Pollack Craig Evan, Armstrong Katrina
The Robert Wood Johnson Clinical Scholars Program, Leonard Davis Institute of Health Economics, University of Pennsylvania, 1303B Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104, USA.
Arch Intern Med. 2009 May 25;169(10):945-9; discussion 950-3. doi: 10.1001/archinternmed.2009.69.
The extent to which retail clinics provide access to care for underserved populations remains largely unknown. The purpose of this study was to determine whether retail clinics tend to be located in census tracts with higher medical need.
The locations of retail clinics as of July 1, 2008, were mapped and linked to the 2000 US Census and 2008 Health Resources and Services Administration data. Bivariate analyses and logistic regression models with random effects were used to compare the characteristics of census tracts with and without retail clinics. To determine whether retail clinics followed the underlying distribution of chain stores, the location of clinics conditional on there being a chain store was analyzed in 6 counties.
Of the 932 retail clinics, 930 were successfully mapped. Eighteen states had no retail clinics, and 17 states had 25 or more clinics. Within counties with at least 1 retail clinic, census tracts with retail clinics had a lower black population percentage, lower poverty rates, and higher median incomes and were less likely to be medically underserved areas/populations compared with census tracts without retail clinics. Similarly, stores with retail clinics were less likely to be located in medically underserved areas compared with stores without retail clinics.
Retail clinics are currently located in more advantaged neighborhoods, which may make them less accessible for those most in need.
零售诊所为服务不足人群提供医疗服务的程度在很大程度上仍不为人知。本研究的目的是确定零售诊所是否倾向于位于医疗需求较高的普查区。
绘制了截至2008年7月1日的零售诊所位置图,并将其与2000年美国人口普查数据以及2008年卫生资源与服务管理局的数据相链接。采用双变量分析和具有随机效应的逻辑回归模型,比较有零售诊所和没有零售诊所的普查区的特征。为了确定零售诊所是否遵循连锁商店的潜在分布情况,在6个县分析了以有连锁商店为条件的诊所位置。
在932家零售诊所中,930家成功绘制了位置图。18个州没有零售诊所,17个州有25家或更多诊所。在至少有1家零售诊所的县内,与没有零售诊所的普查区相比,有零售诊所的普查区黑人人口百分比更低、贫困率更低、收入中位数更高,且更不可能是医疗服务不足地区/人群。同样,与没有零售诊所的商店相比,有零售诊所的商店位于医疗服务不足地区的可能性更小。
零售诊所目前位于条件更优越的社区,这可能使最需要的人更难获得其服务。