The nation’s Test to Treat sites, a Biden Administration initiative to connect marginalized communities to COVID-19 testing and treatments like Paxlovid, have a geographic care access barrier problem, with 15 percent of Americans living at least an hour-long drive away from the nearest facility.
The care access barriers are also carving out rural-urban disparities, with more rural dwellers facing long drives to the Test to Treat sites, researchers wrote in JAMA Network Open.
These findings come as the US grapples with disparities in COVID-19 treatment access. Previous research from the CDC has revealed differences in Paxlovid access that fall along racial lines, with White patients being more likely to get a prescription than Black or Hispanic patients.
This latest study showed that geography, too, can sully attempts to connect marginalized folks to care. The Test to Treat program, an initiative out of the Biden Administration, seeks to collocate COVID-19 testing and treatment access by allowing pharmacists to prescribe Paxlovid to high-risk individuals testing positive for the virus.
The researchers, hailing from Brigham and Women’s Hospital, the University of Virginia School of Medicine, and the University of Pittsburgh, assessed the locations of the 2,227 unique Test to Treat sites that had been listed on the healthdata.gov website by May 4, 2022. From there, they calculated the shortest travel time required from the population center of every census tract to get to one of the 10 closest sites. They also stratified the data by demographic subgroup.
Overall, 15 percent of the US population lives at least an hour’s drive away from a Test to Treat location. When zooming in on rural populations in particular, 59 percent live more than a 60-minute drive to the closest site.
Notably, some already high-risk populations are more likely to live far away from Test to Treat sites than the typical American. Nearly 1 in 5 of the elderly (17 percent) live a 60-minute drive from sites, while 30 percent of American Indian and Alaska Native people also live about an hour away. That finding was particularly salient after accounting for rurality among AI/AN people.
“There are clear disparities in spatial access to Test to Treat sites, most notably in several communities which have experienced worse outcomes throughout the pandemic,” lead author Rohan Khazanchi, MD, MPH, a resident in the Brigham’s Internal Medicine-Pediatrics Residency Program, stated publicly. “These findings challenge us to consider what opportunities exist for strategic placement of Test to Treat sites in closer proximity to the communities that may need this program most.”
And although Black and Hispanic populations were more likely than their White counterparts to live close to a Test to Treat facility (8 percent versus 17 percent), the above-mentioned CDC data has shown that they still aren’t getting those outpatient treatments like Paxlovid.
“I think this speaks to a broader point that, to really achieve equity, solely placing a site in the right community doesn’t automatically solve problems with access to care,” Khazanchi added.
“There’s still intentional education, outreach and communication that you have to do on top of that to build trust in marginalized communities and ensure that medications are getting to the people who need them most.”
This study wasn’t perfect, the researchers emphasized. For example, using driving distance as a proxy for geographic care access barriers does not account for the challenges faced by individuals living in urban areas and who rely on public transportation. The most recent data shows that 1 in 10 seniors—a subpopulation particularly at high risk for severe COVID-19 infection—rely on public transportation for healthcare access.
That’s important context for understanding disparities in Paxlovid access among Black and Hispanic folks, despite the shorter driving distances they may have to Test to Treat sites.
“The latest CDC data reaffirms that racial and ethnic disparities in treating COVID-19 with Paxlovid have persisted despite well-intentioned policies,” Utibe Essien, MD, MPH, an assistant professor of medicine at the University of Pittsburgh and a co-author of the study, said in a statement. “Our findings, and these continued disparities, show that we have to address long-standing structural barriers to achieving pharmacoequity, including Internet access for telemedicine services, limited transportation, and language barriers.”
Source: Patient Engagement HIT
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