Disadvantaged urban children with asthma depend heavily on emergency departments (EDs) for episodic care. We hypothesized that among an urban population of children with asthma, higher spatial accessibility to primary care pediatric services would be associated with (1) more scheduled primary care visits for asthma, (2) better longitudinal asthma management, and (3) fewer unscheduled visits for asthma care.
We enrolled children aged 12 months to 17 years, inclusive, who sought acute asthma care in an urban pediatric ED. Eligibility criteria included a history of unscheduled visits for asthma in the previous year. We collected comprehensive data on each participant's asthma medical management and prior health care utilization. In addition, we calculated each participant's spatial accessibility to primary care pediatric services, reported as a provider-to-population ratio at their place of residence. Patients then were stratified by their spatial accessibility to care and compared with respect to measures of medical management and health care utilization.
Among the 411 eligible participants, the spatial accessibility of primary care ranged from 7.4 to 350.2 full-time pediatric providers per 100,000 children <18 years of age, with a mean of 57.7 +/- 40.0. Patients in the middle and highest tertiles of spatial accessibility made significantly more scheduled visits for asthma care than patients in the lowest tertile. There were no differences among tertiles of accessibility with respect to asthma management or with respect to unscheduled visits for asthma care.
Within this highly urban, largely disadvantaged and minority population of children with chronic asthma, patients with higher spatial accessibility to primary care services made significantly more scheduled visits for asthma care.
"These social influences include service availability and capacity, affordability (and the option of third-party payment), limitations caused by restrictive eligibility criteria and the level of community and social network support for the patient (Kirby, 2008). As Anderson and others (2002) have found, the relative importance of predisposing, need and enabling/impeding factors for healthcare use varies by the health concern and the structure of the health service system in question (Gilbert, Branch, & Longmate, 1993; Kelly et al., 1992; Patrick et al., 1988; Tanner, Cockerham, & Spaeth, 1983). For example, decisions about the utilisation of the dental care system is more likely to be influenced by personal need (e.g. "
[Show abstract][Hide abstract] ABSTRACT: As sex offenders are probated or paroled into the community, sex offender treatment and monitoring is often a condition of their release. In Kentucky, sex offenders are required to participate in community-based treatment for two years or more. However, some sex offenders are disadvantaged in accessing mandated treatment. This is a result of decisions concerning the placement of treatment programmes, the sex offenders’ preference to return to communities where they can rely on family and other indigenous support networks, and some statutes (e.g. sex offender registration and residency restriction laws). This study utilises spatial methodologies, including an origin–destination (OD) matrix, to determine the time, in minutes, that sex offenders travel to sex offender treatment providers and non-spatial ordinary least squares (OLS) regression techniques to determine the association between family, neighbourhood and community characteristics on sex offenders’ travel time to treatment. Findings suggest that there is substantial disadvantage in treatment access, measured by travel time, for sex offenders who live in impoverished rural communities.
Journal of Sexual Aggression 06/2011; 1–17(3-iFirst article). DOI:10.1080/13552600.2011.580064
"Access to care and utilization are major issues in rural and inner-city areas, which experience poorer health care resources. Patients with higher spatial accessibility to primary care services have been found to make significantly more scheduled visits for asthma care, and subsequently fewer urgent care visits (Teach et al., 2006). Inner-city "
[Show abstract][Hide abstract] ABSTRACT: This study examined data from the 2005-2006 National Survey of Children with Special Health Care Needs to assess the relationship among children with asthma between a reported medical home and emergency department (ED) use. The authors used 21 questions to measure 6 medical home components: personal doctor/nurse, family-centered, compassionate, culturally effective and comprehensive care, and effective care coordination. Weighted zero-inflated Poisson regression analyses assessed the independent effects of having a medical home on annual number of child ED visits while controlling for child and parental characteristics, and the differential likelihood of securing a medical home. Nearly half (49.9%) of asthmatic children had a medical home. Receiving primary care in a medical home was associated with fewer ED visits (incidence rate ratio = 0.93; 95% confidence interval = 0.89-0.97). A medical home in which physicians and parents share responsibility for ensuring that children have access to needed services may improve child and family outcomes for children with asthma.
Medical Care Research and Review 05/2010; 67(4):450-75. DOI:10.1177/1077558710367735 · 2.62 Impact Factor
"First, long-time rural dwellers are increasingly working off-farm with regional urban places being the most frequent work destinations [22,23]. For this sub-population of rural people, accessing health care near their workplace may be particularly important because trips are usually scheduled at a convenient time unless the condition is perceived as life threatening . Second, those who move from urban to rural places often retain many of their urban characteristics and so have strong social and economic ties to the urban environment . "
[Show abstract][Hide abstract] ABSTRACT: Rural-urban disparities in health and healthcare are often attributed to differences in geographic access to care and health seeking behavior. Less is known about the differences between rural locations in health care seeking and outcomes. This study examines how commuting patterns in different rural areas are associated with perforated appendicitis.
Controlling for age, sex, insurance type, comorbid conditions, socioeconomic status, appendectomy rates, hospital type, and hospital location, we found that patient residence in a rural ZIP code with significant levels of commuting to metropolitan areas was associated with higher risk of perforation compared to residence in rural areas with commuting to smaller urban clusters. The former group was more likely to seek care in an urbanized area, and was more likely to receive care in a Children's Hospital.
To our knowledge, this is the first study to differentiate rural dwellers with respect to outcomes associated with appendicitis as opposed to simply comparing "rural" to "urban". Risk of perforated appendicitis associated with commuting patterns is larger than that posed by several individual indicators including some age-sex cohort effects. Future studies linking the activity spaces of rural dwellers to individual patterns of seeking care will further our understanding of perforated appendicitis and ambulatory care sensitive conditions in general.
International Journal of Health Geographics 02/2008; 7(1):56. DOI:10.1186/1476-072X-7-56 · 2.62 Impact Factor
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