Staloff Jonathan A, Morenz Anna M, Hayes Sophia A, Bhatia-Lin Ananya L, Liao Joshua M
Department of Family Medicine, University of Washington, Seattle, WA 98195, United States.
Department of Medicine, University of Arizona, Tucson, AZ 85724, United States.
Health Aff Sch. 2025 Apr 2;3(4):qxaf066. doi: 10.1093/haschl/qxaf066. eCollection 2025 Apr.
Social drivers of health aggregate geographically, contributing to health inequities that primary care access may mitigate. Two area-level measures of social disadvantage are the Area Deprivation Index and Social Vulnerability Index. This rapid review aimed to assess the association between these measures and primary care access. We conducted a rapid review of US studies published through February 11, 2025. Included studies were categorized as defining primary care access by self-reported access to primary care, geographic accessibility, or utilization. We analyzed 31 studies, of which 68% ( = 9/13 Area Deprivation Index, = 12/18 Social Vulnerability Index) found that greater area-level social disadvantage was consistently associated with reduced primary care access. This association was most consistently observed in studies measuring primary care access via self-report ( = 2/2), vaccine uptake ( = 5/7), and via a higher odds of using telephone vs audio-visual or in-person primary care in areas of high socioeconomic disadvantage ( = 5/5). These findings have implications for telemedicine payment policy and care redesign. The possible expiration of Medicare's expanded telemedicine reimbursement may disproportionately reduce access points to primary care for individuals living in high socioeconomic disadvantage areas. These findings also support the need for community-level interventions to increase access to primary care administered vaccines.
健康的社会驱动因素在地理上呈现聚集性,导致了健康不平等现象,而初级保健服务的可及性或许能够缓解这种不平等。社会劣势的两个区域层面衡量指标是区域贫困指数和社会脆弱性指数。本快速综述旨在评估这些指标与初级保健服务可及性之间的关联。我们对截至2025年2月11日发表的美国研究进行了快速综述。纳入的研究被分类为通过自我报告的初级保健服务可及性、地理可及性或利用率来定义初级保健服务可及性。我们分析了31项研究,其中68%(区域贫困指数研究中9/13,社会脆弱性指数研究中12/18)发现,区域层面更大的社会劣势与初级保健服务可及性降低始终相关。这种关联在通过自我报告衡量初级保健服务可及性的研究中(2/2)、疫苗接种情况的研究中(5/7)以及在社会经济劣势较高地区使用电话而非视听或面对面初级保健服务的几率更高的研究中(5/5)最为一致地被观察到。这些发现对远程医疗支付政策和医疗服务重新设计具有启示意义。医疗保险扩大的远程医疗报销可能到期,这可能会不成比例地减少生活在社会经济劣势较高地区的个人获得初级保健服务的途径。这些发现还支持开展社区层面干预措施的必要性,以增加获得初级保健管理疫苗的机会。