From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS).
J Am Board Fam Med. 2024 May-Jun;37(3):455-465. doi: 10.3122/jabfm.2023.230346R1.
Direct primary care (DPC) critics are concerned that the periodic fee precludes participation from vulnerable populations. The purpose is to describe the demographics and appointments of a, now closed, academic DPC clinic and determine whether there are differences in vulnerability between census tracts with and without any clinic patients.
We linked geocoded data from the DPC's electronic health record with the social vulnerability index (SVI). To characterize users, we described their age, sex, language, membership, diagnoses, and appointments. Descriptive statistics included frequencies, proportions or medians, and interquartile ranges. To determine differences in SVI, we calculated a localized SVI percentile within Harris County. A test assuming equal variances and Mann-Whitney Tests were used to assess differences in SVI and all other census variables, respectively, between those tracts with and without any clinic patients.
We included 322 patients and 772 appointments. Patients were seen an average of 2.4 times and were predominantly female (58.4%). More than a third (37.3%) spoke Spanish. There was a mean of 3.68 ICD-10 codes per patient. Census tracts in which DPC patients lived had significantly higher SVI scores (ie, more vulnerable) than tracts where no DPC clinic patients resided (median, 0.60 vs 0.47, p-value < 0.05).
This academic DPC clinic cared for individuals living in vulnerable census tracts relative to those tracts without any clinic patients. The clinic, unfortunately, closed due to multiple obstacles. Nevertheless, this finding counters the perception that DPC clinics primarily draw from affluent neighborhoods.
直接初级保健（DPC）的批评者担心定期费用会阻止弱势群体参与。目的是描述一家已关闭的学术 DPC 诊所的人口统计学和预约情况，并确定是否有患者的普查地段与无患者的普查地段之间存在脆弱性差异。
我们将 DPC 的电子健康记录中的地理编码数据与社会脆弱性指数（SVI）相关联。为了描述用户，我们描述了他们的年龄、性别、语言、会员资格、诊断和预约情况。描述性统计包括频率、比例或中位数和四分位距。为了确定 SVI 的差异，我们在哈里斯县内计算了局部 SVI 百分位数。采用方差相等的 t 检验和 Mann-Whitney U 检验分别评估 SVI 和所有其他普查变量在有和无诊所患者的普查地段之间的差异。
我们纳入了 322 名患者和 772 次预约。患者平均就诊 2.4 次，主要为女性（58.4%）。超过三分之一（37.3%）的患者讲西班牙语。每位患者平均有 3.68 个 ICD-10 编码。DPC 患者居住的普查地段的 SVI 评分（即更脆弱）明显高于没有 DPC 诊所患者居住的地段（中位数分别为 0.60 和 0.47，p 值<0.05）。
与没有诊所患者的地段相比，这家学术性 DPC 诊所为居住在脆弱普查地段的个体提供了服务。不幸的是，该诊所因多种障碍而关闭。然而，这一发现反驳了 DPC 诊所主要从富裕社区招募患者的观点。
