RESUMEN
Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental health.
Asunto(s)
Bisexualidad/psicología , Disparidades en el Estado de Salud , Trastornos Mentales/epidemiología , Pobreza/psicología , Adulto , Bisexualidad/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Pobreza/estadística & datos numéricos , Prejuicio/psicología , Investigación Cualitativa , Encuestas y CuestionariosRESUMEN
INTRODUCTION: The Ontario Telemedicine Network (OTN) uses technology to help make medical services more accessible to people in medically underserved rural and remote parts of Ontario, Canada. We examined access to OTN-enabled health and medical services in Northern Ontario, which has 775,000 people in communities scattered across an area of 803,000 km(2). MATERIALS AND METHODS: We used ArcGIS Network Analyst (Esri, Redlands, CA) to conduct a service area analysis with travel time as a measure of potential access to care. We used road distance and speed limits to estimate travel time between Northern Ontario communities and the nearest OTN unit. RESULTS: In 2014 there were 2,331 OTN units, of which 552 (24%) were located in Northern Ontario. All seven communities in Northern Ontario with a population of 10,000 or greater had OTN units. Almost 97% of the 59 communities with 1,000-10,000 people were within 30 min of an OTN unit. The percentage of communities within 30 min steadily decreased with decreasing population size, to 58% for communities with fewer than 50 people. In total, 86% (690/802) of Northern Ontario communities were within an hour's drive of an OTN unit. CONCLUSIONS: This study showed that most Northern Ontario communities were within an hour's drive of an OTN unit. The current distribution of OTN units has the potential to increase access to medical services and to reduce the need for medically related travel for residents of these communities.
Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Área sin Atención Médica , Servicios de Salud Rural/organización & administración , Telemedicina/estadística & datos numéricos , Viaje/estadística & datos numéricos , Sistemas de Información Geográfica , Ontario , Características de la Residencia/estadística & datos numéricos , Factores de TiempoRESUMEN
INTRODUCTION: Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km(2). The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province. MATERIALS AND METHODS: We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care. RESULTS: There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south. CONCLUSIONS: Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.