• J Gen Intern Med · Sep 2022

    Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act.

    • Eliana Sullivan, Whitney E Zahnd, Jane M Zhu, Erin Kenzie, Mary Patzel, and Melinda Davis.
    • Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA. sullelia@ohsu.edu.
    • J Gen Intern Med. 2022 Sep 1; 37 (12): 294129472941-2947.

    BackgroundThe 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30 min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans.ObjectiveAssess the extent to which the 2018 MISSION Act facilitates spatial access to primary care for Veterans living in rural versus urban Oregon.DesignWe identified locations of all VA and non-VA primary care clinics in Oregon then calculated 30-min drive-time catchment areas from census tract centroids to the nearest clinics. We compared measures of spatial access to primary care for Veterans in rural, micropolitan, and urban areas.ParticipantsAmerican Community Survey data representing Oregon adults.Main MeasuresTwo measures of spatial access focusing on the number of clinics (supply), and an access index based on the two-step floating catchment area method (2SFCA) which accounts for number of clinics (supply) and population size (demand).Key ResultsCompared to only 13.0% of rural Veterans, 83.6% of urban Veterans lived within 30 min' drive time of VA primary care. Given the MISSION Act's eligibility criteria, 81.6% of rural Veterans and ~ 97% of urban and micropolitan Veterans had spatial access to primary care. When accounting for both supply and demand, rural areas had significantly higher access scores (p < 0.05) compared to urban areas.ConclusionsUsing MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.© 2021. Society of General Internal Medicine.

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