ORIGINAL RESEARCH
Michael Topmiller, PhD; Hannah Shadowen, MPH; Hoon Byun, DrPH; Mark Carrozza, MA; Jeong Young Park, PhD; Yalda Jabbarpour, MD; Alison Huffstetler, MD
Corresponding Author: Michael Topmiller, PhD; The Robert Graham Center for Policy Studies in Family Medicine, American Academy of Family Physicians
Email: mtopmiller@aafp.org
DOI: 10.3122/jabfm.2023.230400R1
Keywords: Access to Care, Geographic Information Systems, Health Disparities, Maps, Primary Care Physicians, Primary Health Care, Workforce
Dates: Submitted: 11-01-2023; Revised: 01-09-2024; Accepted: 01-17-2024
FINAL PUBLICATION: |HTML| |PDF|
BACKGROUND: 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 no USC.
METHODS: 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 four 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); (4) Low-Low (low PCP capacity, low USC). We use t-tests to explore differences in the characteristics of counties with similar rates of primary care capacity.
RESULTS: 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.
CONCLUSIONS: 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.