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Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families

IMPORTANCE: Military service members and their families have greater mental health care needs compared with their civilian counterparts. Some communities have inadequate access to psychiatrists for this population. OBJECTIVES: To identify geographic variations in the availability of military and civ...

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Autores principales: Bacolod, Marigee, Heissel, Jennifer, Shen, Yu-Chu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9856908/
https://www.ncbi.nlm.nih.gov/pubmed/36595295
http://dx.doi.org/10.1001/jamanetworkopen.2022.49314
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author Bacolod, Marigee
Heissel, Jennifer
Shen, Yu-Chu
author_facet Bacolod, Marigee
Heissel, Jennifer
Shen, Yu-Chu
author_sort Bacolod, Marigee
collection PubMed
description IMPORTANCE: Military service members and their families have greater mental health care needs compared with their civilian counterparts. Some communities have inadequate access to psychiatrists for this population. OBJECTIVES: To identify geographic variations in the availability of military and civilian psychiatrists within a 30-minute driving time of TRICARE (the US military’s health care program) beneficiaries’ communities and compare the likelihood of living in areas with inadequate access to psychiatrists for historically underserved and other communities. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of all zip code communities in the continental US, Hawaii, and Alaska with at least one TRICARE beneficiary between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census to estimate a logistic regression to compare differences between communities with and without a psychiatrist shortage. Data were analyzed from September 2021 to November 2022. MAIN OUTCOMES AND MEASURES: A community’s likelihood of having a shortage of military and civilian psychiatrists within a 30-minute driving time and a community’s likelihood of having no psychiatrists. Odds ratios were calculated to estimate likelihood of the outcomes. RESULTS: This study includes 39 487 unique communities where 13% of the population is Black and 14% of the population is Hispanic. During the study period, 35% of TRICARE beneficiaries lived in communities with a shortage of both military and civilian psychiatrists, and 6% lived in communities with no access to military or civilian psychiatrists. Low-income communities with high income inequality were 1.64 (95% CI, 1.30-2.07) times more likely to have inadequate access to psychiatrists and 2.59 (95% CI, 1.82-3.69) times more likely to have no access to psychiatrists, compared with reference communities (average income without high income inequality); low-income communities without high income inequality were 1.37 (95% CI, 1.05-1.78) times more likely to have inadequate access to psychiatrists and 1.93 (95% CI, 1.28-2.89) times more likely to have no access to psychiatrists. Rural communities were 6.65 (95% CI, 5.09-8.69) times more likely to have inadequate access to psychiatrists than urban communities. CONCLUSIONS AND RELEVANCE: In this cohort study of US communities, 35% of TRICARE beneficiaries lived in communities with inadequate access to psychiatrists. Psychiatric capacity was structurally inequitable along 2 separate dimensions: the income gradient and rurality. Developing targeted strategies for these shortage areas could alleviate disparities.
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spelling pubmed-98569082023-02-03 Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families Bacolod, Marigee Heissel, Jennifer Shen, Yu-Chu JAMA Netw Open Original Investigation IMPORTANCE: Military service members and their families have greater mental health care needs compared with their civilian counterparts. Some communities have inadequate access to psychiatrists for this population. OBJECTIVES: To identify geographic variations in the availability of military and civilian psychiatrists within a 30-minute driving time of TRICARE (the US military’s health care program) beneficiaries’ communities and compare the likelihood of living in areas with inadequate access to psychiatrists for historically underserved and other communities. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of all zip code communities in the continental US, Hawaii, and Alaska with at least one TRICARE beneficiary between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census to estimate a logistic regression to compare differences between communities with and without a psychiatrist shortage. Data were analyzed from September 2021 to November 2022. MAIN OUTCOMES AND MEASURES: A community’s likelihood of having a shortage of military and civilian psychiatrists within a 30-minute driving time and a community’s likelihood of having no psychiatrists. Odds ratios were calculated to estimate likelihood of the outcomes. RESULTS: This study includes 39 487 unique communities where 13% of the population is Black and 14% of the population is Hispanic. During the study period, 35% of TRICARE beneficiaries lived in communities with a shortage of both military and civilian psychiatrists, and 6% lived in communities with no access to military or civilian psychiatrists. Low-income communities with high income inequality were 1.64 (95% CI, 1.30-2.07) times more likely to have inadequate access to psychiatrists and 2.59 (95% CI, 1.82-3.69) times more likely to have no access to psychiatrists, compared with reference communities (average income without high income inequality); low-income communities without high income inequality were 1.37 (95% CI, 1.05-1.78) times more likely to have inadequate access to psychiatrists and 1.93 (95% CI, 1.28-2.89) times more likely to have no access to psychiatrists. Rural communities were 6.65 (95% CI, 5.09-8.69) times more likely to have inadequate access to psychiatrists than urban communities. CONCLUSIONS AND RELEVANCE: In this cohort study of US communities, 35% of TRICARE beneficiaries lived in communities with inadequate access to psychiatrists. Psychiatric capacity was structurally inequitable along 2 separate dimensions: the income gradient and rurality. Developing targeted strategies for these shortage areas could alleviate disparities. American Medical Association 2023-01-03 /pmc/articles/PMC9856908/ /pubmed/36595295 http://dx.doi.org/10.1001/jamanetworkopen.2022.49314 Text en Copyright 2023 Bacolod M et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Bacolod, Marigee
Heissel, Jennifer
Shen, Yu-Chu
Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families
title Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families
title_full Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families
title_fullStr Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families
title_full_unstemmed Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families
title_short Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families
title_sort spatial analysis of access to psychiatrists for us military personnel and their families
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9856908/
https://www.ncbi.nlm.nih.gov/pubmed/36595295
http://dx.doi.org/10.1001/jamanetworkopen.2022.49314
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