The association between geographic access to providers and the treatment quality of pediatric depression

Navneet Upadhyay, Rajender Aparasu, Paul J. Rowan, Marc Labaron Fleming, Rajesh Balkrishnan, Hua Chen

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To examine the association of geographic access to providers with racial/ethnic variations in treatment quality among youth with depression. Methods: The geographic access to providers who initiated the depression treatment was measured using the travel distance estimated based on Google Maps® and the provider density within a 5-mile radius of each patient residence. Depression treatment quality was measured as treatment engagement, defined as having ≥2 prescriptions or psychotherapy with 2-month following a new depression diagnosis, and treatment completion defined as having ≥8 sessions of psychotherapy within 12 weeks or received ≥84 days of continuous treatment with antidepressants within 114 days following the treatment initiation. Results: The results of multivariate logistic regression analysis have demonstrated that the travel distance to provider was only negatively associated with the treatment engagement of Hispanics (5.0 - 14.9 vs ≤ 4.9 miles: OR=0.74, 95% CI [0.54–0.88]; ≥15 vs ≤ 4.9 miles: OR=0.82, 95% CI [0.56–0.97]), while a higher mental health specialist density was only positively associated with the treatment engagement of Blacks (1.00–1.99 vs < 1.00: OR=1.63, 95% CI [1.03–4.51]; 2.00–4.99 vs < 1.0: OR=2.28, 95% CI [1.21–7.11]). Among those who have engaged in the treatment, travel distance was associated with a lower likelihood of treatment completion in all racial/ethnic groups. Limitations: The study did not account for types of transportation used by patients. Conclusion: Geographic access barriers had a negative association with treatment quality of pediatric depression. Minority children were more sensitive to the barriers than Whites.

Original languageEnglish
Pages (from-to)162-170
Number of pages9
JournalJournal of Affective Disorders
Volume253
DOIs
StatePublished - 15 Jun 2019

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Depression
Pediatrics
Therapeutics
Psychotherapy
Transportation of Patients
Hispanic Americans
Ethnic Groups
Antidepressive Agents
Prescriptions
Mental Health
Logistic Models
Regression Analysis

Keywords

  • Children and adolescents
  • Depression
  • Geographic access
  • Pediatrics
  • Racial disparity

Cite this

Upadhyay, Navneet ; Aparasu, Rajender ; Rowan, Paul J. ; Fleming, Marc Labaron ; Balkrishnan, Rajesh ; Chen, Hua. / The association between geographic access to providers and the treatment quality of pediatric depression. In: Journal of Affective Disorders. 2019 ; Vol. 253. pp. 162-170.
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abstract = "Objective: To examine the association of geographic access to providers with racial/ethnic variations in treatment quality among youth with depression. Methods: The geographic access to providers who initiated the depression treatment was measured using the travel distance estimated based on Google Maps{\circledR} and the provider density within a 5-mile radius of each patient residence. Depression treatment quality was measured as treatment engagement, defined as having ≥2 prescriptions or psychotherapy with 2-month following a new depression diagnosis, and treatment completion defined as having ≥8 sessions of psychotherapy within 12 weeks or received ≥84 days of continuous treatment with antidepressants within 114 days following the treatment initiation. Results: The results of multivariate logistic regression analysis have demonstrated that the travel distance to provider was only negatively associated with the treatment engagement of Hispanics (5.0 - 14.9 vs ≤ 4.9 miles: OR=0.74, 95{\%} CI [0.54–0.88]; ≥15 vs ≤ 4.9 miles: OR=0.82, 95{\%} CI [0.56–0.97]), while a higher mental health specialist density was only positively associated with the treatment engagement of Blacks (1.00–1.99 vs < 1.00: OR=1.63, 95{\%} CI [1.03–4.51]; 2.00–4.99 vs < 1.0: OR=2.28, 95{\%} CI [1.21–7.11]). Among those who have engaged in the treatment, travel distance was associated with a lower likelihood of treatment completion in all racial/ethnic groups. Limitations: The study did not account for types of transportation used by patients. Conclusion: Geographic access barriers had a negative association with treatment quality of pediatric depression. Minority children were more sensitive to the barriers than Whites.",
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The association between geographic access to providers and the treatment quality of pediatric depression. / Upadhyay, Navneet; Aparasu, Rajender; Rowan, Paul J.; Fleming, Marc Labaron; Balkrishnan, Rajesh; Chen, Hua.

In: Journal of Affective Disorders, Vol. 253, 15.06.2019, p. 162-170.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Balkrishnan, Rajesh

AU - Chen, Hua

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AB - Objective: To examine the association of geographic access to providers with racial/ethnic variations in treatment quality among youth with depression. Methods: The geographic access to providers who initiated the depression treatment was measured using the travel distance estimated based on Google Maps® and the provider density within a 5-mile radius of each patient residence. Depression treatment quality was measured as treatment engagement, defined as having ≥2 prescriptions or psychotherapy with 2-month following a new depression diagnosis, and treatment completion defined as having ≥8 sessions of psychotherapy within 12 weeks or received ≥84 days of continuous treatment with antidepressants within 114 days following the treatment initiation. Results: The results of multivariate logistic regression analysis have demonstrated that the travel distance to provider was only negatively associated with the treatment engagement of Hispanics (5.0 - 14.9 vs ≤ 4.9 miles: OR=0.74, 95% CI [0.54–0.88]; ≥15 vs ≤ 4.9 miles: OR=0.82, 95% CI [0.56–0.97]), while a higher mental health specialist density was only positively associated with the treatment engagement of Blacks (1.00–1.99 vs < 1.00: OR=1.63, 95% CI [1.03–4.51]; 2.00–4.99 vs < 1.0: OR=2.28, 95% CI [1.21–7.11]). Among those who have engaged in the treatment, travel distance was associated with a lower likelihood of treatment completion in all racial/ethnic groups. Limitations: The study did not account for types of transportation used by patients. Conclusion: Geographic access barriers had a negative association with treatment quality of pediatric depression. Minority children were more sensitive to the barriers than Whites.

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