Eliana Sullivan1, Whitney E Zahnd2, Jane M Zhu3, Erin Kenzie4, Mary Patzel4, Melinda Davis4,5,6. 1. Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA. sullelia@ohsu.edu. 2. Arnold School of Public Health, Rural & Minority Health Research Center, University of South Carolina, Columbia, SC, USA. 3. Division of General Internal Medicine, Oregon Health & Science University, Portland, OR, USA. 4. Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA. 5. Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA. 6. OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA.
Abstract
BACKGROUND: The 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30 min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans. OBJECTIVE: Assess the extent to which the 2018 MISSION Act facilitates spatial access to primary care for Veterans living in rural versus urban Oregon. DESIGN: We identified locations of all VA and non-VA primary care clinics in Oregon then calculated 30-min drive-time catchment areas from census tract centroids to the nearest clinics. We compared measures of spatial access to primary care for Veterans in rural, micropolitan, and urban areas. PARTICIPANTS: American Community Survey data representing Oregon adults. MAIN MEASURES: Two measures of spatial access focusing on the number of clinics (supply), and an access index based on the two-step floating catchment area method (2SFCA) which accounts for number of clinics (supply) and population size (demand). KEY RESULTS: Compared to only 13.0% of rural Veterans, 83.6% of urban Veterans lived within 30 min' drive time of VA primary care. Given the MISSION Act's eligibility criteria, 81.6% of rural Veterans and ~ 97% of urban and micropolitan Veterans had spatial access to primary care. When accounting for both supply and demand, rural areas had significantly higher access scores (p < 0.05) compared to urban areas. CONCLUSIONS: Using MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.
BACKGROUND: The 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30 min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans. OBJECTIVE: Assess the extent to which the 2018 MISSION Act facilitates spatial access to primary care for Veterans living in rural versus urban Oregon. DESIGN: We identified locations of all VA and non-VA primary care clinics in Oregon then calculated 30-min drive-time catchment areas from census tract centroids to the nearest clinics. We compared measures of spatial access to primary care for Veterans in rural, micropolitan, and urban areas. PARTICIPANTS: American Community Survey data representing Oregon adults. MAIN MEASURES: Two measures of spatial access focusing on the number of clinics (supply), and an access index based on the two-step floating catchment area method (2SFCA) which accounts for number of clinics (supply) and population size (demand). KEY RESULTS: Compared to only 13.0% of rural Veterans, 83.6% of urban Veterans lived within 30 min' drive time of VA primary care. Given the MISSION Act's eligibility criteria, 81.6% of rural Veterans and ~ 97% of urban and micropolitan Veterans had spatial access to primary care. When accounting for both supply and demand, rural areas had significantly higher access scores (p < 0.05) compared to urban areas. CONCLUSIONS: Using MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.
Authors: George G Sayre; Emily L Neely; Carol E Simons; Christine A Sulc; David H Au; P Michael Ho Journal: J Gen Intern Med Date: 2018-07-23 Impact factor: 5.128
Authors: Audrey L Jones; Michael J Fine; Roslyn A Stone; Shasha Gao; Leslie R M Hausmann; Kelly H Burkitt; Peter A Taber; Galen E Switzer; Chester B Good; Megan E Vanneman; Susan L Zickmund Journal: J Gen Intern Med Date: 2019-09 Impact factor: 5.128
Authors: Jan M Eberth; Whitney E Zahnd; Michele J Josey; Mario Schootman; Peiyin Hung; Janice C Probst Journal: Spat Spatiotemporal Epidemiol Date: 2021-03-06
Authors: Michael E Ohl; Margaret Carrell; Andrew Thurman; Mark Vander Weg; Teresa Hudson; Michelle Mengeling; Mary Vaughan-Sarrazin Journal: BMC Health Serv Res Date: 2018-05-29 Impact factor: 2.655
Authors: Amrita N Singh; Victoria Sanchez; Erin S Kenzie; Eliana Sullivan; James L McCormack; Jean Hiebert Larson; Alissa Robbins; Tiffany Weekley; Brigit A Hatch; Caitlin Dickinson; Nancy C Elder; John P Muench; Melinda M Davis Journal: PLoS One Date: 2022-06-28 Impact factor: 3.752