Abstract
Behavioral Health (BH) screening is critical for early diagnosis and treatment of pediatric mental disorders. The objective of this study was to assess the impact of geographic access to primary care providers (PCP) on pediatric BH screening in children with different race/ethnicity. A retrospective cohort study was conducted using the 2013–2016 administrative claims data from a large pediatric Medicaid Managed Care Plan that have been linked to 2010 US Census data and the 2017 National Provider Identifier (NPI) Registry. Geographic access was defined as the actual travel distance to nearest PCP and the PCP density within 10-mile travel radius from each individual's residence. Stratified multivariate logistic regression was conducted to examine the association between the geographic access to PCP and the likelihood of receiving screening for behavioral disorders within each racial/ethnic group. BH screening rate was 12.6% among 402,655 children and adolescents who met the inclusion criteria. Multivariable analysis stratified by individual race/ethnicity revealed that Hispanic and Black children were more vulnerable to the geographic access barriers than their non-Hispanic White counterparts. The increase in travel distance to the nearest PCP was negatively associated with screening uptake only among Hispanics (10–20 miles vs. 0–10 miles: OR = 0.78, 95% CI [0.71–0.86]; 20–30 miles vs. 0–10 miles: OR = 0.35, 95% CI [0.23–0.54]). In a subgroup that had access to at least one PCP within 10 miles of travel distance, the variation in PCP density had a greater impact on the screening uptake among Hispanics and Blacks than that in non-Hispanic Whites.
Highlights
To assess the impact of geographic access to primary care providers (PCPs) on the receipt of behavioral disorder screening among children and adolescents from different racial/ethnic groups
Geographical distribution of providers and health care facilities are strongly associated with the race/ethnicity and socioeconomic status.[15]. Individual with similar race/ethnicity and economic status tends to live together; in turn, clusters of minorities living in poor neighborhood can be observed in all major metropolitan areas in the United States.[15]. Minorities living in poor neighborhoods often have lesser travel means, access to non-existent or inconsistent public transport system and lesser time flexibility.[16,17,18] Combined with the sparser availability of providers in these neighborhoods, geographic access to providers could potentially affect minorities more than whites.[15, 19] To test this hypothesis, the objective of our study was to investigate the impact of geographic access to PCP on odds of receiving behavioral health screening among pediatric population across race/ethnicity
Of the children and adolescents identified, 61.7% were Hispanics, 75.8% were between ages of 7-18 years, 50.7% were male, and 83.0% were below poverty level
Summary
[9, 10] The association of geographic access to primary care providers (PCPs) with pediatric behavior disorder screening is yet to be examined. Minorities living in poor neighborhoods often have lesser travel means, access to non-existent or inconsistent public transport system and lesser time flexibility.[16,17,18] Combined with the sparser availability of providers in these neighborhoods, geographic access to providers could potentially affect minorities more than whites.[15, 19] To test this hypothesis, the objective of our study was to investigate the impact of geographic access to PCP on odds of receiving behavioral health screening among pediatric population across race/ethnicity
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