Variation in Primary Care Service Patterns by Rural‐Urban Location

Weigel, Paula; Ullrich, Fred; Shane, Dan M.; Mueller, Keith J.

doi:10.1111/jrh.12146

Cited by 41 publications

(29 citation statements)

References 16 publications

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“…We are not aware of any studies concerning practice variation of surgical and gynaecological procedures by GPs inside PHC, but our findings of sizeable variations in services provided by health care providers is in line with other studies in this research field [1–3, 5, 7, 8, 25]. The main determinant of practice variation in our study was GP gender.…”

Section: Discussionsupporting

confidence: 90%

“…Regarding our findings that GPs working in the largest municipalities have lower odds of performing major surgical procedures, this seem to align well with a study from Iowa. Here, GPs working in nonmetropolitan settings performed more services including surgical procedures than GPs working in metropolitan areas [25]. Interestingly, Rivet et al found that a larger range of procedures was associated with a higher level of job satisfaction among primary care physicians [29].…”

Section: Discussionmentioning

confidence: 99%

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Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

et al. 2017

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BackgroundStudies of Primary Health Care (PHC) reveal considerable practice variations in terms of the range of services provided. In Norway, general practitioners (GPs) are traditionally expected to perform IUD-insertions and several surgical procedures as a part of comprehensive PHC. We aimed to investigate variation in the provision of surgical procedures and IUD-insertions across GPs and over time and explore determinants of such variation.MethodsRetrospective registry study of Norwegian GPs. From a comprehensive database of GPs’ reimbursement claims, we obtained procedure codes and GP characteristics such as age, gender, list size and municipality characteristics from 2006 through 2013. Multivariable logistic regression models were fitted to explore determinants of practice variation.ResultsWe extracted data from 4,828 GPs. In 2013, 91.0, 76.1 and 74.8% were reimbursed at least once for minor and major surgical procedures and IUD-insertion, respectively. Female GPs had lower odds for performing major surgical procedures (OR 0.38, 95% CI 0.32–0.45) and higher odds for performing IUD-insertions (OR 6.28, 95% CI 4.47–8.82) than male GPs. Older GPs and GPs with shorter patient lists were less likely to perform surgical procedures. GPs with longer patient lists had higher odds for performing IUD-insertions. The proportion of GPs performing surgical procedures increased over time, while the proportion decreased for IUD-insertions. The number of IUD-insertions in specialist care increased from 12,575 in 2011 to 15 216 (+21.0%) in 2014.ConclusionWe observed a large variation in the provision of surgical procedures and IUD-insertions amongst GPs in Norway. The GPs’ age, gender, list size and size of municipality were associated with performing the procedures. Our findings suggest a shift of IUD-insertions from primary to specialist care.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

et al. 2017

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“…– 11 However, in recent years, strategies have been implemented at the regional, state, and federal levels to increase the number of providers practicing in rural healthcare 1215 In addition, the care environment has changed in the last decade as a result of the increased use of internet applications and advanced communication technologies 16.…”

Section: Introductionmentioning

confidence: 99%

Recruiting Rural Healthcare Providers Today: a Systematic Review of Training Program Success and Determinants of Geographic Choices

et al. 2017

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BackgroundRural areas have historically struggled with shortages of healthcare providers; however, advanced communication technologies have transformed rural healthcare, and practice in underserved areas has been recognized as a policy priority. This systematic review aims to assess reasons for current providers’ geographic choices and the success of training programs aimed at increasing rural provider recruitment.MethodsThis systematic review (PROSPERO: CRD42015025403) searched seven databases for published and gray literature on the current cohort of US rural healthcare practitioners (2005 to March 2017). Two reviewers independently screened citations for inclusion; one reviewer extracted data and assessed risk of bias, with a senior systematic reviewer checking the data; quality of evidence was assessed using the GRADE approach.ResultsOf 7276 screened citations, we identified 31 studies exploring reasons for geographic choices and 24 studies documenting the impact of training programs. Growing up in a rural community is a key determinant and is consistently associated with choosing rural practice. Most existing studies assess physicians, and only a few are based on multivariate analyses that take competing and potentially correlated predictors into account. The success rate of placing providers-in-training in rural practice after graduation, on average, is 44% (range 20–84%; N = 31 programs). We did not identify program characteristics that are consistently associated with program success. Data are primarily based on rural tracks for medical residents.DiscussionThe review provides insight into the relative importance of demographic characteristics and motivational factors in determining which providers should be targeted to maximize return on recruitment efforts. Existing programs exposing students to rural practice during their training are promising but require further refining. Public policy must include a specific focus on the trajectory of the healthcare workforce and must consider alternative models of healthcare delivery that promote a more diverse, interdisciplinary combination of providers.Electronic supplementary materialThe online version of this article (10.1007/s11606-017-4210-z) contains supplementary material, which is available to authorized users.

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“…Additional barriers to accessing specialty care for minor illnesses during cancer treatment or health maintenance during survivorship may include household material hardship 36,37 and the absence of infrastructure such as mass transit in rural areas. 41 We also found that physicians were significantly more comfortable than advanced-level practitioners in providing acute medical care to on-therapy patients, suggesting that more extensive training may have an impact on comfort level in caring for patients with complex chronic illnesses. Despite the large percentage of PCPs reporting the recent provision of care for patients with childhood cancer and/or survivors in their practices, we found that less than one-half were comfortable in providing such care independently, and that the majority desired collaboration with pediatric oncologists.…”

Section: Discussionmentioning

confidence: 62%

“…This may reflect the general practice patterns in rural primary care, in which providers are more likely to perform services that would be performed by specialists in an urban area. 41 We also found that physicians were significantly more comfortable than advanced-level practitioners in providing acute medical care to on-therapy patients, suggesting that more extensive training may have an impact on comfort level in caring for patients with complex chronic illnesses. 42 Provider experience (older age and larger number of patients seen per week) was associated with greater comfort in independently providing health maintenance care to survivors.…”

Section: Discussionmentioning

confidence: 62%

Providing health care for patients with childhood cancer and survivors: A survey of pediatric primary care providers

Wadhwa

Chen

Bhatia

et al. 2019

Cancer

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BACKGROUND:The current study was conducted to assess self-reported comfort levels of pediatric primary care providers (PCPs) in providing acute medical care to patients with childhood cancer who currently were receiving therapy (on-therapy patients) and health maintenance care to childhood cancer survivors, independently and in conjunction with pediatric oncologists, along with confidence levels regarding knowledge about immunizations for survivors. All levels were measured using 7-point Likert scales. METHODS: A cross-sectional, 23-item survey mailed to practicing PCPs affiliated with a tertiary children's hospital was analyzed. RESULTS: The response rate was 64.4% (259 of 402 eligible PCPs). The mean PCP comfort level was higher when collaborating with a pediatric oncologist to provide acute medical care for on-therapy patients and health maintenance care for childhood cancer survivors (mean ratings of 6.0 ± 1.5 and 6.4 ± 1.3, respectively) compared with independently providing such care (mean ratings of 4.6 ± 1.8 and 5.0 ± 1.7, respectively; P < .0001). Only approximately 30% of PCPs were confident in their knowledge regarding immunizations for survivors. Certain factors were found to be associated with PCP comfort in providing care in conjunction with a pediatric oncologist. For acute care, these factors were rural location compared with urban location (odds ratio [OR], 5.0; 95% CI, 1.9-13.1 [P = .03]) and having cared for ≥6 on-therapy patients within the past year versus none (OR, 3.8; 95% CI, 1.9-7.5 [P = .0001]). For survivor health maintenance care, practice location <50 miles from pediatric oncology specialty care versus ≥50 miles was the only factor found to be associated with PCP comfort (OR, 2.8; 95% CI, 1.3-6.1 [P = .009]). CONCLUSIONS: The findings of the current study underscore the need for collaboration between pediatric oncologists and PCPs when caring for children with cancer across the spectrum of care. Cancer 2019;125:3864-3872.

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Variation in Primary Care Service Patterns by Rural‐Urban Location

Abstract: Primary care physicians who value practicing a relatively diverse range of services may find locating in rural areas an appealing choice. Health systems and policy makers seeking to attract primary care physicians to rural areas can incorporate this reality into a recruitment strategy.

Cited by 41 publications

References 16 publications

Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

Recruiting Rural Healthcare Providers Today: a Systematic Review of Training Program Success and Determinants of Geographic Choices

Providing health care for patients with childhood cancer and survivors: A survey of pediatric primary care providers

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