Knapp K K, Paavola F G, Maine L L, Sorofman B, Politzer R M
School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA.
J Am Pharm Assoc (Wash). 1999 Mar-Apr;39(2):127-35. doi: 10.1016/s1086-5802(16)30486-7.
To determine the rural distribution of primary care providers (primary care physicians, physician assistants, nurse practitioners, and nurse midwives) and pharmacists.
Five-digit ZIP code mapping to study the availability of primary care providers and pharmacists, alone and in combinations, in rural areas and ZIP code-based health professional shortage areas (HPSAs). National averages for annual physician visits for hypertension, asthma, and diabetes were used to estimate the sufficiency of the rural physician supply.
Rural areas of the United States.
In rural areas, all providers were present in lower densities than national averages, particularly in HPSAs. The primary care physician supply was insufficient to meet national averages for office visits for hypertension, asthma, and diabetes. Among available providers, the most prevalent co-presence was primary care physician with pharmacist. HPSAs showed very low physician density (1 per 22,122), and the most prevalent providers were pharmacists. States varied widely in provider density.
Despite longstanding efforts and the expansion of managed care, primary care providers remain in short supply in rural areas, especially ZIP code-based HPSAs. Making the best use of available providers should be encouraged. The continued shortfall of primary care providers in rural areas, particularly HPSAs, makes it logical to use other available providers and combinations to increase health care access. Pharmacists could increase care for patients with conditions treated with medications. Other available providers, based on skills and work site, could also offset shortages.
确定基层医疗服务提供者（基层医疗医生、医师助理、执业护士和助产士）和药剂师在农村地区的分布情况。
采用五位邮政编码地图来研究农村地区以及基于邮政编码的卫生专业人员短缺地区（HPSA）单独及组合存在的基层医疗服务提供者和药剂师的可及性。使用全国高血压、哮喘和糖尿病年度医生诊疗次数的平均值来估计农村地区医生供应的充足程度。
美国农村地区。
在农村地区，所有医疗服务提供者的分布密度均低于全国平均水平，在卫生专业人员短缺地区尤其如此。基层医疗医生的供应不足以满足高血压、哮喘和糖尿病门诊就诊的全国平均需求。在现有的医疗服务提供者中，最常见的组合是基层医疗医生和药剂师同时存在。卫生专业人员短缺地区的医生密度非常低（每22,122人中有1名），最常见的医疗服务提供者是药剂师。各州的医疗服务提供者密度差异很大。
尽管长期以来一直在努力且管理式医疗有所扩展，但农村地区，尤其是基于邮政编码的卫生专业人员短缺地区，基层医疗服务提供者仍然短缺。应鼓励充分利用现有的医疗服务提供者。农村地区，尤其是卫生专业人员短缺地区，基层医疗服务提供者持续短缺，因此合理的做法是利用其他现有的医疗服务提供者及其组合来增加医疗服务的可及性。药剂师可以增加对使用药物治疗疾病患者的护理。其他现有的医疗服务提供者，根据其技能和工作地点，也可以弥补短缺。
