Neighborhood Determinants of Primary Care Access in Virginia
Hannah M Shadowen1,2,3, Jennifer L Gilbert2, Benjamin Webel2
1Department of Health Policy, Virginia Commonwealth University, Richmond, Virginia shadowenhm@vcu.edu.
Purpose:
Primary care is the foundation of any health care system. Primary care improves the health of communities and decreases health inequities. Yet, workforce shortages have worsened in the United States. Understanding characteristics of where workforce gaps are greatest is key to developing effective workforce solutions.
Methods:
We used the 2019 Virginia All-Payers Claims Database to identify primary care physicians (PCPs) and the number of distinct patients seen by each physician. These data were used to identify PCP access by census tract measured using an enhanced 2-stage floating catchment method. Guided by the Andersen model of health care utilization, we identified predisposing, enabling, need, and structural community characteristics from public data sources. We assessed associations between PCP access and these characteristics using spatial autoregressive models with lagged independent variables. Analyses were performed from 2023 to 2024.
Results:
In Virginia, 56.0% of census tracts had adequate PCP access. No association was found between PCP access and predisposing factors. Multiple enabling factors (ie, marital status, education, English language proficiency) were significantly associated with PCP access. Among need measures, PCP access was only positively associated with diagnosis of depression per 1,000 residents (0.01; P <.001). Structural factors had the greatest association with access. Neighborhoods with disproportionately greater numbers of Black residents had significantly greater PCP access compared with neighborhoods with disproportionately greater numbers of White residents (-0.35; P <.05). Rural communities had less PCP access than suburban neighborhoods (-0.53; P <.001).
Conclusions:
There is an inadequate primary care workforce in Virginia. Structural factors, rather than predisposing, enabling, or need factors, contribute most to PCP access. Whereas Black segregated communities might have greater PCP access, rural communities are significantly disadvantaged.
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