By Annie Rouza, M.D., MPH
This is the final article of a series to support the GAFP’s strategic plan initiative of advancing health equity in Georgia.
Social determinants of health (SDOH) are non-medical factors in patients’ lives that can affect their health and quality of life outcomes.1 Screening tools from AAFP and CMS have risk-stratified several SDOH, including economic instability and transportation shortage.1,2 In keeping with the Healthy People 2030’s objective to facilitate access to health care, primary care physicians should consider screening for transportation barriers in their practice because it can limit patients’ access to care.1,2
Why is this important? As of 2017, 5.8 million people in the U.S. missed health care appointments because of transportation challenges.3 A 2020 analysis conducted by Georgians for a Healthy Future designated 117 out of 159 counties in Georgia as health transportation shortage areas.4
Definition: Health transportation shortage includes lack of vehicle access, inadequate public transit infrastructure, and prohibitive transportation costs that preclude or delay access to medical care.3 Discontinued or delayed care can lead to adverse health outcomes from chronic illness complications, lost opportunities for early detection of diseases, and missed medication refills3. Unfortunately, transportation challenges disproportionately affect people from low socioeconomic status and minority racial groups3. Georgia’s 2019 rate of unemployment in African Americans (7%) compared to Caucasians (4%) mirrors its 2020 vehicle ownership trend where more African American households (13%) are without a vehicle compared to Caucasian households (3.8%).3,4 Because existing systemic inequalities negatively impact economic stability in these groups, their capacity for vehicle ownership, available funds for transportation fare, and access to care are also impacted.3,4,5
Screening tools: The AAFP Social Needs Screening Tool is a 15-question survey that can be used to screen patients for SDOH, including transportation challenges.
Interventions: Health transportation interventions like bus or taxi vouchers and free or reimbursed transportation costs can improve health outcomes when delivered as part of a multi-component chronic disease care regimen.6 The AAFP’s Neighborhood Navigator is a database that uses zip codes to help connect financially qualifying patients to different community organizations for assistance with bus passes, taxi vouchers, and health care ground transportation. For Medicaid patients in Georgia, the Non-Emergency Medical Transportation program (NEMT) provides transportation to medically necessary appointments for Medicaid covered services.4 Demand-response or paratransit systems, which require patients to request pick up in advance, are also available in many Georgia counties for disabled patients.4 Additionally, making available telemedicine appointments (video, phones) whenever possible can help minimize health transportation challenges. Every practice and patient will have different needs, so it is recommended that health care teams follow up with patients to assess the utility of these tools and potential need for further assistance.
Demand-response or Paratransit systems: https://www.nwgrc.org/services/area-agency-on-aging/transportation-services-by-county/
- (n.d.). Healthy people partners and SDOH. https://health.gov/healthypeople/priority-areas/social-determinants-health/healthy-people-partners-and-sdoh
- (n.d.). Healthy people 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/reduce-proportion-people-who-cant-get-medical-care-when-they-need-it-ahs-04
- Wolfe, M., McDonald, N., & Holmes, M. (2020). Transportation barriers to health care in the United States: Findings from the National Health Interview Survey, 1997-2017. American Journal of Public Health, 110(6), 815-822.
- GHF, & Sutton, C. (2021). Health transportation shortages: A barrier to healthcare for Georgians.
- National Equity Atlas (2022). Unemployment Georgia. https://nationalequityatlas.org/indicators/Unemployment#/?breakdown=1&geo=02000000000013000
- Starbird, L., DiMaina, C., Sun, C., & Han, H. (2019). A systematic review of interventions to minimize transportation barriers among people with chronic diseases. Journal of Community Health, 44, 400-411. https://doi.org/https://doi.org/10.1007/s10900-018-0572-3
Dr. Rouza completed an internship in obstetrics-gynecology and a Master of Public Health. She is now a preventive medicine resident taking part in the Health Equity, Advocacy, and Policy track at Emory University School of Medicine.