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Rural populations and early periodic screening, diagnosis, and treatment services: Challenges and opportunities for local public health departments

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  • Hale, N.L.
  • Smith, M.
  • Hardin, J.
  • Brock-Martin, A.

Abstract

Objectives: We examined geographic differences in Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits as the South Carolina Department of Health and Environmental Control (SCDHEC) transitioned from direct service provision (DSP) to assuring delivery within the larger health care system. Methods: We examined infant cohorts with continuous Medicaid coverage and normal birth weights from 1995 to 2010. Outcome variables included any EPSDT visit and the ratio of observed to expected visits. Change in SCDHEC market share over time by residence was the primary variable of interest. We used growth curve models to examine changes in EPSDT visits by rural areas and levels of DSP over time. Results: A small proportion of the study population (10%) resided in rural counties that were more dependent on SCDHEC for DSP. The trajectory of not having visits among counties with high DSPs was steeper in rural areas (0.208; P = .001) compared with urban areas (0.145; P = .002). In counties with high DSPs, the slope of the predicted ratio in rural areas (-0.033; P

Suggested Citation

  • Hale, N.L. & Smith, M. & Hardin, J. & Brock-Martin, A., 2015. "Rural populations and early periodic screening, diagnosis, and treatment services: Challenges and opportunities for local public health departments," American Journal of Public Health, American Public Health Association, vol. 105, pages 330-336.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2014.302449_5
    DOI: 10.2105/AJPH.2014.302449
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