Racial/ethnic minority and low-income hotspots and their geographic proximity to integrated care providers

Erick G Guerrero,Dennis Kao

doi:10.1186/1747-597x-8-34

Abstract

BackgroundThe high prevalence of mental health issues among clients attending substance abuse treatment (SAT) has pressured treatment providers to develop integrated substance abuse and mental health care. However, access to integrated care is limited to certain communities. Racial and ethnic minority and low-income communities may not have access to needed integrated care in large urban areas. Because the main principle of health care reform is to expand health insurance to low-income individuals to improve access to care and reduce health disparities among minorities, it is necessary to understand the extent to which integrated care is geographically accessible in minority and low-income communities.MethodsNational Survey of Substance Abuse Treatment Services data from 2010 were used to examine geographic availability of facilities offering integration of mental health services in SAT programs in Los Angeles County, California. Using geographic information systems (GIS), service areas were constructed for each facility (N = 402 facilities; 104 offering integrated services) representing the surrounding area within a 10-minute drive. Spatial autocorrelation analyses were used to derive hot spots (or clusters) of census tracts with high concentrations of African American, Asian, Latino, and low-income households. Access to integrated care was reflected by the hot spot coverage of each facility, i.e., the proportion of its service area that overlapped with each type of hot spot.ResultsGIS analysis suggested that ethnic and low-income communities have limited access to facilities offering integrated care; only one fourth of SAT providers offered integrated care. Regression analysis showed facilities whose service areas overlapped more with Latino hot spots were less likely to offer integrated care, as well as a potential interaction effect between Latino and high-poverty hot spots.ConclusionDespite significant pressure to enhance access to integrated services, ethnic and racial minority communities are disadvantaged in terms of proximity to this type of care. These findings can inform health care policy to increase geographic access to integrated care for the increasing number of clients with public health insurance.

Highlights

The high prevalence of mental health issues among clients attending substance abuse treatment (SAT) has pressured treatment providers to develop integrated substance abuse and mental health care
geographic information systems (GIS) mapping of hot spots Figure 1 shows the geographic distribution of facilities that treat both substance abuse and mental health disorders (104 of 402 SAT facilities)
The geographic distribution of integrated care facilities appears evenly spread throughout Los Angeles County, the map in Figure 2 shows specific hot spots of African American, Asian, and Latino communities with limited access

Summary

Introduction

The high prevalence of mental health issues among clients attending substance abuse treatment (SAT) has pressured treatment providers to develop integrated substance abuse and mental health care. Because the main principle of health care reform is to expand health insurance to low-income individuals to improve access to care and reduce health disparities among minorities, it is necessary to understand the extent to which integrated care is geographically accessible in minority and low-income communities. The substance abuse treatment (SAT) field in the United States faces an unprecedented challenge to reduce health disparities among racial and ethnic minority populations suffering from co-occurring substance abuse and mental health disorders [1,2,3]. Health care reform in the United States, through the Affordable Care Act, will enable states and counties to provide funding and regulation for behavioral health organizations to further develop integrated care services and expand public insurance coverage for low-income and ethnic minority communities. Integrated care service providers may be limited in low-income and racial and ethnic minority communities in which they are highly needed. County and identified the probability of offering integrated care using these communities as main predictive factors

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