Driving Access to Psychiatrists and Internet Availability: A National Cross-sectional Study

Robert A. Kleinman, MD

Brigham and Women’s Hospital, Massachusetts General Hospital, McLean Hospital
Driving Access to Psychiatrists and Internet Availability: A National Cross-sectional Study

Scientific Abstract

Background: The expansion of telepsychiatry has been enabled by temporary regulatory waivers during the COVID-19 pandemic. Extending these waivers has been proposed as a strategy to increase access to psychiatric care in rural regions. However, little is about travel times for individuals to access psychiatric care or internet access in regions distant from psychiatrists. This study determined driving times to the closest psychiatrist across the US and examined broadband internet access in counties with elevated driving times.

Methods: The primary outcome was the population-weighted one-way mean driving time from block group mean center of populations (MCP), from the 2010 US census, to the closest psychiatric practice identified from the National Provider Identifier database (May 2020 update). Block groups were included in the analysis if they contained at least 1 resident, had an MCP that was within 3 miles of the road network, and had a possible driving route to a psychiatry practice. Driving times were estimated using historical average traffic data. Urban-rural status was defined using 2010 Rural Urban Commuting Area codes. Fixed broadband internet coverage was obtained from the Federal Communication Commission. A two-tailed weighted t-test was used to compare driving times in urban and rural regions.

Results: The population-weighted mean driving time from block group MCPs to the closest psychiatrist in the United States was 9.4 minutes (95% CI: 9.3-9.5). The population-weighted mean driving time was 7.1 minutes (95% CI: 7.1–7.2) in urban regions and 21.9 minutes (95% CI: 21.3–22.4) in rural regions (p < 0.001). In counties with a population-weighted mean driving time to the closest psychiatrist ≥ 30 minutes, 49.5% of residents did not have fixed broadband internet access, and 60.3% of residents in counties with a with a population-weighted mean driving time to the closest psychiatrist ≥ 60 minutes did not have fixed broadband internet access.

Conclusions: Initiatives to expand access to psychiatric care in counties with elevated driving times to the closest psychiatrist will need to account for limited access to fixed broadband internet.

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Authors

Robert A. Kleinman, MD