Tài liệu Spatial analysis of elderly access to primary care services docx

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International Journal of Health

Geographics

Research Open Access

Spatial analysis of elderly access to primary care services

Lee R Mobley*1, Elisabeth Root1, Luc Anselin2, Nancy Lozano-Gracia2 and

Julia Koschinsky2

Address: 1RTI International, 275 Cox, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194, USA and 2University of Illinois, Urbana￾Champaign, 220 Davenport Hall, 607 South Mathews Avenue, Urbana, IL 61801-3671, USA

Email: Lee R Mobley* - [email protected]; Elisabeth Root - [email protected]; Luc Anselin - [email protected]; Nancy Lozano￾Gracia - [email protected]; Julia Koschinsky - [email protected]

* Corresponding author

Abstract

Background: Admissions for Ambulatory Care Sensitive Conditions (ACSCs) are considered

preventable admissions, because they are unlikely to occur when good preventive health care is

received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above

who qualify for Medicare health insurance) are signals of poor preventive care utilization. The

relevant geographic market to use in studying these admission rates is the primary care physician

market. Our conceptual model assumes that local market conditions serving as interventions along

the pathways to preventive care services utilization can impact ACSC admission rates.

Results: We examine the relationships between market-level supply and demand factors on

market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s.

Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services

Administration's Primary Care Service Area Project, spatial regression is used to estimate the

model, controlling for disease severity using detailed information from Medicare claims files. Our

evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are

about equally more likely to be admitted for ACSCs. Greater availability of physicians does not

seem to matter, but greater prevalence of non-physician clinicians and international medical

graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in

poor rural areas.

Conclusion: The relative importance of non-physician clinicians and international medical

graduates in providing primary care to the elderly in geographic areas of greatest need can inform

the ongoing debate regarding whether there is an impending shortage of physicians in the United

States. These findings support other authors who claim that the existing supply of physicians is

perhaps adequate, however the distribution of them across the landscape may not be optimal. The

finding that elderly who reside in sprawling urban areas have access impediments about equal to

residents of poor rural communities is new, and demonstrates the value of conceptualizing and

modelling impedance based on place and local context.

Published: 15 May 2006

International Journal of Health Geographics 2006, 5:19 doi:10.1186/1476-072X-5-19

Received: 02 April 2006

Accepted: 15 May 2006

This article is available from: http://www.ij-healthgeographics.com/content/5/1/19

© 2006 Mobley et al; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.