Distance between residence and preventive health care source: Impact on completion of preventive health care actions

Distance between client residence and health care provider location is negatively related to health seeking behavior in women; as the distance from a health care source increases, women are less likely to seek health care for themselves. Determining distance can be difficult when studies involve special populations, specifically women with HIV infection, since the collection of physical address information may be prohibited by institutional review boards. A review of 110 randomly selected electronic medical records from women with HIV infection was conducted and utilized a database developed a priori to link address information to census block. The single abstractor searched by the database by zip code then street name then street number to identify the census block, which was recorded on the abstraction instrument to determine if increased distance reduced the completion of preventive health care screening tests for breast, cervical and colorectal cancer in women with HIV infection receiving care from an urban university-based health care center. Screening test completion was divided into four categories: completed on time, completed early, completed late or not completed. Logistic regression was used to examine modifiers and interaction effects, as well as determine which characteristics (i.e., age/age cohort, race), HIV-related factors (i.e., length of time with HIV infection), and comorbid conditions (i.e., diabetes mellitus, depression) were significantly related to the completion of preventive health care screening tests. Depending on the screening test, completion rates in women with HIV infection differ significantly when distance and other variables are considered.