Clinical research studyHealth Care Utilization and the Proportion of Primary Care Physicians
Section snippets
Study Design
A retrospective cross-sectional study using multivariate regression was performed to evaluate the relationship between the proportion of physicians practicing primary care within metropolitan statistical areas and 4 key indicators of health care utilization.
Data Source
The Area Resource File database contains county-level data from 3028 US counties, and allows aggregation of the data into 323 metropolitan statistical areas. The Area Resource File defines a metropolitan statistical area as an area
Results
Table 1 summarizes the independent variables. Across the 323 metropolitan statistical areas, there was a mean of 165 office-based physicians per 100,000 population when combining the datasets from the 3 years (1990, 1995, and 1999). Across the metropolitan statistical areas, 34% of these doctors were primary care physicians (range 20.3%-54.1%). The mean population density for these time points was 388 persons per square mile, 12.6% of whom were aged >65 years, and 10.7% of whom were
Discussion
The results of this study suggest that as the proportion of physicians who are in primary care practice increases, health care utilization decreases. This relationship remained statistically significant for inpatient hospitalizations, emergency department visits, and total surgeries, even when controlled for population and physician variables. In practical terms, if a metropolitan statistical area with a population of 775,000 increased its proportion of primary care physicians from 35% to 40%,
Acknowledgments
We are indebted to Dr. Douglas Hough for his guidance and inspiration, and to Ms. Cheri Smith and Dr. Eric Bass for their assistance. Dr. Wright is an Arnold P. Gold Foundation Associate Professor of Medicine. Drs. Kravet and Wright are Miller-Coulson Scholars.
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