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Spatial analysis of elderly access to primary care services.
Lee R Mobley1, Elisabeth Root, Luc Anselin
1RTI International, 275 Cox, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194, USA. lmobley@rti.org
International Journal of Health Geographics
|May 17, 2006
Summary
Elderly in rural or suburban areas face similar risks for preventable hospital admissions. Increased non-physician clinicians and international medical graduates reduce these admissions, especially in underserved rural regions.
Area of Science:
- Health Services Research
- Geriatric Care
- Public Health Policy
Background:
- Ambulatory Care Sensitive Conditions (ACSCs) admissions among the elderly signal poor preventive care access.
- Primary care physician markets are key geographic areas for studying these admission rates.
- Local market conditions influence preventive care utilization and ACSC admission rates.
Purpose of the Study:
- Examine market-level factors influencing ACSC admission rates in the elderly.
- Investigate the impact of supply and demand on preventable hospitalizations.
- Understand geographic disparities in elderly healthcare access.
Main Methods:
- Utilized 6,475 natural markets in the mainland U.S. (Primary Care Service Area Project).
- Employed spatial regression analysis to model ACSC admission rates.
- Controlled for disease severity using Medicare claims data.
Main Results:
- Elderly in impoverished rural and sprawling suburban areas show similar high rates of ACSC admissions.
- Physician availability did not significantly impact ACSC admissions.
- Higher prevalence of non-physician clinicians and international medical graduates reduced ACSC admissions, particularly in poor rural areas.
Conclusions:
- Non-physician clinicians and international medical graduates play a crucial role in primary care for the elderly in high-need areas.
- Physician distribution, not necessarily supply, may be suboptimal.
- Access impediments for the elderly in sprawling urban areas are comparable to those in poor rural communities, highlighting the importance of local context.