From The Robert Graham Center for Policy Studies in Family Medicine, American Academy of Family Physicians, Cincinnati, OH, Washington, DC (MT, HB, MC, JYP, YJ, AH); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (HS).
J Am Board Fam Med. 2024 May-Jun;37(3):436-443. doi: 10.3122/jabfm.2023.230400R1.
The NASEM Primary Care Report and Primary Care scorecard highlighted the importance of primary care physician (PCP) capacity and having a usual source of care (USC). However, research has found that PCP capacity and USC do not always correlate. This exploratory study compares geographic patterns and the characteristics of counties with similar rates of PCP capacity but varying rates of USC.
Our county-level, cross-sectional approach includes estimates from the Robert Graham Center and data from the Robert Wood Johnson County Health Rankings (CHR). We utilized conditional mapping methods to first identify US counties with the highest rates of social deprivation (SDI). Next, counties were stratified based on primary care physician (PCP) capacity and usual source of care (USC) terciles, allowing us to identify 4 types of counties: (1) High-Low (high PCP capacity, low USC); (2) High-High (high PCP capacity, high USC); (3) Low-High (low PCP capacity, high USC); and (4) Low-Low (low PCP capacity, low USC). We use test to explore differences in the characteristics of counties with similar rates of primary care capacity.
The results show clear geographic patterns: High-High counties are located primarily in the northern and northeastern US; High-Low counties are located primarily in the southwestern and southern US. Low-High counties are concentrated in the Appalachian and Great Lakes regions; Low-Low counties are concentrated in the southeastern US and Texas. Descriptive results reveal that rates of racial and ethnic minorities, the uninsured, and social deprivation are highest in counties with low rates of USC for both high PCP and low PCP areas.
Recognizing PCP shortages and improving rates of USC are key strategies for increasing access to high-quality, primary care. Targeting strategies by geographic region will allow for tailored models to improve access to and continuity of primary care. For example, we found that many of the counties with the lowest rates of USC are found in non-Medicaid expansion states (Texas, Georgia, and Florida) with high rates of uninsured populations, suggesting that expanding Medicaid and improving access to health insurance are key strategies for increasing USC in these states.
NASEM 初级保健报告和初级保健记分卡强调了初级保健医生（PCP）能力和拥有常规医疗服务来源（USC）的重要性。然而，研究发现 PCP 能力和 USC 并不总是相关的。这项探索性研究比较了具有相似 PCP 能力但 USC 率不同的县的地理模式和特征。
我们的县级横断面方法包括罗伯特·格雷厄姆中心的估计和罗伯特·伍德·约翰逊县健康排名（CHR）的数据。我们利用条件映射方法首先确定美国社会剥夺程度最高的县（SDI）。接下来，根据初级保健医生（PCP）能力和常规医疗服务来源（USC）三分位数对各县进行分层，使我们能够识别出 4 种类型的县：（1）高-低（PCP 能力高，USC 低）；（2）高-高（PCP 能力高，USC 高）；（3）低-高（PCP 能力低，USC 高）；（4）低-低（PCP 能力低，USC 低）。我们使用 检验探索具有相似初级保健能力率的县的特征差异。
结果显示出明显的地理模式：高-高县主要位于美国北部和东北部；高-低县主要位于美国西南部和南部。低-高县集中在阿巴拉契亚和大湖区；低-低县集中在东南部和德克萨斯州。描述性结果表明，在 PCP 高和低地区 USC 率低的县，少数民族、无保险和社会剥夺的比例最高。
认识到初级保健医生短缺和提高 USC 率是增加高质量初级保健可及性的关键策略。按地理区域制定策略将允许采用定制模型来改善初级保健的可及性和连续性。例如，我们发现 USC 率最低的许多县都位于非医疗补助扩大州（德克萨斯州、佐治亚州和佛罗里达州），这些州的未参保人口比例很高，这表明扩大医疗补助和改善医疗保险的可及性是提高这些州 USC 率的关键策略。
