Multi-method assessment of access to primary medical care in rural Colorado

Fryer GE, Drisko J, Krugman RD, Vojir CP, Prochazka A, Miyoshi TJ, Miller ME.

POLICY RELEVANCE: This paper introduces new analytical techniques helpful in evaluating the adequacy of accessibility to generalist physician resources for residents of non-MSA areas. Using methods which reveal provider caseload implications for the results of distance to care normative modeling can inform configuration of primary care delivery systems sensitive to the distribution of rural populations. OBJECTIVES: To conduct an analysis of access to primary medical care in rural Colorado, through simultaneous consideration of primary care physician-to-population and distance-to-nearest provider indices. Analysis examined the potential development and implications of excessively large, perhaps unmanageable patient caseloads which might result from every rural Coloadoan's exclusive use of the nearest generalist physician as a regular source of care. METHODS: Using American Medical Association Physician Masterfile data for 1995 and coordinates for latitude and longitude from U.S. Census files, the authors calculated distance to the nearest primary care physician for residents of each of the 1317 block groups in Colorado's 52 rural counties. Caseloads for each generalist physician were computed assuming the population used the nearest provider for care. RESULTS: Straight-line mileage to primary medical care was modest for rural Coloradoans; median distance of 2.5 miles. Almost two-thirds (65%) resided within 5 miles and virtually all (99%) within 30 miles of a generalist physician. But had everyone traveled the shortest possible distance to care, demand for service from many of the 343 primary care doctors in rural regions of the state would have been overwhelming. CONCLUSIONS: The results of simultaneous application of distance-to-care and provider-to-population techniques unrestricted by geographic boundaries, depict access to primary medical care and corresponding consumer difficulty more fully than previously done. Further combination of methods of needs assessment such as those used in this analysis may better inform the future efforts of organizations mandated to address health care underservice in rural areas.

Fryer GE, Drisko J, Krugman RD, Vojir CP, Prochazka A, Miyoshi TJ, Miller ME. Multi-method assessment of access to primary medical care in rural Colorado. J Rural Health, 1999; 15(1):113-121.