The impact of geographic accessibility on the intensity and quality of depression treatment

OBJECTIVES. For depression, this research measures the impact of travel tim e on visit frequency and the probability of receiving treatment in concorda nce with AHCPR guidelines. METHODS. The medical, insurance, and pharmacy records of a community-based sample of 435 subjects with current depression were abstracted to identify those treated for depression, to determine the number of depression visits made over a 6-month period, and to ascertain whether treatment was provided in concordance with AHCPR guidelines. A Geographic Information System was used to calculate the travel time from each patient to their preferred prov ider. Poisson and logistic regression analyses were used to estimate the im pact of travel time on visit frequency and guideline-concordance, controlli ng for patient casemix. RESULTS. In the community-based sample, 106 subjects were treated for depre ssion by 105 different preferred providers. About one-third (30.7%) were tr eated by a mental health specialist. One average, patients made 2.8 depress ion visits over the 6-month period. One-third (28.9%) of the patients recei ved guideline-concordant treatment for depression. The average number of vi sits for those receiving guideline-concordant care was significantly greate r than for those not receiving guideline-concordant care (P < 0.01). Travel time to the preferred provider was significantly associated with making fe wer visits (P < 0.0001) and having a lower likelihood of receiving guidelin e-concordant care (P < 0.05). DISCUSSION. For depression, both pharmacotherapy and psychotherapy treatmen t regimens require frequent provider contact to be effective. This study su ggests that travel barriers may prevent rural patients from making a suffic ient number of visits to receive effective guideline-concordant treatment.