Spatial Accessibility
2023-5-12
2SVCA: Disparities in spatial accessibility of primary care in Louisiana: From physical to virtual accessibility
telehealth accessibility
Abstract:
Telehealth has been widely employed and has transformed how healthcare is delivered in the United States as a result of COVID-19 pandemic. While telehealth is utilized and encouraged to reduce the cost and travel burden for access to healthcare, there are debates on whether telehealth can promote equity in healthcare services by narrowing the gap among diverse groups. Using the Two-Step Floating Catchment Area (2SFCA) and Two-Step Virtual Catchment Area (2SVCA) methods, this study compares the disparities of physical and virtual access to primary care physicians (PCPs) in Louisiana. Both physical and virtual access to PCPs exhibit similar spatial patterns with higher scores concentrated in urban areas, followed by low-density and rural areas. However, the two accessibility measures diverge where broadband availability and affordability come to play an important role. Residents in rural areas experience additive disadvantage of even more limited telehealth accessibility than physical accessibility due to lack of broadband service provision. Areas with greater Black population proportions tend to have better physical accessibility, but such an advantage is eradicated for telehealth accessibility because of lower broadband subscription rates in these neighborhoods. Both physical and virtual accessibility scores decline in neighborhoods with higher Area Deprivation Index (ADI) values, and the disparity is further widened for in virtual accessibility compared to than physical accessibility. The study also examines how factors such as urbanicity, Black population proportion, and ADI interact in their effects on disparities of the two accessibility measures.
Keywords: two-step floating catchment area (2SFCA) method, two-step virtual catchment area (2SVCA) method, telehealth access, broadband availability, broadband affordability, primary care disparity, Louisiana
Summary:
- Study examines disparities in spatial accessibility to primary care physicians (PCPs) in Louisiana
- Measures physical accessibility via visits using Two-Step Floating Catchment Area (2SFCA) method
- Measures virtual accessibility via telehealth using refined Two-Step Virtual Catchment Area (2SVCA) method
- Physical accessibility higher in urban areas, lower in rural areas
- Virtual accessibility exhibits similar pattern but more sporadic due to broadband availability and affordability
- Physical accessibility increases with higher Black population percentage
- Virtual accessibility shows no clear trend by Black population percentage
- Both physical and virtual accessibility decline with higher Area Deprivation Index (ADI)
- Rural-urban and ADI disparities wider for virtual vs. physical accessibility
- Virtual accessibility disadvantage greatest for rural areas
Study questions and answers:
| Study Questions | Answers |
|---|---|
| What two types of spatial accessibility were examined? | Physical accessibility via visits and virtual accessibility via telehealth |
| How was physical accessibility measured? | Using Two-Step Floating Catchment Area (2SFCA) method |
| How was virtual accessibility measured? | Using refined Two-Step Virtual Catchment Area (2SVCA) method |
| How did physical accessibility vary by geography? | Higher in urban areas, lower in rural areas |
| How did virtual accessibility vary by geography? | Similar pattern but more sporadic due to broadband issues |
| How did physical accessibility vary by race? | Increased with higher Black population percentage |
| How did virtual accessibility vary by race? | No clear trend by Black population percentage |
| How did both measures vary by ADI? | Declined with higher ADI (more disadvantaged) |
| How did rural-urban disparities differ between measures? | Wider for virtual vs. physical accessibility |
| Which areas had greatest virtual accessibility disadvantage? | Rural areas |