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加强农村医生队伍在服务不足的社区:农村住院医师规划和发展计划是否找到了最佳点?

Bolstering the rural physician workforce in underserved communities: Are Rural Residency Planning and Development Programs finding the sweet spot?

机构信息

Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

出版信息

J Rural Health. 2023 Jun;39(3):521-528. doi: 10.1111/jrh.12735. Epub 2022 Dec 25.

DOI:10.1111/jrh.12735
PMID:36566476
Abstract

PURPOSE

The purpose of this study is to describe the characteristics of Rural Residency Planning and Development (RRPD) Programs, compare the characteristics of counties with and without RRPD programs, and identify rural places where future RRPD programs could be developed.

METHODS

The study sample comprised 67 rural sites training residents in 40 counties in 24 US states. Descriptive statistics were used to describe RRPD programs and logistic regression to predict the probability of a county being an RRPD site as a function of population, primary care physicians (PCP) per 10,000 population, and the social vulnerability index (SVI) compared to a control sample of nonmetro counties without RRPD sites.

FINDINGS

Most RRPD grantees (78%) were family medicine programs affiliated with medical schools (97%). RRPD counties were more populous (P<.01), had a higher population density (P<.05), and a higher percent of the non-White or Hispanic population (P = .05) compared to non-RRPD counties. Both higher population (P<.001) and PCP ratio (P = .046) were strong predictors, while SVI (P = .07) was a weak predictor of being an RRPD county.

CONCLUSIONS

RRPD sites appear to represent a "sweet spot" of rural counties that have the population and physician supply to support a training program but also are relatively more socially vulnerable with high-need populations. Additional counties fitting this "sweet spot" could be targeted for funding to address health disparities and health workforce maldistribution.

摘要

目的

本研究旨在描述农村居住规划与发展(RRPD)计划的特点,比较有和没有 RRPD 计划的县的特点,并确定未来 RRPD 计划可以开展的农村地区。

方法

研究样本包括在 24 个州的 40 个县培训住院医师的 67 个农村地点。使用描述性统计来描述 RRPD 计划,并使用逻辑回归预测一个县作为 RRPD 地点的概率,作为人口、每 10000 人口的初级保健医生(PCP)以及与没有 RRPD 地点的非都市区县的社会脆弱性指数(SVI)的函数。

结果

大多数 RRPD 受赠者(78%)是隶属于医学院的家庭医学项目(97%)。RRPD 县的人口更多(P<.01),人口密度更高(P<.05),非白种人或西班牙裔人口的比例更高(P =.05),与非 RRPD 县相比。人口(P<.001)和 PCP 比例(P =.046)均为强有力的预测因素,而 SVI(P =.07)则为 RRPD 县的弱预测因素。

结论

RRPD 地点似乎代表了具有支持培训计划所需的人口和医生供应的农村县的“理想选择”,但也相对更具社会脆弱性,人口需求更高。可以针对其他符合这一“理想选择”的县进行资金投入,以解决健康差距和卫生人力分布不均的问题。

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