How Adults' Access to Outpatient Physician Services Relates to the Local Supply of Primary Care Physicians in the Rural Southeast

Abstract

Objective. To examine how access to outpatient medical care varies with local primary care physician densities across primary care service areas (PCSAs) in the rural Southeast, for adults as a whole and separately for the elderly and poor. Data Sources. Access data from a 2002 to 2003 telephone survey of 4,311 adults living in 298 PCSAs within 150 rural counties in eight Southeastern states were linked geographically with physician practice location data from the American Medical and American Osteopathic Associations and population data from the U.S. Census. Study Design. In a cross‐sectional study design, we used a series of logistic regression models to assess how 26 measures of various aspects of access to outpatient physician services varied for subjects arranged into five groups based on the population‐per‐physician ratios of the PCSAs where they lived. Principal Findings. Among adults as a whole, more individuals reported traveling over 30 minutes for outpatient care in PCSAs with more than 3,500 people per physician than in PCSAs with fewer than 1,500 people per physician (39.1 versus 18.5 percent, p<.001) and more reported travel difficulties. Otherwise, PCSA density of primary care physicians was unrelated to reported barriers to care, unrelated to people's satisfaction with care, and unrelated to indicators of people's use of services. Use rates of six recommended preventive health services varied in no consistent direction with physician densities. Among the elderly, only the proportion traveling over 30 minutes for care was greater in areas with lowest physician densities. Among subjects covered under Medicaid or uninsured, lower local physician densities were associated with longer travel time, difficulties with travel and reaching one's physician by phone, and two areas of dissatisfaction with care. Conclusions. For adults as a whole in the rural South and for the elderly there, low local primary care physician densities are associated with travel inconvenience but not convincingly with other aspects of access to outpatient care. Access for those insured under Medicaid and the uninsured, however, is in more ways sensitive to local physician densities.

Higher Physician Density is Associated with Lower Incidence of Late-stage Colorectal Cancer

“…Given the generally lower rates of CRC screening compared to other preventive health services, differences in screening are unlikely to be the sole factor. In addition, given the known timeline for development of CRC, changes in screening practices after 2001 are unlikely to be the sole determinants of changes in 41 while the link appeared to be stronger in some, but not all studies, examining rural health care. Pathman et al found that higher number of persons per physician in each county was associated with longer travel times but no other significant barriers to care 41 with no difference in the utilization of preventive health services.…”

“…In addition, given the known timeline for development of CRC, changes in screening practices after 2001 are unlikely to be the sole determinants of changes in 41 while the link appeared to be stronger in some, but not all studies, examining rural health care. Pathman et al found that higher number of persons per physician in each county was associated with longer travel times but no other significant barriers to care 41 with no difference in the utilization of preventive health services. However, among patients who were covered under Medicaid or were uninsured, lower physician-per-population ratio was associated with lower satisfaction with care and difficulty in contacting medical personnel.…”

Do adults who believe in periodic health examinations receive more clinical preventive services?

“…A random digit dialing telephone survey, described in detail elsewhere (Pathman, Ricketts et al 2006), was conducted from mid 2002 to mid 2003 to assess adults' baseline use of healthcare services and perceived barriers in the 150 non-metropolitan counties targeted in the SRAP. Survey methods were modeled after those of the Behavioral Risk Factor Surveillance Survey of the CDC (Centers for Disease Control and Prevention 2005).…”

“…) Using data from a telephone survey of adults in the rural South (Pathman, Ricketts et al 2006), this study assessed whether having negative or ambivalent beliefs about periodic health examinations places individuals at risk for receiving fewer CPS and identified sociodemographic and other characteristics of individuals less likely to value periodic examinations. This study further assessed whether people's beliefs in periodic health examinations might explain why individuals in some sociodemographic groups are more likely to receive recommended CPS than people in other groups.…”

Exploring the Association of Homicides in Northern Mexico and Healthcare Access for US Residents

“…County level physician supply controlled for local access. [40][41] A binary indicator for MSA status was included. Individual characteristics included categorical indicators of sex, age, race, state of residence, income, education, and health status (continuous) measured as number of days in the prior month that poor physical or mental health restricted usual activities.…”