Fifty-four percent of counties in the United States do not have COVID-19 test sites, underscoring a serious patient access to care issue and highlighting an urban-rural divide that has plagued the industry for decades, according to a new report from health navigation software company Castlight Health.
This data is troublesome as states across the country explore the reopening process, looking to phase out of the stay-at-home orders that were initially set in place to cap coronavirus spread.
“We know that in order to reopen states’ economies and communities, we need a substantial increase in COVID-19 testing,” Maeve O’Meara, Castlight Health CEO, said in a statement. “Our analysis shows where gaps remain, and how retail clinics, as they expand testing locations, could hold the key to delivering critical testing capacity, especially for vulnerable citizens.”
Using its own data about COVID-19 testing sites across the country, which the company aggregated from public health agencies nationwide, the report showed discrepancies between state and community preparedness.
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Although 46 of the 48 states in the continental US can boast adequate test sites for its population volume, within each state there are some test access desserts. A notable proportion of counties across the country have zero COVID-19 testing sites in them.
And there is a critical urban-rural divide at play, the data shows. Just as rural communities have long faced geographic barriers to care pre-COVID, these areas are likely to face similar issues with testing.
Sixty-eight percent of rural counties have no test sites, compared to just 38 percent of counties in metropolitan counties, defined as having more than 50,000 people in their populations.
The report used Texas as an example for the rural-urban divide in test site availability and access. Texas is one of the 46 states that can report it has COVID-19 test sites that meet the 1 percent capacity threshold. But a closer, county-by-county look painted a different picture.
The urban centers throughout Texas — Dallas, Houston, and Austin — actually exceed the 1 percent capacity benchmark, the report pointed out. Harris County, which houses Houston, can test 1.8 percent of its population weekly. For Dallas county, that number is 1.4 percent, and in Travis County, where Austin is located, that number is a whopping 2.3 percent of the population weekly.
But moving out of those urban settings one sees a different story. There are 26 counties in the center of the state that do not have a COVID-19 test site, leaving 315,000 individuals without access to this type of care, unless they drive a considerable distance.
Depending on where they are located, patients could face a drive between 100 and 112 miles away to receive a COVID-19 test, something many patients may see as prohibitive to accessing care.
What’s more, counties that do have a COVID-19 test site do not meet adequate testing capacity. The industry has reached a consensus that in order for a test site to meet capacity, it must be able to test at least 1 percent of the county population each week. Of the counties that do have a COVID-19 test site, 58 percent of them do not meet this minimum capacity, the report said.
But the future is not entirely stark, the report said. Retail health clinics have the power to help close gaps in care access.
In Haskell, Texas, where a COVID-19 test might be an hour and a half away, making testing available in the Walmart Supercenter 16 miles away could make care more accessible.
Walmart is one of many retailers that have gotten into the healthcare business and pledged to make COVID-19 testing readily available. Rite Aid, Walgreens, Kroger, Target, CVS Health, and any number of organizations also opening up retail health clinics have likewise stated plans to host COVID-19 testing.
Some of them have followed through, playing host to the drive-through clinics profiled at the start of the virus outbreak.
“Due to their broad geographic distribution across urban, suburban and rural locations, retail clinics may be our best hope to lay the testing groundwork needed to safely return the nation to work,” the report concluded. “By looking across the country and understanding where testing capacity is available, retailers can use their existing infrastructure to fill gaps in COVID-19 testing where health care facilities and other clinics cannot.”
Retail health providers have been talking about opening up testing sites since the coronavirus became widespread in March, but at the end of March and in April critics pointed out the clinics have not entirely followed through.
Retail health is working to ramp up its efforts. On April 27, for example, CVS Health announced it would “significantly expand” its testing capabilities. Throughout the beginning of May, Walmart has also opened testing centers across the country. Walgreens, Kroger, and Rite Aid have also announced increased testing efforts.
As the nation continues to phase in its reopening, it will be essential to understand testing access on a population level. Although states may report adequate testing, a more granular approach may be helpful for truly understanding patient access.
Source: PatientEngagement HIT