PMH41 IMPACT OF GEOGRAPHIC ACCESS TO PROVIDERS ON TREATMENT ENGAGEMENT AND COMPLETION IN PEDIATRIC DEPRESSION POPULATION IN SOUTHEAST TEXAS

Abstract

To examine the impact of geographic access to providers on treatment engagement and treatment completion in children and adolescents with newly diagnosed depression. A retrospective cohort study was conducted in using 2013 to 2016 data from a Medicaid Managed Care plan in Texas. Children and adolescents aged 4-18 years and received depression treatment following an incident depression diagnosis were identified. Treatment engagement was defined as ≥2 visits for psychotherapy or >=2 antidepressant prescriptions. Treatment completion was defined as ≥8 sessions of psychotherapy or 84 days of antidepressants out of 114 days post-the index treatment. Three measures for geographic access to providers were the travel distance to the providers who initiated the treatment; the density of mental health specialists per 10,000 population within a 5-mile circle from the population weighted centroid of each patient’s zip code, and the density of PCPs. 3,472 children and adolescents who met the inclusion criteria were identified. The findings of the multivariable logistic regression analysis showed that travel distance to the provider who initiated the treatment was negatively associated with the likelihood of treatment engagement only among Hispanics (5-15 miles vs. 0-4.9 miles: OR=0.74, 95%CI [0.54-0.88]; >15 miles vs. 0-4.9 mile: OR=0.82, 95%CI [0.56-0.97]). While, the travel distance to the provider who initiated treatment was associated with reduced likelihood of treatment completion in all racial/ethnic groups. Those who lived 15 miles or more away from the provider who initiated the treatment were 22% less likely to complete the treatment than those who traveled less than 5 miles (OR=0.78, 95%CI[0.55-0.93]. Geographic access to providers had a significant effect on both treatment engagement and treatment completion for pediatric depression. As compared to Whites, Hispanics were more sensitive to travel distance to provider and less likely to engage in and complete the treatment.