiving osteoporosis screening (adjusted odds ratio [aOR], 0.90; 95% CI, 0.86-0.95) and spirometry (aOR, 0.90; 95% CI, 0.88-0.92) while patients with a drive time of 91 to 120 minutes had lower odds of receiving cardiac rehabilitation (aOR, 0.80; 95% CI, 0.74-0.87). Results were similar in analyses restricted to urban patients or patients whose primary care clinic was in a tertiary care center.Conclusions and RelevanceIn this retrospective cohort study, longer drive time was associated with less frequent receipt of guideline-recommended services across multiple components of care. To improve quality of care and health outcomes, health systems and clinicians should adopt strategies to mitigate travel burden, even for urban patients.

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Section: Discussionmentioning

confidence: 99%

Drive Time and Receipt of Guideline-Recommended Screening, Diagnosis, and Treatment

et al. 2022

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“…Temporary policy changes that expanded telehealth during the COVID-19 pandemic helped reduce transportation-related barriers to receiving certain types of healthcare services such as initial screenings and follow-up appointments. 42 Examples of flexibilities offered during the COVID-19 pandemic included allowances for telehealth services to be provided through commonly used apps and across state lines, expanding Medicare telehealth services, and allowances for billing of telehealth services as if care was provided in person. 43 Permanent policy changes based on lessons learned from the COVID-19 pandemic can continue to support telehealth expansion, which is particularly important for rural communities with limited healthcare accessibility.…”

Section: Discussionmentioning

confidence: 99%

System- and Individual-Level Barriers to Accessing Medical Care Services Across the Rural-Urban Spectrum, Washington State

Graves

Abshire

Alejandro

2022

Health�Serv�Insights

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Background: Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality. Methods: Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design. Results: About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care ( P < .001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality. Conclusions: To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations.

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“…The purpose of these conversation was to gain insights into their experience with telehealth and to have them strategize on what defines an ideal telemedicine program for their needs. Conversations from the one-on-one meetings offer a standardized method for gathering information from multiple respondents, while allowing the flexibility to pursue interesting threads that may arise in conversations [ 20 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…While studies have found that interprofessional interactions between public health and urban planning research is limited, there is a desire for greater collaboration between the fields [ 19 ]. Engaging directly with built environment issues is critical as disruptions to the health and urban systems are likely to reshape access barriers to care today with potential long term implications [ 20 ]. Little is known about how providers are currently using telehealth tools and ways that they may promote healthcare more effectively [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Advancing Access to Healthcare through Telehealth: A Brownsville Community Assessment

Ledesma

Champagne‐Langabeer

2022

Healthcare

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(1) Background: This paper focuses on the development of a community assessment for telehealth using an interprofessional lens, which sits at the intersection of public health and urban planning using multistakeholder input. The paper analyzes the process of designing and implementing a telemedicine plan for the City of Brownsville and its surrounding metros. (2) Methods: We employed an interprofessional approach to CBPR which assumed all stakeholders as equal partners alongside the researchers to uncover the most relevant and useful knowledge to inform the development of telehealth community assessment. (3) Results: Key findings include that: physicians do not have the technology, financial means, or staff to provide a comprehensive system for telemedicine; and due to language and literacy barriers, many patients are not able to use a web-based system of telemedicine. We also found that all stakeholders believe that telehealth is a convenient tool that has the capacity to increase patient access and care. (4) Conclusions: Ultimately, the use of an interprofessional community-based participatory research (CBPR) design allowed our team to bring together local knowledge with that of trained experts to advance the research efforts.

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Addressing transportation barriers to health care during the COVID-19 pandemic: Perspectives of care coordinators

Cited by 46 publications

References 19 publications

Drive Time and Receipt of Guideline-Recommended Screening, Diagnosis, and Treatment

Drive Time and Receipt of Guideline-Recommended Screening, Diagnosis, and Treatment

System- and Individual-Level Barriers to Accessing Medical Care Services Across the Rural-Urban Spectrum, Washington State

Advancing Access to Healthcare through Telehealth: A Brownsville Community Assessment

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