A Quantitative Analysis of Transportation Equity in Outpatient Clinic Settings
Poster #: 157
Session/Time: B
Author:
Collette Christine Sholi, BS, MS
Mentor:
Julie Sill, PhD
Research Type: Public Health
Abstract
INTRODUCTION:
Healthcare disparities are often fueled by obstacles that patients face outside of healthcare. Transportation equity is a necessary factor to consider when evaluating this topic. Though not always obvious, Social Determinants of Health (SDoH) may impact the availability, reliability, and safety of transportation for medical appointments. This prevents patients from regularly accessing care & negatively impacting long-term population health outcomes. This community based participatory research (CBPR) effort incorporates community member input to investigate how patient transportation to healthcare appointments is impacted by SDoH in HR and highlights the quantitative results of a larger mixed methods project.
METHODS:
Aim: To Identify transportation used for medical appointments for patients in HR and barriers to outpatient healthcare that may be influenced by SDoH. Design: The prospective, CBPR study had a mixed methods convergent design and was implemented over a 6-month period. Eleven team members from EVMS/ODU partnered with community members from the Hampton Roads Community Collaborative (HRCC) to design and implement the study. HRCC team members participated in the design of survey materials, data collection, and dissemination. Inclusion criteria and sampling: The team recruited adults 18 years or older residing within the HR region to complete a community survey on the topic. Convenience sampling was utilized in EVMS/ACC outpatient clinics and at free, local community events in all 7 HR cities. Additionally, recruitment flyers with links to the questionnaire were strategically place in areas of high foot traffic on the EVMS/ACC healthcare campus and at local HR businesses. Data collection: Data was collected over a 6-month period via a 24-item questionnaire. The paper-based survey was also implemented via an electronic QR code in REDCap.
RESULTS:
A total of 252 responses were recorded. Seventy-five % of HRCQ participants reported their most common method of transportation to medical appointments was by car or truck (n=148) and 12.7% reported utilizing medical transport. A weak association noted that patients from Hampton were more likely to take the bus to appointments (r= 0.266 p<0.001) & use medical transportation (r=0.164, p=0.012) as compared to other HR regions. Additionally, patients from Portsmouth were more likely to ride a bike (r=0.130, p=0.047) while patients from Norfolk were more likely to walk to their appointments (r=0.182, p<0.006). When assessing barriers to primary care services, patients from Hampton reported less access to safe transportation (r= -0.201 p=0.004), less access to last minute or same day appointments (r= -0.204 p=0.004) & a lack of reliable transportation to medical appointments (r= -0.165 p=0.018). When evaluating SDoH, there was a weak correlation for Norfolk patients regarding the reliability of healthcare transportation (r= -0.140, p=.045), but they overcame challenges by utilizing the assistance of family or friends (r=0.152 p=0.032).
CONCLUSION:
The quantitative results of the CBPR project highlight that patients from different regions in HR utilize varying methods of transportation & face different barriers when accessing healthcare appointments. Dissemination: Our data points to city-specific interventions to improve transportation for provider office visits to reduce healthcare disparities in HR.
Healthcare disparities are often fueled by obstacles that patients face outside of healthcare. Transportation equity is a necessary factor to consider when evaluating this topic. Though not always obvious, Social Determinants of Health (SDoH) may impact the availability, reliability, and safety of transportation for medical appointments. This prevents patients from regularly accessing care & negatively impacting long-term population health outcomes. This community based participatory research (CBPR) effort incorporates community member input to investigate how patient transportation to healthcare appointments is impacted by SDoH in HR and highlights the quantitative results of a larger mixed methods project.
METHODS:
Aim: To Identify transportation used for medical appointments for patients in HR and barriers to outpatient healthcare that may be influenced by SDoH. Design: The prospective, CBPR study had a mixed methods convergent design and was implemented over a 6-month period. Eleven team members from EVMS/ODU partnered with community members from the Hampton Roads Community Collaborative (HRCC) to design and implement the study. HRCC team members participated in the design of survey materials, data collection, and dissemination. Inclusion criteria and sampling: The team recruited adults 18 years or older residing within the HR region to complete a community survey on the topic. Convenience sampling was utilized in EVMS/ACC outpatient clinics and at free, local community events in all 7 HR cities. Additionally, recruitment flyers with links to the questionnaire were strategically place in areas of high foot traffic on the EVMS/ACC healthcare campus and at local HR businesses. Data collection: Data was collected over a 6-month period via a 24-item questionnaire. The paper-based survey was also implemented via an electronic QR code in REDCap.
RESULTS:
A total of 252 responses were recorded. Seventy-five % of HRCQ participants reported their most common method of transportation to medical appointments was by car or truck (n=148) and 12.7% reported utilizing medical transport. A weak association noted that patients from Hampton were more likely to take the bus to appointments (r= 0.266 p<0.001) & use medical transportation (r=0.164, p=0.012) as compared to other HR regions. Additionally, patients from Portsmouth were more likely to ride a bike (r=0.130, p=0.047) while patients from Norfolk were more likely to walk to their appointments (r=0.182, p<0.006). When assessing barriers to primary care services, patients from Hampton reported less access to safe transportation (r= -0.201 p=0.004), less access to last minute or same day appointments (r= -0.204 p=0.004) & a lack of reliable transportation to medical appointments (r= -0.165 p=0.018). When evaluating SDoH, there was a weak correlation for Norfolk patients regarding the reliability of healthcare transportation (r= -0.140, p=.045), but they overcame challenges by utilizing the assistance of family or friends (r=0.152 p=0.032).
CONCLUSION:
The quantitative results of the CBPR project highlight that patients from different regions in HR utilize varying methods of transportation & face different barriers when accessing healthcare appointments. Dissemination: Our data points to city-specific interventions to improve transportation for provider office visits to reduce healthcare disparities in HR.