Xierali Imam M
From Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine, Georgetown University Medical Center, Washington, DC; and Department of Geography and Anthropology, Louisiana State University, Baton Rouge.
J Am Board Fam Med. 2018 Mar-Apr;31(2):260-269. doi: 10.3122/jabfm.2018.02.170287.
Physician multisite practicing may affect access to care. However, study measuring the degree of multisite practicing is generally lacking. This study aimed to describe physician multisite practicing patterns in Georgia and to assess its impact on access to care.
Using data from the Georgia Medicaid Management Information System, the American Medical Association Physician Masterfile, and the US Census, mean number of practice sites per physician was calculated. Counts of sites per physician were then modeled in a negative binomial regression. Local differences in spatial accessibility were assessed based on single-site verse multisite practice locations.
Among 20,116 physicians (mean age, 49.4 years; 30.5% female) in Georgia, 63.2% reported multiple practice sites. The average practice sites per physician was 3.3 overall, 2.6 for primary care physicians, and 3.6 for other physicians. Younger age, male sex, and practicing in group practice setting were associated with a higher number of practice sites per physician. Spatial accessibility index changed substantially when controlling for multiple practice sites.
Physician multisite practicing was prevalent and affected geographic access to care. More research and investment into health workforce information infrastructure seem warranted to accommodate changing physician practice patterns in data collection and dissemination.
医生多点执业可能会影响医疗服务的可及性。然而,衡量多点执业程度的研究普遍缺乏。本研究旨在描述佐治亚州医生的多点执业模式,并评估其对医疗服务可及性的影响。
利用佐治亚州医疗补助管理信息系统、美国医学协会医生主文件和美国人口普查的数据,计算每位医生的平均执业地点数量。然后,在负二项回归中对每位医生的执业地点数量进行建模。基于单地点与多地点执业地点评估空间可及性的局部差异。
在佐治亚州的20116名医生(平均年龄49.4岁;30.5%为女性)中,63.2%报告有多个执业地点。每位医生的平均执业地点总数为3.3个,初级保健医生为2.6个,其他医生为3.6个。年龄较小、男性以及在团体执业环境中执业与每位医生更多的执业地点相关。在控制多个执业地点时,空间可及性指数发生了显著变化。
医生多点执业很普遍,并影响了医疗服务的地理可及性。似乎有必要对卫生人力信息基础设施进行更多研究和投资,以适应数据收集和传播中不断变化的医生执业模式。