Measuring Primary Care Access for Vulnerable Groups
This study measured geographic accessibility to community health centers in Philadelphia and examined its association with health care utilization among vulnerable populations. The authors developed a gravity model to calculate block-group level geographic accessibility scores based on distance to nearby health centers. Residents with low geographic accessibility were less likely to have a regular source of care, more likely to use the emergency department instead of a primary care office, and less likely to receive some preventive health services compared to those with high accessibility, even after adjusting for individual characteristics. Many neighborhoods with both low accessibility and high levels of public insurance were not classified as Health Professional Shortage Areas or Medically Underserved Areas by federal metrics. The study demonstrates an approach for reliably measuring local variations in primary care access
![Measuring Access to Primary Care for Vulnerable Populations: Geographic accessibility to community health centers in Philadelphia Giridhar Mallya, MD, MSHP 1,2,3,6 ; Josh Metlay, MD, PhD 1,2,3,4,6 ; Sam Field, PhD 5,6 1 Robert Wood Johnson Clinical Scholars Program, 2 Leonard Davis Institute of Health Economics, 3 Center for Public Health Initiatives, 4 Division of General Internal Medicine, 5 Center for Health Equity Research and Promotion, 6 University of Pennsylvania Table 1: Physician readiness to advise patients on the costs of commonly prescribed services Results Figure 1: Geographic accessibility to community health centers by block group Notes: Geographic accessibility tertiles were based on 5-mile-radii and included only health centers located in Philadelphia. Table 1: Adjusted odds ratios of health care utilization among vulnerable populations with low vs. high geographic accessibility Notes: Adjusted odds ratios (AORs) and 95% confidence intervals are reported; AORs adjusted for age, race, gender, home language, employment, education, health status, and presence of chronic condition(s). *P<0.05 and **P<0.10 for adjusted odds ratios. Figure 2: Areas with low geographic accessibility and high public insurance vs. HPSAs/MUAs Notes: Geographic accessibility was based on 5-mile-radii and included only health centers located in Philadelphia. High public insurance defined as a Philadelphia neighborhoods with greater than the median level of public insurance (20%). HPSA = Health Profession Shortage Area; MUA = Medically Underserved Area. Conclusions and Policy Implications ,[object Object],[object Object],Objectives ,[object Object],[object Object],Background ,[object Object],[object Object],[object Object],[object Object],Methods ,[object Object],[object Object],[object Object],[object Object],Regular source of care Visit in last year ED instead of office No care due to cost No med due to cost Mammogram in last year Pap smear in last year Flex sig or colonoscopy w/i 5 years Uninsured (n=347) 0.82 (0.36-1.86) 0.80 (0.35-1.87) 2.58 (0.54-12.28) 1.38 (0.65-2.94) 0.91 (0.43-1.95) 3.98 (0.59-26.76) 1.43 (0.51-3.96) 0.15** (0.02-1.17) Medicaid/Adult Basic (n=653) 1.33 (0.44-4.01) 1.00 (0.32-3.13) -- 3.65* (1.09-12.29) 3.55* (1.69-7.46) 0.34* (0.14-0.84) 0.50** (0.24-1.04) 1.40 (0.61-3.25) Poor (n=1362) 0.92 (0.51-1.65) 1.09 (0.61-1.95) 3.75 (0.36-38.90) 1.56 (0.90-2.68) 1.47** (0.92-2.36) 0.61** (0.35-1.04) 0.74 (0.47-1.18) 1.32 (0.77-2.27) Non-poor/non-publicly insured (n=1470) 1.83* (1.03-3.23) 0.87 (0.53-1.41) -- 0.87 (0.52-1.45) 1.13 (0.67-1.90) 0.97 (0.59-1.61) 1.23 (0.80-1.89) 0.99 (0.61-1.60)](https://image.slidesharecdn.com/mallya-giridhar-measuringaccesstoprimarycareforvulnerablepopulations-9-25-08-100819091406-phpapp01/85/Measuring-Access-to-Primary-Care-for-Vulnerable-Populations-9-25-08-1-320.jpg)
