Impact of Barriers on Access to Health Care In Socorro County, New Mexico 公开
McNeil, Carrie Susan (2012)
Abstract
Abstract
Purpose: This study evaluates the impact of barriers to
accessing health care within a
poor, rural, tri-cultural New Mexico county. Specifically, the
effect of barriers and
demographics on whether a person (1) has a primary doctor, (2)
seeks routine care,
(3) rates health as fair or poor, and (4) experiences above average
days with mental
health symptoms, or (5) above average days with activities limited
by mental health.
Methods: Predictive models for the above 5 outcomes were
developed using SUDAAN
to evaluate data adjusted for post-stratification weighting; data
had been collected by
participants (n=835) in a county-wide health needs assessment in
2011.
Results: Indicators related to poverty and rural residence
were positive predictors for
reduced use of health services and for reporting a poorer health
status. Respondents
citing cost as barrier to accessing care had increased odds of not
having a doctor (OR
1.75 (1.16-2.63)) and of reporting poor health status (OR 1.59
(1.01-2.50)). Those with
annual household incomes below $20,000 had higher odds of reporting
increased
days with mental health symptoms (OR 1.35 (0.93-1.94)), poor health
(OR 1.47
(0.95-2.33)), and not seeking routine care last year (OR 1.47
(1.01-2.17)). Reporting
distance as a barrier to accessing care increased the odds a
respondent also reported
poor health status (OR 1.89 (1.11-3.13)) and/or above average
number of days in
which activities were limited by overall health (OR 1.73
(1.07-2.80)). Additional
significant predictors for the models included differences in
ethnicity, having
children in the household and identifying clinic hours and
citizenship concerns as
barriers to accessing healthcare.
Conclusions: In this study, demographics and barriers
related to being rural and poor
increased the chances that a person lacks a doctor or regular
healthcare. Living in
poverty and/or outside of the main city also increased the odds a
person had poor
health status.
Table of Contents
Table of Contents
Introduction
.........................................................................................................................
1
Methods
..............................................................................................................................
6
Data Source and Collection Methodology
......................................................................
6
Data Analysis
..................................................................................................................
8
Results
................................................................................................................................10
Demographics
................................................................................................................
11
Model 1: Persons Having or Not Having at Least One Primary Care
Doctor ................ 14
Model 2: Persons Having Not Seen a Provider for Routine Care within
1 Year ............ 16
Model 3: Self-Reported State of Health
.........................................................................
18
Model 4: Number of Days with Mental Health Symptoms
........................................... 21
Model 5: Reported Number of Days with Activity Limited due to
Mental and/or
Physical Health Issues
..................................................................................................
22
Discussion
.........................................................................................................................
24
Model 1
..........................................................................................................................
24
Model 2
.........................................................................................................................
26
Model 3
.........................................................................................................................
28
Model 4
.........................................................................................................................
30
Model 5
..........................................................................................................................
31
Conclusions
.......................................................................................................................
32
Demographic Differences in Access to Care and Status of Health
............................... 32
Impact of Being Rural and Poor on Accessing Care and Health Status
....................... 33
Appendix 1: Maps
.............................................................................................................
36
Map 1: Socorro County location in the Southwestern Quadrant of New
Mexico ......... 36
Map 2: Sampling Sites for the 2011 Socorro County Community
Needs Assessment . 37
Appendix 2: Survey Questions from 2011 Socorro County CNA
...................................... 38
References
.........................................................................................................................
40
List of Tables
Table 1. Ethnicity, Poverty and Population Density for Socorro
County, New Mexico and
the United States
.....................................................................................................
4
Table 2. Socorro County Health Indicators Compared to New Mexico
and U.S. ............... 4
Table 3. Distances from Study Sites to PSGH and Albuquerque
Hospitals ....................... 4
Table 4. Post-stratified Weights Based On Sampling Conducted in the
Socorro County
2011 Community Needs Assessment Samples
........................................................ 8
Table 5. Model Outcomes and Potential Predictive Variables
..........................................10
Table 6. Respondent Age, Income, Number of Kids in Household and
Smoking by
Location of Residence [% (SE)]
.............................................................................
12
Table 7. Reported Barriers to Accessing Healthcare by Location of
Residence [% (SE)] . 13
Table 8. Reported Barriers to Accessing Healthcare by Gender, by
Income & for Persons
over 65 Years Old [% (SE)]
....................................................................................
13
Table 9. Outcome 1: Whether or Not Respondent Has At Least 1
Regular Doctor ........... 14
Table 10. Outcome 1: Determinants of Whether Respondent Does
Not Have a Regular
Doctor
....................................................................................................................
16
Table 11. Percent of Respondents Who Had or Had Not Seen Doctor for
Routine Care
within Past Year [% (SE)]
......................................................................................
17
Table 12. Outcome 2: Determinants of Whether Respondent Did
Not See Provider for
Routine Care Within 1 Year
...................................................................................
18
Table 13. Reported State of Health by Location, Income and Gender
[% (SE)] ............... 19
Table 14. Outcome 3: Determinants of Self-Reported Poor to Fair
Health ..................... 20
Table 15. Average Number of Days during Past 30 Days with Mental
Health Symptoms
and/or Activity Limited by Physical-Mental Health Issues
.................................. 21
Table 16. Outcome 4: Determinants of Higher Number of Days with
Mental Health
Symptoms than State Average
..............................................................................
22
Table 17. Determinants of Having More Days Limited by Physical
and/or Mental Health
than Expected Based on State Average
.................................................................
23
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