Access to Care

In the United States, extraordinary health care resources are available to some people, but others have inadequate access to high quality care. The Affordable Care Act has the potential to dramatically increase access to health care in the United States, depending on whether millions of previously uninsured people can obtain health insurance and then use that insurance to gain access to care. The Robert Graham Center for Policy Studies in Family Medicine and Primary Care supports improvement in access to care through resources and tools that assess the supply of and need for primary care physicians and health centers throughout the United States.

Primary Care Physician Mapper

The Primary Care Physician Mapper allows you to explore the current distribution of primary care physicians in the United States.

View Mapper »

UDS Mapper

The UDS Mapper shows which neighborhoods and regions in the United States have the greatest need for primary care physicians and health centers.

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Narrow Results:

  • What Now for Obamacare?

    Commentaries & Editorials | Nov 11, 2016 | Douglas Kamerow, MD

    With Trump headed for the White House and Republicans still in control of both houses of Congress, we are told that Obamacare’s demise is just a matter of time.

  • Obama Turns His Hand to Health Policy Analysis

    Commentaries & Editorials | Aug 15, 2016 | Douglas Kamerow

    It is not uncommon to see a U.S. president commenting in a newspaper op-ed column.

  • Who is Using Telehealth in Primary Care? Safety Net Clinics and Health Maintenance Organizations (HMOs)

    Articles | Aug 01, 2016 | Megan Coffman, MS; Miranda Moore, PhD; Anuradha Jetty, MPH; Kathleen Klink, MD; and Andrew Bazemore, MD, MPH

  • Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas

    Articles | May 16, 2016 | Songhai C. Barclift , MD, FACOG; Elizabeth J. Brown, MD, MSHP; Sean C. Finnegan, MS; Elena R. Cohen, BA; and Kathleen Klink , MD, FAAFP

    The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program.

  • Supporting Health Reform in Mexico: Experiences and Suggestions From an International Primary Health Care Conference

    Articles | May 16, 2016 | Chris van Weel, MD, PhD; Deborah Turnbull, MPsy, PhD; José Ramirez, MD; Andrew Bazemore, MD, MSHP; Richard H. Glazier, MD; Carlos Jaen, MD, PhD; Bob Phillips, MD, MSHP; and Jon Salsberg, PhD

    A pre-conference at the 2015 Cancun NAPCRG conference aimed to develop an action plan and build leadership

  • Access to Primary Care in U.S. Counties Is Associated with Lower Obesity Rates

    Articles | Apr 14, 2016 | Anne H. Gaglioti, MD; Stephen Petterson, PhD; Andrew Bazemore, MD, MPH; and Robert Phillips, MD

    Obesity causes substantial morbidity and mortality in the United States. Evidence shows that primary care physician (PCP) supply correlates positively with improved health, but its association with obesity in the United States as not been adequately characterized.

  • Characteristics and Distribution of Graduate Medical Education Training Sites: Are We Missing Opportunities to Meet U.S. Health Workforce Needs?

    Articles | Mar 29, 2016 | Janice Blanchard, MD; Stephen Petterson, PhD; Andrew Bazemore, MD, MPH; and Fitzhugh Mullins, MD

    this study characterizes the distribution of residency training sites in different settings for three high-need specialties-family medicine, internal medicine, and general surgery.

  • Summary: Understanding the Impact of Medicare Advantage on Hopitalization Rates2 page PDF

    Reports | Mar 15, 2016 | The Robert Graham Center

  • Understanding the Impact of Medicare Advantage on Hospitalization Rates: A 12-State Study34 page PDF

    Reports | Mar 15, 2016 | Stephen Petterson, PhD; Andrew Bazemore, MD, MPH; Yalda Jabbarpour, MD; and Peter Wingrove, BS

  • Complexity of Ambulatory Care Visits of Patients with Diabetes as Reflected by Diagnoses per Visit

    Articles | Jan 12, 2016 | Miranda Moore, PhD; Claire Gibbons, PhD; Newton Cheng, MS; Megan Coffman, MS; Stephen Petterson, PhD; and Andrew Bazemore, MD, MpH

    To explore complexity, we looked at diabetes as a case study to determine whether and how the complexity of office-based visits varies by physician specialty type, as measured by the number of diagnoses reported per visits.

  • Primary Care and the Triple Aim: An Annotated Bibliography43 page PDF

    Reports | Nov 05, 2015 | The Robert Graham Center

  • Robert Graham Center 2015 Telehealth Report22 page PDF

    Reports | Oct 30, 2015 | The Robert Graham Center

  • What's Happening to Cheap Generic Drugs?

    Commentaries & Editorials | Oct 05, 2015 | Douglas Kamerow, MD

    Prices for certain generic drugs have skyrocketed recently. Sometimes this is due to standard market circumstances, but increasingly it is caused by aggressive pricing strategies by pharmaceutical companies.

  • More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalization

    Articles | May 01, 2015 | Andrew Bazemore, MD; Robert Phillips, MD, MSPH; Petterson, Stephen, PhD; and Lars Peterson, MD, PhD

    Comprehensiveness is lauded as 1 of the 5 core virtues of primary care, but its relationship with outcomes is unclear. We measured associations between variations in comprehensiveness of practice among family physicians and healthcare utilization and costs for their Medicare beneficiaries.

  • Smaller Practices Are Less Likely to Report PCMH Certification

    One Pagers | Apr 01, 2015 | Melanie Raffoul, MD; Stephen Petterson, PhD; Miranda Moore, PhD; Andrew Bazemore, MD, MPH; and Lars Peterson, MD, PhD

    Despite efforts to achieve broad transformation of primary care practices into patient-centered medical homes (PCMHs), certification rates have lagged in small and solo practices. The challenges these groups face with the transformation and certification processes should be addressed to continue national momentum toward reshaping the nation’s primary care platform.

  • Estimating the Residency Expansion Required to Avoid Projected Primary Care Physician Shortages by 2035

    Articles | Mar 16, 2015 | Stephen M. Petterson, PhD; Winston R. Liaw, MD, MPH; Carol Tran, MD; and Andrew W. Bazemore, MD MPH

    The purpose of this study was to calculate the projected primary care physician shortage, determine the amount and composition of residency growth needed, and estimate the impact of retirement age and panel size changes.

  • Consideration About Retirement from Clinical Practices by Obstetrician Gynecologist

    Articles | Mar 02, 2015 | Williams Rayburn, MD, MBA; Albert Strunk, JD, MD; and Stephen Petterson, PhD

    Retirement of obstetrician-gynecologists is becoming a matter of increasing concern in light of an expected shortage of practicing physicians. Determining a retirement age is often complex. We address what constitutes a usual retirement age range from general clinical practice for an obstetrician-gynecologist, compare this with practitioners in other specialties, and suggest factors of importance to obstetrician-gynecologists before retirement.

  • Opting Out of Medicaid Expansion May Cost States Additional Primary Care Physicians

    One Pagers | Jan 01, 2015 | Mark W. Lin, MD; Stephen Petterson, Phd; Claire Gibbons, Phd; Sean Finnegan, MS; Andrew Bazemore, MD, MpH

    States currently electing not to expand Medicaid possibly forego the opportunity to expand their primary care workforces by a total of 1,525 physicians. Increased demand from expansion states and a limited primary care physician pool may provide a pull across state lines to the disadvantage of nonexpansion states.

  • Fewer Family Physicians are in Solo Practices

    Articles | Jan 01, 2015 | Lars Peterson, MD, PhD; Elizabeth Baxley, MD; Carlos Jaen, MD, PhD; and Robert Phillips, MD, MSPH

    Over the past 20 years there has been a statistically significant trend toward fewer family physicians identifying as being in solo practice. Further study to determine the reasons for this decline and its impact on access to care will be critical because rural areas are more dependent on solo practitioners.

  • Trends in Office-Based Care for Reproductive-Aged Women According to Physician Specialty: A Ten-Year Study

    Articles | Dec 23, 2014 | Stephen Petterson, PhD; Andrew Bazemore, MD, MPH; Robert Phillips, MD, MSHP; and William Rayburn, MD

    The anticipated increase in access to health care has prompted an interest in where women go for their office-based care. The objectives of this study were to examine which types of office site are chosen by reproductive-aged women for their health care and to compare the reasons for their visits among these sites.

  • Do Residents Who Train in Safety Net Settings Return for Practice?

    Articles | Dec 15, 2014 | Phillips, Robert L. MD, MSPH; Petterson, Stephen PhD; Bazemore, Andrew MD, MPH

    This study examines the relationship between training during residency in a federally qualified health center (FQHC), rural health clinic (RHC), or critical access hospital (CAH) and subsequent practice in these settings.

  • Trends in Physician House Calls to Medicare Beneficiaries

    Articles | Nov 30, 2014 | Lars Peterson, MD, PhD; Stephen Landers, Andrew Bazemore, MD, MPH

    House calls (HCs) to older adults seemed to be headed for extinction in recent decades. HCs may be a tool to ensure access and reduce institutionalization of the elderly population. This study determines the number and distribution of HCs by physician specialty over time and analyzes associations of providing HCs with physician and area-level characteristics.

  • General Internists and Family Physicians: Partners in Geriatric Medicine?

    Commentaries & Editorials | Nov 30, 2014 | James W. Mold, MD, MPH, Larry A. Green, MD, and George E. Fryer, PhD

    General internists and family physicians: Partners in geriatric medicine?

  • A Retrospective Analysis of the Relationship Between Medical Student Debt and Primary Care Practice in the United States

    Articles | Nov 17, 2014 | Julie Phillips; Stephen Petterson, PhD; Andrew Bazemore, MD, MPH; and Robert Phillips, MD, MSHP

    A retrospective analysis of the relationship between medical student debt and primary care practice in the United States

  • Public Health and Community Medicine Instruction and Physician Practice Location

    Articles | Nov 01, 2014 | Imam Xierali, PhD; Rika Maeshiro, MD, MPH; Sherese Johnson, MPH; Taniececea Arceneaux, PhD; and Malika Fair, MD, MPH

    Background: Experts have historically recommended better integration of public health content into medical education. Whether this adoption is associated with physician practice location has not been studied.

  • Structure and Characteristics of Family Medicine Maternity Care Fellowship

    Articles | Oct 01, 2014 | Lars Peterson, MD, PhD; Brenna Blackburn, MPH; Robert Phillips, MD, MSPH; and James Puffer MD

    Fewer family physicians are providing maternity care. Maternity Care Fellowships (MCFs) provide training in advanced obstetrical skills, including cesarean sections. These programs lack official recognition and certification. MCF graduates have been studied, but there are no studies of the fellowships. The objective of this study was to assess the structure and organization of family medicine MCFs

  • Health is Primary: Family Medicine for America's Health

    Articles | Oct 01, 2014 | Perry A. Pugno, MD, MPH; John W. Saultz, MD; Michael L. Tuggy, MD; Jeffrey M. Borkan, MD, PhD; Grant S. Hoekzema, MD; Jennifer E. DeVoe, MD, DPhil; Jane A. Weida, MD; Lars E. Peterson, MD, PhD; Lauren S. Hughes, MD, MPH; Jerry E. Kruse, MD, MSPH; James C. Puffer, MD

    More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to “renew the specialty to meet the needs of people and society,” this article reviews the important results of this collaboration.

  • Impact of Global Health Experience During Residency in Graduate Practice Location: A Multiple Cohort Study

    Articles | Sep 01, 2014 | Winston Liaw, MD; Andrew Bazemore, MD, MPH; Imam Xierali, PhD; John Walden, MD; and Phillip Diller, MD, PhD

    The impact of global health experiences on practice location is not clear. Graduates of programs with global health experiences were more likely to practice in an underserved or rural area. Making these experiences available may affect participants and nonparticipants.

  • Factors Influencing Family Physicians' Contribution to the Child Health Care Workforce

    Articles | Sep 01, 2014 | Laura Makaroff, DO; Xierali Imam, PhD; Stephen Petterson, PhD; Scott Shipman, MD, MPH; Andrew Bazemore, MD, MPH; and James Puffer, MD

    We wanted to explore demographic and geographic factors associated with family physicians' provision of care to children. We analyzed the proportion of family physicians providing care to children using survey data collected by the American Board of FamilyMedicine from 2006 to 2009. Using a cross-sectional study design and logistic regression analysis, we examined the association of various physician demographic and geographic factors and providing care of children.

  • One in Fifteen Family Physicians Principally Provide Emergency or Urgent Care

    Articles | Aug 01, 2014 | Stephen Petterson, PhD; Lars Peterson, MD, PhD; Robert L. Phillips, MD, MSHP; Miranda Moore, PhD; Sean Finnegan, MS; Megan Coffman, MS; and Andrew Bazemore, MD, MPH

    A small but nontrivial proportion of US family physicians devote most of their time providing emergency or urgent care. With considerable attention focused on expanding access to primary care, it is important to account for providers principally working outside of traditional primary care.

  • Mental Health Treatment in the Primary Care Setting: Patterns and Pathways.

    Articles | Jun 09, 2014 | Stephen Petterson, PhD; Benjamin Miller, PsyD; Jessica Payne-Murphy, MA; Robert Phillips, MD, MSPH

    The redesign of primary care through the patient-centered medical home offers an opportunity to assess the role of primary care in treating mental health relative to the rest of the health care system. Better understanding the patterns of care between primary care and mental health providers helps guide necessary policy changes. This article reports the findings from 109,593 respondents to the 2002–2009 Medical Expenditure Panel Surveys (MEPS).

  • The Changing Landscape of Primary Care HPSAs and the Influence on Practice Location

    One Pagers | May 01, 2014 | Sean C. Finnegan, MS; Newton Cheng, MS; Andrew W. Bazemore, MD, MPH; Jennifer L. Rankin, PhD, MPH, MHA; and Stephen M. Petterson, PhD

    Health professional shortage area (HPSA) designations were created to highlight areas of primary care shortage and direct incentives to physicians willing to practice in these areas. We demonstrate the volatility of these geographies by examining the HPSA status of primary care physicians whose practice locations were the same in 2008 and 2013. Although the change in the percentage of physicians practicing in HPSAs over this period was negligible, approximately 28% of the stationary physicians lost a primary care HPSA designation, whereas about 21% gained a designation.

  • Primary Care, Behavioral Health, Provider Colocation and Rurality

    Articles | May 01, 2014 | Benjamin Miller ,PsyD; Stephen Petterson, PhD; Shandra Levrey, PhD; Jessica Payne-Murphy, MA; Miranda Moore, PhD; and Andrew Bazemore, MD, MPH

    Purpose: The purpose of this study was to characterize the proximity of primary care and behavioral health service delivery sites in the United States and factors influencing their colocation.

  • Ages of Obstetrician-Gynecologist at Retirement from Clinical Practice

    Articles | Apr 15, 2014 | William Rayburn, MD; Stephen Petterson, PhD; Newton Cheng, MS

    Expansion of medical school enrollment in the 1960s through 1980s has led to more baby boomer physicians reaching retirement age. The objectives were to determine the number of obstetrician-gynecologists nearing retirement age and how eventual retirement will affect the future supply of obstetrician-gynecologists

  • Trends in Family Physicians Performing Deliveries, 2003-2010

    Articles | Mar 15, 2014 | William F. Rayburn MD, MBA; Stephen M. Petterson PhD; and Robert L. Phillips MD, MSPH

    This observational study examined the proportion of family physicians continuing to perform deliveries from 2003–2010. Presented at the 9th annual Association of American Medical Colleges Physician Workforce Research Conference, Alexandria, Virginia, USA, May 2, 2013.

  • The Impact of Insurance and a Usual Source of Care on Emergency Department Use in the United States

    Articles | Feb 15, 2014 | Liaw, Winston, MD, MPH; Petterson, Stephen, PhD; Rabin, David L., MPH; and Bazemore, Andrew, MD, MPH

    Finding a usual source of care (USC) is difficult for certain populations. This analysis determines how insurance type and having a USC affect the settings in which patients seek care.

  • Ecology of Healthcare: The Need to Address Low Utilization in American Indians/ Alaska Natives

    One Pagers | Feb 01, 2014 | Elise A.G. Meyers, BA; Stephen Petterson, PHD; Claire Gibbons, PHD; And Andrew Bazemore, MD, MPH

    Disparities in health and access to health care continue to persist among the American Indian/Alaska Native population, despite federal efforts to call attention to and address these disparities.

  • Patients with High-Cost Chronic Conditions Rely Heavily on Primary Care Physicians

    Articles | Jan 15, 2014 | Manisha, Sharma, MD; Newton Cheng, MS; Miranda Moore, PhD; Megan Coffman, MS; and Andrew Bazemore, MD, MPH

    Today’s US physician workforce principally comprises specialists trained in the care of specific chronic conditions in the outpatient setting. However, a majority of patients seeking care for most of 14 high-cost chronic conditions were more likely to see a primary care physician than a specialist physician.

  • Family Physicians in the Maternity Care Workforce: Factors Influencing Declining Trends.

    Articles | Nov 15, 2013 | Sebastian Tong, MD, MPH; Laura Makaroff, MD, MPH; Imam Xierali, PhD; James Puffer, MD; Warren Newton, MD; and Andrew Bazemore, MD, MPH

    Family physicians provide access to maternity care for a disproportionate share of rural and urban underserved communities. This paper aims to determine trends in maternity care provision by family physicians and the characteristics of family physicians that provide maternity care. We used American Board of Family Medicine survey data collected from every family physician during application for the Maintenance of Certification Examination to determine the percentage of family physicians that provided maternity care from 2000 to 2010.

  • Comparison of Primary Care Service Areas and Estimated Drive times25 page PDF

    Presentations | Oct 30, 2013 | Sean Finnegan, MS

    Comparison of Primary Care Service Areas and Estimated Drive Times: An Evaluation of the Geographic Accessibility to Primary Care Services for the Populations within Primary Care Service Areas

  • A Needs-Based Method for Estimating the Behavioral Health Staff Needs of Community Health Centers

    Articles | Jul 15, 2013 | Bridget Teevan Burke, Benjamin F Miller, Michelle Proser, Stephen M Petterson, Andrew W Bazemore, Eric Goplerud and Robert L Phillips.

    Federally Qualified Health Centers are expanding to increase access for millions of more Americans with a goal of doubling capacity to serve 40 million people. Health centers provide a lot of behavioral health services but many have difficulty accessing mental health and substance use professionals for their patients. To meet the needs of the underserved and newly insured it is important to better estimate how many behavioral health professionals are needed.

  • Training a Health Care Workforce to Meet Your State's Needs (and Wants)35 page PDF

    Presentations | Apr 15, 2013 | Andrew Bazemore, MD, MpH

    Training a Health Care Workforce to Meet Your State's Needs (and Wants): Addressing Challenges: Data, Tools and Primary Care

  • Effectiveness Over Efficiency: Underestimating the Primary Care Physicians Shortage

    Articles | Feb 01, 2013 | Robert Phillips, MD, MSPH; Andrew Bazemore, MD, MPH; and Lars Peterson, MD, PhD

    Interest in improving health care outcomes requires increasing the effectiveness of primary care. Focus on effectiveness is leading many innovative health systems to shrink primary care patient panels to strengthen relationships, and to enhance primary care teams to increase comprehensiveness. Such strategies would make primary care shortages worse than predicted, and are compounded by substantial declines in clinicians of all types choosing primary care careers.

  • Health Care Transition

    One Pagers | Dec 01, 2012 | Patricia A. Stoeck, Md; Newton Cheng, Ms; Anne J. Berry, Ba; Andrew W. Bazemore, Md, Mph; And Robert L. Phillips, Jr., Md, Msph

    Youth with special health care needs who receive care within a patient-centered medical home (PCMH) are significantly more likely to receive services for transitioning to adult care. Broader implementation of the PCMH may contribute to wider use of health care transition counseling and enhanced support for such patients as they prepare to enter adulthood.

  • Is Exposure to Student-Run Clinic Associated with Future Primary Care Practice?

    Articles | Sep 15, 2012 | Sebastian Tong, MD, MPH; Robert Phillilps, MD,MSPH; and Rebecca Berman, MD

    This study explored whether or not there is an association between presence of a student-run clinic at a medical school and future practice of medical school graduates in a primary care specialty through using a 2005 survey of all student-run clinics associated with medical schools, supplemented by direct survey of schools missing from this dataset. No association between having a student-run clinic in 2005 at a medical school and proportion of its graduates who currently practice primary care was found.

  • Integrating Community Health Centers Into Organized Delivery Systems Can Improve Access to Subspecialty Care

    Articles | Aug 15, 2012 | Katherine Neuhausen, MD; Kevin Grumbach, MD; Andrew Bazemore, MD, MPH; Robert L. Phillips Jr, MD, MSPH

    The Affordable Care Act is funding the expansion of community health centers to increase access to primary care, but this approach will not ensure effective access to subspecialty services. To address this issue, we interviewed directors of twenty community health centers. Our analysis of their responses led us to identify six unique models of how community health centers access subspecialty care, which we called Tin Cup, Hospital Partnership, Buy Your Own Subspecialists, Telehealth, Teaching Community, and Integrated System. We determined that the Integrated System model appears to provide the most comprehensive and cohesive access to subspecialty care. Because Medicaid accountable care organizations encourage integrated delivery of care, they offer a promising policy solution to improve the integration of community health centers into “medical neighborhoods.”

  • Measures of Social Deprivation That Predict Health Care Access and Need Within a Rational Area of Primary Care Service Delivery

    Articles | Jul 15, 2012 | Danielle C. Butler, MBBS, MPH; Stephen Petterson, PhD; Robert L. Phillips, MD, MSPH; and Andrew W. Bazemore, MD, MPH

    Objective: To develop a measure of social deprivation that is associated with health care access and health outcomes at a novel geographic level, primary care service area. Data Sources/Study Setting: Secondary analysis of data from the Dartmouth Atlas, AMA Masterfile, National Provider Identifier data, Small Area Health Insurance Estimates, American Community Survey, Area Resource File, and Behavioural Risk Factor Surveillance System. Data were aggregated to primary care service areas (PCSAs). Study Design: Social deprivation variables were selected from literature review and international examples. Factor analysis was used. Correlation and multivariate analyses were conducted between index, health outcomes, and measures of health care access. The derived index was compared with poverty as a predictor of health outcomes. Data Collection/Extraction Methods: Variables not available at the PCSA level were estimated at block level, then aggregated to PCSA level. Principle Findings: Our social deprivation index is positively associated with poor access and poor health outcomes. This pattern holds in multivariate analyses controlling for other measures of access. A multidimensional measure of deprivation is more strongly associated with health outcomes than a measure of poverty alone. Conclusions: This geographic index has utility for identifying areas in need of assistance and is timely for revision of 35-year-old provider shortage and geographic underservice designation criteria used to allocate federal resources.

  • The Percentage of Family Physicians Attending to Women's Gender-Specific Health Needs is Declining

    Articles | Jun 15, 2012 | Imam M. Xierali, PhD; James C. Puffer, MD; Sebastian T. C. Tong, BA; Andrew W. Bazemore, MD, MPH; and Larry A. Green, MD

    As the largest and most widely distributed of primary care physicians, family physicians have an important role in providing women's health care, especially in rural and underserved areas. The proportion of family physicians who are attending to women is declining. Policy intervention may be needed to help family physicians maintain the comprehensiveness of care necessary to address the wide range of medical problems of women they encounter within their practices.

  • Proportion of Family Physicians Providing Maternity Care Continues to Decline

    Articles | May 15, 2012 | Sebastian T. C. Tong, BA; Laura A. Makaroff, DO; Imam M. Xierali, PhD; Parwen Parhat, MA; James C. Puffer, MD; Warren P. Newton, MD, MPH; and Andrew W. Bazemore, MD, MPH

    Family physicians traditionally have played an integral role in delivering babies as a component of the comprehensive care they provide for women. The proportion of family physicians who report providing any maternity care continues to decrease. This trend is particularly concerning because family physicians are the most widely distributed specialty and are essential to health care access in rural areas.

  • Declining Numbers of Family Physicians are Caring for Children

    Articles | Mar 15, 2012 | Andrew W. Bazemore, MD, MPH; Laura A. Makaroff, DO; James C. Puffer, MD; Parwen Parhat, MA; Robert L. Phillips, MD, MSPH; Imam M. Xierali, PhD; and Jason Rinaldo, PhD

    http://www.graham-center.org/online/graham/home/publications/articles/2012/abazems-declining-numbers.html

  • Increasing Graduate Medical Education (GME) in Critical Access Hospitals (CAH) could enhance physician recruitment and retention in rural America

    Articles | Jan 15, 2012 | mam M. Xierali; Sarah A. Sweeney; Robert L. Phillips, Jr.; Andrew W. Bazemore; and Stephen M. Petterson, PhD

    Critical Access Hospitals (CAHs) are essential to a functioning health care safety net and are a potential partner of rural Graduate Medical Education (GME) which is associated with greater likelihood of service in rural and underserved areas. Currently, very little Medicare funding supports GME in the CAH setting, highlighting a missed opportunity to improve access to care in rural America.

  • Refocusing Geriatricians’ Role in Training to Improve Care for Older Adults

    One Pagers | Jan 01, 2012 | Elizabeth J. Bragg, PhD, RN; Gregg A. Warshaw, MD; Stephen M. Petterson, PhD; Imam M. Xierali, PhD; Andrew W. Bazemore, MD, MPH; and Robert L. Phillips, Jr., MD, MSPH

    The current number of geriatricians cannot keep up with the health care needs of the growing number of older adults. To fill the gap, more geriatricians should focus on training primary care and other specialty physicians to care for older adults.

  • Evidence About the Role of the PCMH and ACOs in Improving Quality and Safety36 page PDF

    Presentations | May 15, 2011 | Robert L. Phillips, Jr., MD, MSPH

    Evidence about the Role of the PCMH and ACOs in Improving Quality and Safety

  • FPs Lower Hospital Readmission Rates and Costs

    One Pagers | May 01, 2011 | Veerappa K. Chetty, PhD; Larry Culpepper, MD, MPH; Robert L. Phillips, Jr., MD, MSPH; Jennifer Rankin, PhD, MPH, MS, MHA; Imam Xierali, PhD; Sean Finnegan, BS; and Brian Jack, MD

    Hospital readmission after discharge is often a costly failing of the U.S. health care system to adequately manage patients who are ill. Increasing the number of family physicians (FPs) is associated with significant reductions in hospital readmissions and substantial cost savings.

  • Rural-Urban Distribution of the U.S. Geriatrics Physician Workforce

    Articles | Apr 15, 2011 | LE Peterson; A Bazemore; EJ Bragg; I Xierali; and GA Warshaw

    OBJECTIVES: To determine the distribution of geriatricians across the rural-urban continuum from 2000 to 2008 and to compare with primary care physicians in 2008. DESIGN: County-level analysis of physician data from the American Medical Association Physician Masterfile for 2000, 2004, and 2008 merged with U.S. Census data on the number of older (≥65) county residents. Descriptive statistics for each year were stratified according to 2003 Rural Urban Continuum Codes (RUCCs). SETTING: United States. PARTICIPANTS: Physicians in the United States. MEASUREMENTS: Number of physicians per county elderly population. RESULTS: The number of self-identified geriatricians nationwide increased from 5,157 to 7,412 from 2000 to 2008. The number of geriatricians increased in each RUCC level, with nearly 90% of geriatricians residing in urban areas in all years. In 2008, the number of geriatricians per 10,000 older adults declined as rurality increased (from 1.48 in the most-urban areas to 0.80 in the most rural). General internal medicine physicians are more plentiful in urban counties and declined as rurality increased (from 27.29 to 3.85 per 10,000 older adults in 2008). In contrast, family physicians were more evenly distributed with the elderly population across the rural-urban continuum (22.02 to 14.27 per 10,000 older adults in 2008). CONCLUSION: Small numbers of geriatricians combined with a growing elderly population poses a challenge and an opportunity. Healthcare systems and policy-makers will need to modify care models to better use the skill of geriatricians in concert with other providers to provide quality care for older rural and urban Americans.

  • Paul Ambrose Spring Forum: Primary Care Present and Future43 page PDF

    Presentations | Apr 15, 2011 | Robert L. Phillips, Jr., MD, MSPH

    Primary Care Present and Future

  • Comparison Between U.S. Preventive Services Task Force Recommendations and Medicare Coverage

    Articles | Jan 15, 2011 | LI Lesser; AH Krist; DB Kamerow; and AW Bazemore

    The U.S. Preventive Services Task Force (USPSTF) is authorized by the U.S. government to review and disseminate the scientific evidence for clinical preventive services. The purpose of this study was to evaluate the alignment of Medicare preventive services coverage with the recommendations of the USPSTF before implementation of health reform. METHODS: We recorded all Medicare coverage for preventive services as listed in the Medicare preventive services guide of 2007 (including the 2009 update) for all recommended (A- or B-rated) USPSTF and not recommended (D-rated) guidelines for preventive screening and counseling in adults aged 65 years and older. We analyzed 2 components of preventive care: preventive coordination (risk assessment, patient motivation, and arranging of preventive service) and the preventive service itself. The main outcome measure was the percentage of agreement between USPSTF recommendations and Medicare coverage. RESULTS: The USPSTF recommended 15 preventive interventions for adults aged 65 years and older. Although Medicare partially reimbursed 93% of recommended services, full reimbursement for the preventive coordination, as well as the service, was available for only 7% of these services. This partial coverage is available mostly as part of the Welcome to Medicare Visit. Further, the USPSTF recommended against 16 preventive services; Medicare reimbursed clinicians for 44% of these services. CONCLUSIONS: Medicare coverage for preventive services needs to be reassessed, with special focus on preventive coordination. Continuing previous practices will likely promote both inadequate and excessive delivery of preventive services. The new health care reform law has the potential to improve the provision of preventive services to Medicare beneficiaries.

  • Illinois Health Connect and Your Healthcare Plus Case Statement18 page PDF

    Monographs & Books | Aug 15, 2010 | Robert Graham Center

    This case statement serves as a primer on Illinois Health Connect and Your Healthcare Plus. It describes these programs, their early achievements and the current state environment in which they exist. It then compares them to several model projects occurring in other states.

  • Improving the Delivery of Preventive Services to Medicare eneficiaries

    Commentaries & Editorials | Dec 23, 2009 | Lenard I. Lesser, MD and Andrew W. Bazemore, MD, MPH

    While policy makers emphasize increased use of preventive care as central to health reform's ability to lengthen lives and save costs, busy clinicians still lack financial incentives to coordinate and effect evidence-based prevention. To realize these ambitions, the Department of Health and Human Services should align payments from the CMS with the preventive evidence base produced by the USPSTF. Simultaneously, Congress should implement innovative payment reforms driving new models of preventive coordination and accountability, revisit previously authorized but unnecessary services, and increase support for research on their effectiveness and cost-effectiveness.

  • Family Physicians' Present and Future Role in Caring for the Elderly

    One Pagers | Nov 15, 2009 | Lars E. Peterson, MD, PhD; Andrew W. Bazemore, MD, MPH; Robert L. Phillips Jr., MD, MSPH; Bridget Teevan, MS; Martey S. Dodoo, PhD; Imam Xierali, PhD; and Stephen M. Petterson, PhD

    The population of patients older than 65 years is projected to increase substantially in the coming years, particularly in rural areas. Family physicians are essential providers of geriatric care, especially in rural areas, but need payment reform to improve their capacity to meet the needs of older patients

  • Race and Ethnicity and Rural Mental Health Treatment

    Articles | Aug 15, 2009 | S Petterson, PhD; IC Williams, PhD; EJ Hauenstein, PhD, LCP, MSN, RN; V Rovnyak, PhD; E Merwin, PhD, RN, FAAN

    Objective: Research has shown that there is less use of mental health services in rural areas even when availability, accessibility, demographic, and need factors are controlled. This study examined mental health treatment disparities by determining treatment rates across different racial/ethnic groups. Methods: Data from the first four panels of the Medical Expenditure Panel Survey (MEPS) were used for these analyses. The sample consisted of 36,288 respondents yielding 75,347 person-year observations. The Economic Research Service’s Rural-Urban Continuum was used as a measure of rurality. Results: Findings show that rural residence does little to contribute to existing treatment disparities for racial/ethnic minorities living in these areas. Conclusions: Findings suggest that characteristics of the rural environment may disadvantage all residents with respect to mental health treatment. In more populated areas where mental health services are more plentiful, complex racial and service system factors may play a greater role in evident ethnic/racial treatment disparities.

  • How States Will Solve the Healthcare Workforce Crisis: What to Ask For from the Feds50 page PDF

    Presentations | Jun 15, 2009 | Bob Phillips, MD, MSPH

    How states will solve the healthcare workforce crisis: What to ask for from the Feds

  • Health Care Reform Depends on Family Medicine: Walk Softly Keep the Stick Close44 page PDF

    Presentations | Jun 15, 2009 | Bob Phillips, MD, MSPH

    Health care reform depends on family medicine: Walk softly but keep the stick close

  • Is Colorado Ready for a Primary Care-based Health Care System?72 page PDF

    Presentations | Apr 15, 2009 | Bob Phillips, MD MSPH and Andrew Bazemore, MD MPH

    Is Colorado ready for a primary care-based health care system?

  • Medical school expansion, primary care, and policy: Engaging primary care educators in evidence-based advocacy68 page PDF

    Presentations | Apr 15, 2009 | Andrew Bazemore, MD, MPH; Julie Phillips, MD, MPH; Amy McGaha, MD; Hope Wittenberg, MA

    Medical school expansion, primary care, and policy: Engaging primary care educators in evidence-based advocacy

  • Universal Primary Care34 page PDF

    Presentations | Mar 26, 2009 | Michael Fine, MD, and Shannon Brownlee, MS

    Universal Primary Care - Health Care. Reform. Shovel Ready Now

  • Primary Care's Ecologic Impact on Obesity

    One Pagers | Mar 15, 2009 | Anne Gaglioti, MD; Stephen M. Petterson, PhD; Andrew W. Bazemore, MD, MPH; Robert L. Phillips Jr, MD, MSPH; Martey S. Dodoo, PhD; and Xingyou Zhang, PhD

    Increased primary care physician density on the county level is associated with decreased obesity rates. As we move to restructure the primary care workforce and engage our patients and communities in behavior change, the implications of this association merit closer investigation.

  • The Robert Graham Center Update: A Primary Care Perspective on Health Care Workforce and Expenditures50 page PDF

    Presentations | Mar 15, 2009 | Robert Graham Center

    A compendium of slides for public use that includes original and adapted analyses, commentary, and annotation from the staff of the Robert Graham Center.

  • Health Care: The Next Mortgage Crisis32 page PDF

    Presentations | Mar 15, 2009 | ichael Fine, MD, and Shannon Brownlee, MS

    Health Care: The Next Mortgage Crisis

  • Having a Usual Source of Care reduces ED Visits

    One Pagers | Jan 15, 2009 | Stephen Petterson, PhD; David Rabin, MD, MPH; Robert L. Phillips, Jr., MD, MSPH; Andrew Bazemore, MD, MPH; and Martey S. Dodoo, PhD

    The recent growth in the use of emergency departments (EDs) is costly, undesirable, and unnecessary. This trend is partly due to a growing proportion of persons who lack a usual source of care. This group is increasingly likely to rely on EDs for their health care needs compared with those who have a usual source of care.

  • Primary Care in the ACO: The Role of Primary Care in the Future Healthcare System1 page PDF

    Presentations | Nov 14, 2008 | Erica Brode, MD MPH; Andrew Bazemore, MD, MPH; Kevin Grumbach, MD

  • Will Patients Find Diversity in the Medical Home?

    One Pagers | Jul 15, 2008 | Eddie J. Turner, MD, Andrew W. Bazemore, MD, MPH, Robert L. Phillips, Jr., MD, MSPH and Larry A. Green, MD

    Mexican Americans and blacks experience disparities in health outcomes relative to white populations. During the past five to 10 years, fewer blacks and Mexican Americans are going to medical school and entering primary care professions. To assure the availability of a patient-centered medical home for all Americans, policy makers must work to support a culturally competent and diverse primary care workforce.

  • The Robert Graham Center Update 200847 page PDF

    Presentations | Jul 15, 2008 | Robert Graham Center

    A compendium of slides for public use that includes original and adapted analyses and commentary from the staff of the Robert Graham Center.

  • A Perfect Storm: Changes Impacting Medicare Threaten Primary Care Access in Underserved Areas

    One Pagers | Jun 15, 2008 | Imam Xierali, PhD; Andrew Bazemore, MD MPH; Bob Phillips, MD MSPH; Stephen Petterson, PhD; Martey Dodoo, PhD and Bridget Teevan, MIS

    A convergence of three policies could reduce physician Medicare payments by 14.9 to 22.3 percent in 2008, which could jeopardize access for Medicare beneficiaries in underserved areas. Congress and the Executive Branch should coordinate their roles in setting Medicare payment policy, because their overlapping decisions can have additive impact.

  • Testing Process Errors and Their Harms and Consequences Reported from Family Medicine Practices: A sSudy of the American Academy of Family Physicians National Research Network

    Articles | Jun 15, 2008 | Hickner J, Graham DG, Elder NC, Brandt E, Emsermann CB, Dovey S, Phillips R

    CONTEXT: Little is known about the types and outcomes of testing process errors that occur in primary care. OBJECTIVE: To describe types, predictors and outcomes of testing errors reported by family physicians and office staff. DESIGN: Events were reported anonymously. Each office completed a survey describing their testing processes prior to event reporting. SETTING AND PARTICIPANTS: 243 clinicians and office staff of eight family medicine offices. MAIN OUTCOME MEASURES: Distribution of error types, associations with potential predictors; predictors of harm and consequences of the errors. RESULTS: Participants submitted 590 event reports with 966 testing process errors. Errors occurred in ordering tests (12.9%), implementing tests (17.9%), reporting results to clinicians (24.6%), clinicians responding to results (6.6%), notifying patient of results (6.8%), general administration (17.6%), communication (5.7%) and other categories (7.8%). Charting or filing errors accounted for 14.5% of errors. Significant associations (p<0.05) existed between error types and type of reporter (clinician or staff), number of labs used by the practice, absence of a results follow-up system and patients' race/ethnicity. Adverse consequences included time lost and financial consequences (22%), delays in care (24%), pain/suffering (11%) and adverse clinical consequence (2%). Patients were unharmed in 54% of events; 18% resulted in some harm, and harm status was unknown for 28%. Using multilevel logistic regression analyses, adverse consequences or harm were more common in events that were clinician-reported, involved patients aged 45-64 years and involved test implementation errors. Minority patients were more likely than white, non-Hispanic patients to suffer adverse consequences or harm. CONCLUSIONS: Errors occur throughout the testing process, most commonly involving test implementation and reporting results to clinicians. While significant physical harm was rare, adverse consequences for patients were common. The higher prevalence of harm and adverse consequences for minority patients is a troubling disparity needing further investigation.

  • Brakes for a Runaway Train?48 page PDF

    Presentations | May 23, 2008 | Cathy Schoen, MS

    Brakes for a Runaway Train? The Medical Home's Role in Containing U.S. Health Care Expenditures

  • Physician Distribution and Access: Workforce Priorities

    One Pagers | May 15, 2008 | Xingyou Zhang, PhD; Bob Phillips, MD MSPH; Andrew Bazemore, MD MPH; Martey Dodoo, PhD; Stephen Petterson, PhD; Imam Xierali, PhD, and Larry A. Green, MD

    Most Primary Care Health Professional Shortage Areas (HPSAs) exceed federal population-to-physician designation criteria, yet struggle to maintain access to primary care physicians. Policy options for recruiting and retaining primary care physicians to HPSAs, and new HPSA criteria that support access to primary care practices, should be considered.

  • Non-emergency Medicine-Trained Physician Coverage in Rural Emergency Departments

    Articles | Apr 15, 2008 | Peterson LE, Dodoo M, Bennett KJ, Bazemore A, Phillips RL Jr.

    Rural areas have fewer physicians compared to urban areas, and rural emergency departments often rely on community or contracted providers for staffing. The emergency department workforce is composed of a variety of physician specialties and clinicians. PURPOSE: To determine the distribution of emergency department clinicians and the proportion of care they provide across the rural-urban continuum. METHODS: Cross-sectional analysis of secondary data. The distribution of clinicians who provide emergency department care by county was determined using the 2003 Area Resource File. The percentage of emergency department care provided by clinician type was determined using 2003 Medicare claims data. Logistic regression analyses assessed the odds of being seen by different clinicians with a patient's rurality when presenting to the emergency department. FINDINGS: Board-certified emergency physicians provide 75% of all emergency department care, but only 48% for Medicare beneficiaries of the most rural of counties. The bulk of the remainder of emergency department care is largely provided by family physicians and general internists, with the percentage increasing with rurality. The likelihood of being seen by an emergency physician in the emergency department decreases 5-fold as rurality increases, while being seen by a family physician increases 7-fold. CONCLUSION: Nonemergency physicians provide a significant portion of emergency department care, particularly in rural areas. Medical specialties must cooperate to ensure the availability of high-quality emergency department care to all Americans regardless of physician specialty.

  • Why There Must be Room for Mental Health in the Medical Home

    One Pagers | Mar 15, 2008 | Stephen Petterson, PhD, Bob Phillips, MD MSPH, Andrew Bazemore, MD MPH, Martey Dodoo, PhD, Xingyou Zhang, PhD, and Larry A. Green, MD

    Most people with poor mental health are cared for in primary care settings, despite many barriers. Efforts to provide everyone a medical home will require the inclusion of mental health care if it is to succeed in improving care and reducing costs.

  • Genomics and Healthcare: Will Primary Care Lead or Follow?37 page PDF

    Presentations | Dec 15, 2007 | Greg Feero, MD, PhD

    Genomics and health care: Will primary care lead or follow?

  • Primary Care Data Standards: What Do We Have now? What Do We Still Need?16 page PDF

    Presentations | Oct 15, 2007 | Michael Klinkman, MD, MS

    Harmonizing primary care clinical classification and data standards: Expert panel presentaions - Primary care data standards: What do we have now? What do we still need?

  • Why Is It So Important to Have Organizing Principles and Data Standards for Primary Care?12 page PDF

    Presentations | Oct 10, 2007 | Larry Green, MD

    Harmonizing primary care clinical classification and data standards: Expert panel presentions - Why is it so important to have organizing principles and data standards for primary care?

  • Access Granted: The Primary Care Payoff24 page PDF

    Monographs & Books | Aug 15, 2007 | Robert Graham Center

    Access granted: The primary care payoff

  • Access Denied: A Look at America's Medically Disenfranchised42 page PDF

    Monographs & Books | Aug 01, 2007 | The Robert Graham Center, National Association of Community Health Centers

  • The Distribution of IMGs in US: The Interplay of Poverty, Rurality, and Length of Practice12 page PDF

    Presentations | May 15, 2007 | Xingyou Zhang, PhD Martey Dodoo, PhD Stephen Peterson, PhD Andrew Bazemore, MD, MPH Bob Phillips, MD, MSPH

    The distribution of IMGs in the U.S.: The interplay of poverty, rurality, and length of practice

  • Giving Everyone the Health of the Educated: An Examination of Whether Social Change Would Save More Lives Than Medical Advances

    Articles | Apr 15, 2007 | Steven H. Woolf, MD, MPH, Robert E. Johnson, PhD, Robert L. Phillips, Jr, MD, MSPH and Maike Philipsen, PhD

    OBJECTIVES. Social determinants of health, such as inadequate education, contribute greatly to mortality rates. We examined whether correcting the social conditions that account for excess deaths among individuals with inadequate education might save more lives than medical advances (e.g., new drugs and devices). METHODS. Using US vital statistics data for 1996 through 2002, we applied indirect standardization techniques to estimate the maximum number of averted deaths attributable to medical advances and the number of deaths that would have been averted if mortality rates among adults with lesser education had been the same as those among college-educated adults. RESULTS. Medical advances averted a maximum of 178193 deaths during the study period. Correcting disparities in education-associated mortality rates would have saved 1369335 lives during the same period, a ratio of 8:1. CONCLUSIONS. Higher mortality rates among individuals with inadequate education reflect a complex causal pathway and the influence of confounding variables. Formidable efforts at social change would be necessary to eliminate disparities, but the changes would save more lives than would society’s current heavy investment in medical advances. Spending large sums of money on such advances at the expense of social change may be jeopardizing public health.

  • An Acess Deprivation Index & HealthLandscape14 page PDF

    Presentations | Apr 15, 2007 | Robert Phillips, MD, MSPH, and Andrew Bazemore, MD, MPH

    An access deprivation index and HealthLandscape

  • The NHSC in Rural Counties: A historical review and impact assessment25 page PDF

    Presentations | Mar 15, 2007 | Robert Phillips, MD, MSPH, and Andrew Bazemore, MD, MPH

    The National Health Service Corps in rural counties: A historical review and impact assessment

  • How Well Do Family Physicians Manage Skin Lesions?

    Articles | Jan 15, 2007 | Dan Merenstein, David Meyers, Alex Krixst, Jose Delgado, Jessica L. McCann, Stephen Petterson and Robert L. Phillips

    PURPOSE: Little is known about the epidemiology of new skin lesions seen in primary care. Our primary objective was to determine the percentage of the skin lesions that improved after evaluation by family physicians. Secondarily, we sought to determine patient satisfaction with their care, as well as diagnostic concordance between family physicians and dermatologists in diagnosing and treating skin lesions. METHODS: A prospective cohort study was done in two practice-based research networks. Patients with new skin lesions were eligible. Digital photographs, lesion descriptions and brief patient histories were collected in the family physician's office and independently reviewed by two dermatologists. Patients were administered a telephone survey at days 7, 28 and 84 after the visit to assess the status of lesions and their overall satisfaction with care. RESULTS: After 7 days, 84% of lesions were "much better" or "better." After 28 and 84 days, 89% and 94% of lesions respectively were rated similarly. Overall, patients were satisfied with the dermatologic care provided by their family physician, with 55% of patients reporting highest satisfaction level and 34% reporting second highest on a five point scale at day 7. At days 28 and 84, 93% of the patients reported the two highest levels of satisfaction. Overall diagnostic agreement was 72% between dermatologists and family physicians, with over 80% agreement for the more common diagnoses. CONCLUSION: Our study demonstrates that most skin lesions seen by office-based family physicians resolve within three months, patients are generally satisfied with the care they receive, and the diagnostic and treatment decisions made by primary care physicians are not significantly different from those of their dermatologic colleagues.

  • Imperative Integration: Medical Care for Older Patients

    One Pagers | Oct 01, 2006 | Larry Green, MD, et. al.

    The ecology of medical care changes for older people, with increases in usage of residential and institutional care, emergency departments, and home care. Care integrated across multiple settings, as is proposed for new models of primary care, is essential for the care of older patients.

  • Access, Health, and Wealth: Impact of the National Health Service Corps in Rural America49 page PDF

    Monographs & Books | Sep 15, 2006 | George E. Fryer, PhD; Jessica L. McCann, MA; Martey S. Dodoo, PhD; Larry A. Green, MD; Thomas Miyoshi; Robert L. Phillips, MD, MSPH

  • Examining the Impact of Closing Family Medicine Residency Programs4 page PDF

    Presentations | May 15, 2006 | Jessica McCann, MA Valerie Reese, MD Andrew Bazemore, MD, MPH Robert Phillips, MD, MSPH

    Examining the impact of closing family medicine residency programs

  • The Diminishing Role of FPs in Caring for Children

    One Pagers | May 01, 2006 | Andrew Bazemore, MD, MPH; Robert Phillips, MD, MSPH; Martey Dodoo, PhD; Jessica McCann, MD; Lawrence Klein, PhD; Larry Green, MD

    Nationwide, family physicians (FPs) deliver a smaller proportion of the outpatient care of children than they did 10 years ago. Millions of children depend on FPs for care. Family medicine should reevaluate how it will contribute to the care of the nation's children.

  • Family Physicians Help Meet the Emergency Care Needs of Rural America

    One Pagers | Apr 01, 2006 | Laura Peterson; Andrew Bazemore, MD, MPH; Martey Dodoo, PhD; Robert Phillips, MD, MSPH

    Ensuring access to emergency care in rural areas remains a challenge. High costs and low patient volumes make 100 percent staffing of rural emergency departments (EDs) by emergency medicine residency–trained physicians (EPs) unlikely. As rurality increases, so does the dependence on family physicians (FPs) to provide quality emergent care.

  • Primary Care Physicians’ Perceptions of the Effect of Insurance Status on Clinical Decision Making

    Articles | Mar 01, 2006 | David Meyers, MD; Ranit Mishori, MD; Jessica McCann, MA; Jose Delgado, MD; Ann O'Malley, MD; and Ed Fryer, PhD

    Americans who do not have health insurance receive fewer health services and have poorer health status than those who have insurance. To better understand this disparity, in this study we characterize primary care physician’s perceptions of what effect, if any, patients’ insurance status has on their clinical decision making during office visits.

  • Healthstat: Making America's Health Care More Affordable43 page PDF

    Presentations | Feb 15, 2006 | R. Eric Hart, MD

    HealthSTAT: Making America's health care more affordable

  • Medicare Part D: Who Wins, Who Loses?

    One Pagers | Feb 01, 2006 | G Mallya, MD; Andrew Bazemore, MD, MPH; Robert Phillips, MD, MSPH; Larry Green, MD; Lawrence Klein, PhD; Martey Dodoo, PhD

    The Medicare Part D prescription drug benefit aims to relieve the burden of out-of-pocket prescription drug costs for persons older than 65 years, but its effects will vary. Persons with low income and those without prior prescription coverage are projected to save the most, whereas those who lose employer-based coverage are predicted to pay more for their existing regimens.

  • Out-of-Pocket Prescription Costs a Continuing Burden Under Medicare Part D

    One Pagers | Feb 01, 2006 | G Mallya, MD; Andrew Bazemore, MD, MPH; Robert Phillips, MD, PSPH; Larry Green, MD; Lawrence Klein, PhD; Martey Dodoo, PhD

    Of 29 million expected Part D beneficiaries, 6.9 million are projected to have annual out-of-pocket medication expenses greater than $750. Accounting for one fourth of all Part D enrollees, these beneficiaries also are most likely to have high aggregate health care costs, putting them at continued financial risk unless additional policy options are considered.

  • Mind the Gap: Medicare Part D's Coverage Gaps May Affect Patient Adherence

    One Pagers | Feb 01, 2006 | G Mallya, MD; Andrew Bazemore, MD, MPH; Robert Phillips, MD, MSPH; Larry Green, MD; Lawrence Klein, PhD; Martey Dodoo, PhD

    Medicare Part D will lower medication expenditures for many older patients. However, its complex design incorporates a staggered series of cost-sharing mechanisms that create gaps in coverage and may have a negative impact on medication adherence.

  • Who Will Have Health Insurance in the Year 2025?

    One Pagers | Nov 15, 2005 | Jennifer DeVoe, MD, DPhil; Marty Dodoo, PhD; Robert Phillips, MD, MSPH; Larry Green, MD

    If current trends continue, U.S. health insurance costs will consume the average household's annual income by 2025. As health care becomes unaffordable for most people in the United States, it will be necessary to implement innovative models to move the system in a more equitable and sustainable direction.

  • Number of Persons who Consulted a Physician, 1997 and 2002

    One Pagers | Sep 15, 2005 | Ed Fryer, PhD; Martey Dodoo, PhD; Larry Green, MD; Robert Phillips, MD, MSPH; Ginger Ruddy, MD; Jessica McCann, MD

    Most people in the United States consult a general physician each year, and some see other subspecialists. However, the proportion of people consulting a general physician who sees adults and children appears to be declining.

  • Patterns of Visits to Physicians' Offices, 1980 to 2003

    One Pagers | Sep 01, 2005 | Marey Dodoo, PhD; Ed Fryer, PhD; Larry Green, MD; Robert Phillips, MD, MSPH; Ginger Ruddy, MD; Jessica McCann, MD

    In the past quarter century, the number of office visits to physicians in the United States increased from 581 million per year to 838 million per year, with slightly more than one half of total visits since 1980 being made to primary care physicians. Most visits to primary care physicians were made to family physicians (FPs) and general practitioners (GPs) until the mid 1990s, when visits to general internists and general pediatricians exceeded visits to FPs and GPs.

  • Physician Workforce: The Special Case of Health Centers and the National Health Service Corps

    One Pagers | Jul 15, 2005 | Robert Phillips, MD, MSPH; Ed Fryer, PhD; Ginger Ruddy. MD; Jessica McCann; Martey Dodoo, PhD; CS Klein

    Federally funded health centers and the National Health Service Corps (NHSC) depend on family physicians (FPs) and general practitioners (GPs) to meet the needs of millions of medically underserved people. Policy makers and workforce planners should consider how changes in the production of FPs would affect these programs.

  • The Family Physician Workforce: The Special Case of Rural Populations

    One Pagers | Jul 01, 2005 | Ginger Ruddy MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH; Larry Green, MD; Martey Dodoo, PhD; Jessica McCann, MD

    People living outside metropolitan areas, especially those living in rural counties, depend on family physicians. Resolving the disparities in physician distribution nationwide will require solutions to make rural practice a viable option for more health care workers.

  • Overcoming Obstacles in U.S. Health Care Delivery With a New Practice Model for Family Practice

    Articles | Jun 15, 2005 | Martey S. Dodoo, PhD, and Andrew Bazemore, MD

    Despite brisk advances in science and technology and a bounty of medical knowledge, tools, and techniques to enhance patient care, US physicians still labor daily to provide the highest quality care to their patients at reasonable cost. They struggle against a complex collection of economic and business hurdles and obstacles imposed by the health care system. These challenges have made the current system unworkable for many physicians. Policy analysts have argued that the system cannot continue this way for much longer and have speculated that health care service delivery in the US will soon become a crisis unless it undergoes a major overhaul. This essay highlights some of the hurdles and obstacles that have hindered physicians and presents brief summaries of some proposals currently being discussed to overcome them.

  • Using the Ecology Model to Describe the Impact of Asthma on Patterns of Health Care

    Articles | May 15, 2005 | Barbara P. Yawn, George E. Fryer, Robert L. Phillips, Jr., Susan M. Dovey, David Lanier, Larry A. Green

    BACKGROUND: Asthma changes both the volume and patterns of healthcare of affected people. Most studies of asthma health care utilization have been done in selected insured populations or in a single site such as the emergency department. Asthma is an ambulatory sensitive care condition making it important to understand the relationship between care in all sites across the health service spectrum. Asthma is also more common in people with fewer economic resources making it important to include people across all types of insurance and no insurance categories. The ecology of medical care model may provide a useful framework to describe the use of health services in people with asthma compared to those without asthma and identify subgroups with apparent gaps in care. METHODS: This is a case-control study using the 1999 U.S. Medical Expenditure Panel Survey. Cases are school-aged children (6 to 17 years) and young adults (18 to 44 years) with self-reported asthma. Controls are from the same age groups who have no self-reported asthma. Descriptive analyses and risk ratios are placed within the ecology of medical care model and used to describe and compare the healthcare contact of cases and controls across multiple settings. RESULTS: In 1999, the presence of asthma significantly increased the likelihood of an ambulatory care visit by 20 to 30% and more than doubled the likelihood of making one or more visits to the emergency department (ED). Yet, 18.8% of children and 14.5% of adults with asthma (over a million Americans) had no ambulatory care visits for asthma. About one in 20 to 35 people with asthma (5.2% of children and 3.6% of adults) were seen in the ED or hospital but had no prior or follow-up ambulatory care visits. These Americans were more likely to be uninsured, have no usual source of care and live in metropolitan areas. CONCLUSION: The ecology model confirmed that having asthma changes the likelihood and pattern of care for Americans. More importantly, the ecology model identified a subgroup with asthma who sought only emergent or hospital services.

  • Changes in Age-Adjusted Mortality Rates and Disparities for Rural Physician Shortage Areas Staffed by the National Health Service Corps: 1984-1998

    Articles | Mar 15, 2005 | Donald E. Pathman, MD, MPH; George E. Fryer, PhD; Larry A. Green, MD; and Robert L. Phillips, MD, MSPH.

    OBJECTIVE: This study assesses whether the National Health Service Corps's legislated goals to see health improve and health disparities lessen are being met in rural health professional shortage areas for a key population health indicator: age-adjusted mortality. METHODS: In a descriptive study using a pre-post design with comparison groups, the authors calculated age-adjusted mortality rates at baseline (1981-1983) and follow-up (1996-1998) for the populations of 448 rural whole-county health professional shortage areas arrayed into 3 groups based on the number of study years they were staffed by National Health Service Corps physicians, physician assistants, and nurse practitioners (terms of 1 to 7, 8 to 11, and 12 to 15 years). The authors compared changes over time in age-adjusted mortality rates in the 3 county groups that had National Health Service Corps staffing with rate changes in 172 whole-county rural health professional shortage areas and 772 non-health professional shortage area rural counties that had no National Health Service Corps. RESULTS: At baseline age-adjusted mortality was higher in all 4 health professional shortage area county groups than in the non-health professional shortage area county group. Age-adjusted mortality rates improved with time in all groups, including health professional shortage area counties both with and without National Health Service Corps support, and non-health professional shortage area counties. Essentially, baseline differences in age-adjusted mortality rates between health professional shortage areas and non-health professional shortage area counties did not diminish with time, whether or not there was National Health Service Corps support. CONCLUSIONS: From the early 1980s through the mid-1990s, the National Health Service Corps's goal to see health improve in rural health professional shortage areas was met, but its goal to diminish geographical health disparities was not. Because age-adjusted mortality rates improved in all county groups, the authors conclude that improvement was likely due to a variety of factors, including decreasing poverty and unemployment rates and increasing primary care physician-to-population ratios, to which the National Health Service Corps may have contributed.

  • Patients' Beliefs about Racism, Preferences for Physician Race, and Satisfaction with Care

    Articles | Mar 14, 2005 | Frederick M. Chen, MD, MPH; George E. Fryer, Jr., PhD; Robert L. Phillips, Jr., MD, MSPH; Elisabeth Wilson, MD, MPH; and Donald E. Pathman, MD, MPH

    Few studies have attempted to link patients’ beliefs about racism in the health care system with how they use and experience health care.

  • Report to the Task Force on the Care of Children by Family Physicians79 page PDF

    Monographs & Books | Jan 15, 2005 | Robert L. Phillips, Jr., MD, MSPH; Martey S. Dodoo, PhD; Jessica L. McCann, MA; Andrew Bazemore, MD; George E. Fryer, PhD; Lisa S. Klein; Michael Weitzman, MD; Larry A. Green, MD

    Report to the Task Force on the care of children by family physicians

  • When Do Older Patients Change Primary Care Physicians?

    Articles | Nov 15, 2004 | James W. Mold, MD, MPH; George E. Fryer, PhD; A. Michelle Roberts, BA.

    BACKGROUND: Concerns have been raised about changes in the health care system that may disrupt continuity of care and thereby reduce the quality of that care. The purpose of this study was to look at the reasons older patients say they last changed primary care physicians (PCP), and to look at relationships between the duration of the PCP-patient relationship and the perceived quality of primary care received. METHODS: We analyzed data collected during the first two years of a longitudinal study of primary care patients 65 years of age and older. Variables included socio-demographic characteristics, duration of relationship with current PCP, reasons for leaving last PCP, estimated numbers of visits to PCP, other clinics, emergency departments, and admissions to hospitals and nursing homes in the last year, self-rated health and two measures of health-related quality of life, and the Components of Primary Care Index (CPCI). RESULTS: 799 patients of 23 PCPs were enrolled in year one of the longitudinal study, and 579 were re-evaluated in year two. The mean and median PCP-patient relationship duration were 10.27 and 8 years. Duration of the PCP-patient relationship was associated with greater patient age, income, level of education, and number of visits to the PCP. Longer relationship duration was also associated with higher scores on all eight CPCI subscales. The distribution of reasons for changing PCP was associated with duration of relationship, those with a longer relationship being more likely to change involuntarily. Insurance-related reasons for changing PCP were more common in those who had changed more recently. One hundred and fourteen (14%) changed their PCP during the first year of the study. Three CPCI subscale scores predicted PCP change, accumulated knowledge, communication, and family orientation. Eighty-seven percent changed involuntarily, forty-four percent for insurance related reasons and 40% because their doctor moved, retired, or died. CONCLUSIONS: Older patients, and particularly those who are older and have more education and income, tend to stay with their PCP until they are forced to change. The longer they stay in the relationship, the better they feel about the quality of the primary services they receive. Changes in the health care system may have increased the number of patients forced to change PCP.

  • Variation in Participation in Health Care Settings Associated with Race and Ethnicity

    Articles | Oct 15, 2004 | Erika B. Bliss, MD; David S. Meyers, MD; Robert L. Phillips, Jr., MD, MSPH; George E. Fryer, PhD; Susan M. Dovey, MPH, PhD; and Larry A. Green, MD

    OBJECTIVE: To use the ecology model of health care to contrast participation of Black, Non-Hispanics (Blacks), White, Non-Hispanics (Whites), and Hispanics of any race (Hispanics) in five health care settings and determine whether disparities between those individuals exist among places where they receive care. DESIGN: 1996 Medical Expenditure Panel Survey data were used to estimate the number of Black, White, and Hispanic people per thousand receiving health care in each setting. SETTING: physicians’ offices, outpatient clinics, hospital emergency departments, hospitals, and people’s homes. MAIN OUTCOME MEASURE: Number of people per 1000 per month who had at least one contact in a health care setting. RESULTS: Fewer Blacks and Hispanics than Whites received care in physicians’ offices (154 vs 155 vs 244 per 1000 per month, respectively) and outpatient clinics (15 vs 12 vs 24 per 1000 per month, respectively). There were no significant differences in proportions hospitalized or receiving care in emergency departments. Fewer Hispanics than Blacks or Whites received home health care services (7 vs 14 vs 14 per 1000 per month, respectively). After controlling for 7 variables, Blacks and Hispanics were less likely than Whites to receive care in physicians’ offices [Odds Ratio (OR) = 0.65, 95% Confidence Interval (CI) = 0.60-0.69 for Blacks and OR = 0.79, 95% CI = 0.73-0.85 for Hispanics], outpatient clinics (OR = 0.73, 95% CI = 0.60-0.90 for Blacks and OR = .71, 95% CI = 0.58-0.88 for Hispanics), and hospital emergency departments (OR = 0.80, 95% CI = 0.69-0.94 for Blacks and OR = 0.80, 95% CI = 0.68-0.93 for Hispanics) in a typical month. There was no significant difference between the groups in the likelihood of receiving care in the hospital or at home. CONCLUSIONS: Fewer blacks and Hispanics than whites received healthcare in physicians’ offices, outpatient clinics, and emergency departments in contrast to hospitals and home care. Research and programs aimed at reducing disparities in receipt of care specifically in the outpatient setting may have an important role in the quest to reduce racial and ethnic disparities in health.

  • The Phsyician Workforce of the United States: A Family Medicine Perspective197 page PDF

    Monographs & Books | Oct 15, 2004 | Larry A. Green, MD; Martey S. Dodoo, PhD; Ginger Ruddy, MD; George E. Fryer, PhD; Robert L. Phillips, MD, MSPH; Jessica L. McCann, MA; Edward H. O’Neil, MPA, PhD, FAAN; Lisa S. Klein

    The physician workforce of the United States: A family medicine perspective

  • The Importance of Having Health Insurance and a Usual Source of Care

    One Pagers | Sep 15, 2004 | Robert Phillips, MD, MSPH; M Proser; Larry Green, MD; Ed Fryer, PhD; Jessica McCann, MD; Martey Dodoo, PhD

    The effects of insurance and having a usual source of care are additive. Efforts to improve health care access for all should provide a medical home and health insurance.

  • Modifiable Determinants of Healthcare Utilization Within the African-American Population

    Articles | Sep 01, 2004 | George Rust, MD, MPH; George E. Fryer, MSW, PhD; Robert L. Phillips, Jr., MD, MSPH; Elvan Daniels, MD; Harry Strothers, MD, MMM; and David Satcher, MD, PhD

    BACKGROUND: Significant health disparities directly affect the African-American population. Most previous studies of disparities in access to and utilization of health care have focused on black-white differences rather than focusing on “within-group” analysis of African-Americans. OBJECTIVE: To tease out the differential effects of modifiable risk factors (such as health insurance, usual source of care, and poverty) from personal characteristics (age, gender, rural residence) on health care utilization within the African-American population. METHODS: Secondary data analysis of 3,462 records from African-American respondents to the 1999 Medical Expenditure Panel Survey (MEPS) Household File, a nationally-representative survey of the civilian, non-institutionalized U.S. population in 1999. RESULTS: We found significant variation in the number of office visits, outpatient clinic visits, hospital discharges, days hospitalized, and fills of prescribed medication among 3,462 African-American respondents, who represent a U.S. population of 36,538,639 persons. Personal non-modifiable characteristics such as age and gender were significantly related to health care utilization. Poverty and rural residence were also significantly correlated, but the strongest modifiable predictors of health care utilization for African-American persons in 1999 were whether or not individuals had health insurance and/or a usual source of care. Emergency department visits were the only form of care that showed remarkably little variation based on these modifiable risk factors. CONCLUSIONS: The three modifiable factors of poverty, uninsurance, and having a primary care medical home have a dramatic effect on patterns of care for African-American patients, and could be independently targeted for intervention

  • Chiropractors Are Not a Usual Source of Primary Health Care

    One Pagers | Jun 01, 2004 | Jessica McCann, MD; Robert Phillips, MD, MSPH; Larry Green, MD; Ed Fryer, PhD

    Chiropractors are the largest source of office-based care in the United States that does not involve a physician, but people do not view chiropractors as primary providers of health care or advice. Unlike the care given by primary care providers, the majority of care provided by chiropractors is limited to musculoskeletal problems.

  • Who are the Uninsured Elderly in the United States?

    Articles | Apr 15, 2004 | James W. Mold, MD, MPH; George E. Fryer, PhD; and Cynthia H. Thomas, MSW

    Because of the Medicare program, a common assumption is made that virtually all older Americans have health insurance coverage. Data from the 2000 National Health Interview Survey were analyzed to estimate the number of people aged 65 and older without health insurance, their stated reasons for being uninsured, and the associations between lack of insurance and sociodemographic variables, health status, and access to and use of healthcare services. In 2000, there were approximately 350,000 older Americans with no health insurance. Those without insurance were more likely to be younger, Hispanic, nonwhite, unmarried (widowed, divorced, or never married), poor, and foreign-born. They were less likely to hold U.S. citizenship. Despite relatively high rates of chronic medical conditions, they were unlikely to receive outpatient or home healthcare services. The most common reason given for lack of insurance was its cost. This study reveals important gaps in the availability of health insurance for the elderly, gaps that are likely to affect an increasing number of older Americans in the coming decade.

  • Specialist Physicians Providing Primary Care Services in Colorado

    Articles | Apr 15, 2004 | George E. Fryer, Jr.; Rachel Consoli; Thomas J. Miyoshi; Susan M. Dovey; Robert L. Phillips, Jr.; and Larry A. Green

    BACKGROUND: There is general consensus that the size of the US physician workforce now exceeds the health care needs of the American public. There is a greater proportion of specialists than primary care physicians, a specialty mix different from that of most other developed countries. METHODS: The Colorado Board of Medical Examiners sent a one-page questionnaire to all physicians licensed to practice in the state. It contained the question: "How many hours in the last week did you provide primary care services, defined as either preventive care, routine physical exams, or treatment of common ailments?" The responses of physicians who reported non-primary-care medical specialties were analyzed with respect to their personal and practice characteristics. RESULTS: Just under half (46.5%) of the 2745 specialist respondents reported having provided primary care services. As a group, however, 27.9% of specialist physicians’ direct patient care time was devoted to primary care activities. The amount of primary care services being provided was greater among those not board-certified in their specialties, osteopathic physicians, and specialists spending less time in direct patient care. CONCLUSION: Additional evaluation is needed with a more comprehensive definition of primary care than used in this article, which includes important but difficult-to-measure elements, such as the integration of services, a sustained partnership with patients, and practice in the context of family and community. To the extent possible, this definition should not rely on physician self-definition of which examinations are routine and which ailments are common. However, the contribution of specialists should be considered in future primary care needs assessments, and specialists who experience low demand for their particular specialties may be especially inclined to provide primary care services.

  • The Ecology of Medical Care for Children in the United States: A New Application of an Old Model Reveals Inequities That Can be Corrected

    One Pagers | Dec 15, 2003 | Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

    If equal and adequate access to health care for children in the United States is a goal, we are failing. That failing is most prominent in the setting where most children receive care and preventive services—the doctor’s office.

  • Why Does a U.S. Primary Care Physician Workforce Crisis Matter?

    Commentaries & Editorials | Oct 15, 2003 | Robert L. Phillips, Jr. MD, MSPH, and Barbara Starfield, MD, MPH

    Offers evidence that a primary care workforce crisis may once again be taking shape. The 1990s saw alignment of public policy and funding efforts to increase the primary care workforce, and indeed family medicine training capacity grew by 34 percent.

  • Family Physicians Are an Important Source of Newborn Care: The Case of the State of Maine

    One Pagers | Aug 15, 2003 | Donna Cohen, PhD; Janelle Guirguis-Blake, MD; David Jack, MD; V.K. Chetty, PhD; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

    Family physicians (FPs) provided 30 percent of inpatient newborn care in Maine in the year 2000. FPs cared for a large proportion of newborns, especially those insured by Medicaid and in smaller, rural hospitals where FPs also delivered babies. Family medicine’s commitment to serve vulnerable populations of newborns requires continued federal, state, and institutional support for training and development of future FPs.

  • Family Physicians Make a Substantial Contribution to Maternity Care: The Case of the State of Maine

    One Pagers | Aug 01, 2003 | Donna Cohen, PhD; Janelle Guirguis-Blake, MD; David Jack, MD; V.K. Chetty, PhD; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

    Family physicians provided nearly 20 percent of labor and delivery care in Maine in the year 2000. A substantial proportion of this care was provided to women insured by Medicaid and those delivering in smaller, rural hospitals and residency-affiliated hospitals. As family medicine explores its future scope, research identifying regional variations in the maternity care workforce may clarify the need for maternity care training in residency and labor and delivery services in practice.

  • Variation in the Ecology of Medical Care

    Articles | Jul 15, 2003 | George E. Fryer, Jr., PhD; Larry A. Green, MD; Susan M. Dovey, PhD; Barbara P. Yawn, MD; Robert L. Phillips, MD, MSPH; and David Lanier, MD

    BACKGROUND: We wanted to quantify how the location in which medical care is delivered in the United States varies with the sociodemographic characteristics and health care arrangements of the individual person. METHODS: Data from the 1996 Medical Expenditures Panel Survey (MEPS) were used to estimate the number of persons per 1,000 per month in 1996 who had at least 1 contact with physicians’ offices, hospital outpatient departments, or emergency departments, hospitals, or home care. These data were stratified by age, sex, race, ethnicity, household income, education of head of household, residence in or out of metropolitan statistical areas, having health insurance, and having a usual source of care. RESULTS: Physicians’ offices were overwhelmingly the most common site of health care for all subgroups studied. Lacking a usual source of care was the only variable independently associated with a decreased likelihood of care in all 5 settings, and lack of insurance was associated with lower rates of care in all settings but emergency departments. Generally, more complicated patterns emerged for most sociodemographic characteristics. The combination of having a usual source of care and health insurance was especially related to higher rates of care in all settings except the emergency department. CONCLUSION: Frequency and location of health care delivery varies substantially with sociodemographic characteristics, insurance, and having a usual source of care. Understanding this variation can inform public consideration of policy related to access to care.

  • The Ecology of Medical Care for Children in the United States

    Articles | May 15, 2003 | Susan Dovey, PhD, MPH, Michael Weitzman, MD, George Fryer, PhD, Larry Green, MD, Barbara Yawn, MD, MSc, David Lanier, MD, Robert Phillips, MD, MSPH

    BACKGROUND: Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children. OBJECTIVE: To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings. METHODS: Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children's sociodemographic factors (age, sex, ethnicity, poverty, parent's education, urban or rural residence, insurance status, and whether or not the child had a usual source of care). RESULTS: Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician's office, 82 a dentist's office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists' clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians' and dentists' offices. Only age (<2 years and 13--17 years) and poverty status were associated with hospitalization (P < .05 for each). Rural residence was not associated with any significant variation in proportions of children receiving care in any setting. Having a usual source of care was associated with increased receipt of care in all settings except hospitals. CONCLUSIONS: The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care.

  • Receipt of Preventive Care Among Adults: Insurance Status and Usual Source of Care

    Articles | May 15, 2003 | DeVoe JE, Fryer GE, Phillips R, Green L

    OBJECTIVES: This study ascertained the separate and combined effects of having insurance and a usual source of care on receiving preventive services. METHODS: Descriptive and multivariate analyses of 1996 Medical Expenditure Panel Survey data were conducted. RESULTS: Receipt of preventive services was strongly associated with insurance and a usual source of care. Significant differences were found between insured adults with a usual source of care, who were most likely to have received services, compared with uninsured adults without regular care, who were least likely to have received services. Those with either a usual source of care or insurance had intermediated levels of preventive services. CONCLUSIONS: Having a usual source of care and health insurance are both important to achieving national prevention goals.

  • Family Physicians Are an Important Source of Mental Health Care

    One Pagers | Apr 01, 2003 | Anu Subramanian PhD; Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

    While comprising about 15 percent of the physician workforce, family physicians provided approximately 20 percent of physician office-based mental health visits in the United States between 1980 and 1999. This proportion has remained stable over the past two decades despite a decline in many other types of office visits to family physicians. Family physicians remain an important source of mental health care for Americans.

  • Family Physicians Increase Provision of Well-Infant Care Despite Decline in Prenatal Services

    One Pagers | Jan 01, 2003 | Janelle Guirguis-Blake, MD; Ed Fryer, PhD; Mark Deutchman, MD, MPH; Larry Green, PhD; Susan Dovey, MD, MPH; and Robert Phillips, MD, MSPH

    Over the past 20 years, both FP/GPs and pediatricians have upheld their commitment to preventive care for infants. Non-Metropolitan Statistical Areas (non-MSAs) depend on family physicians for almost half of their well-infant care. In fact, FP/GPs have increased their overall provision of well-infant care despite a decline in delivery of prenatal services. This commitment to child health care demands continued excellence of FP training in pediatric medicine, preventive care, and child advocacy.

  • Family Physicians Are the Main Source of Primary Health Care for the Medicare Population

    One Pagers | Dec 01, 2002 | James Mold, MD, MPH; Ed Fryer, PhD; Robert Phillips, MD, MSPH; Susan Dovey, MD, MPH; Larry Green, MD

    Of people 65 years and older who reported an individual provider as their usual source of health care, 60 percent identified a family physician or general practitioner. The Medicare population relies heavily on family physicians.

  • Title VII Funding is Associated with More Family Physicians and More Physicians Serving the Underserved

    One Pagers | Aug 15, 2002 | David Meyers, MD; Gregory Krol, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH; Larry Green, MD

    Title VII funding of departments of family medicine at U.S. medical schools is significantly associated with expansion of the primary care physician workforce and increased accessibility to physicians for the residents of rural and underserved areas. Title VII has been successful in achieving its stated goals and has had an important role in addressing U.S. physician workforce policy issues.

  • What Physicians Need to Know About Seniors and Limited Prescription Benefits and Why

    One Pagers | Jul 15, 2002 | Chien-Wen T, Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

    More and more often, seniors are faced with outpatient prescription benefits that have annual spending limits and may be forced to cut back on use of medications when they run out of benefits before the end of the year. Family physicians can play a valuable role by helping seniors choose the best value medications for their budgets and by checking whether or not seniors can afford their prescriptions.

  • Using Geographic Information Systems to Understand Health Care Access

    Articles | Nov 15, 2001 | Robert L. Phillips, Jr., MD MSPH, Michael L. Parchman, MD, Thomas J. Miyoshi, MSW

    Geographically locating patients to understand access to care and potential influences on health is not a new concept in primary care. However, it is only the more recent advances geographic information systems (GIS) that have made this process more accessible and robust for primary care. In this paper, we describe briefly some key steps in the integration of GIS in primary care research, and summarize an effort to use GIS for improving access to a community health center (CHC). given the relative universality of such data collection from CHCs nation-wide and recent political commitment to doubling the capacity of CHCs over the next five years, we suggest options for developing centralized processes for evaluating CHC service areas and local unmet health care access needs.

  • Hispanic Versus White, Non-Hispanic Physician Medical Practices in Colorado

    Articles | Aug 15, 2001 | Fryer GE Jr, Green LA, Vojir CP, Krugman RD, Miyoshi TJ, Stine C, Miller ME.

    The purpose of the study was to extend the scope of earlier research on minority physicians attending to the needs of the poor and their own ethnicity by contrasting practice characteristics of Hispanic doctors in Colorado with those of their white, non-Hispanic counterparts. It was found that Hispanic physicians spent more hours per week in direct patient care, were more likely to have a primary care specialty, and were less often specialty board certified than white, non-Hispanic doctors. Hispanic generalists established practices in areas in which the percentages of the population that were (1) below poverty level, (2) Hispanic, (3) Hispanic and below poverty level, and (4) white, non-Hispanic, and below poverty level were greater than in areas in which white, non-Hispanic primary care physicians practiced. These findings argue for special provision to admit ethnic minorities to undergraduate and graduate medical education programs.

  • The United States Relies on Family Physicians, Unlike Any Other Specialty

    One Pagers | May 01, 2001 | Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD

    Designation of a county as a Primary Care Health Personnel Shortage Area (PCHPSA) depends on the number of primary care physicians practicing there. Without family physicians, an additional 1332 of the United States' 3082 urban and rural counties would qualify for designation as primary care HPSAs. This contrasts with an additional 176 counties that would meet the criteria for designation if all internists, pediatricians and ob/gyns in aggregate were withdrawn. The United States relies on family physicians, unlike any other specialty.

  • Shortchanging Adolescents: Room for Improvement in Preventive Care by Physicians

    Articles | Feb 15, 2001 | Merenstein D, Green LA, Fryer GE, Dovey SM

    BACKGROUND AND OBJECTIVES: Behaviors developed in adolescence influence health later in life. Adolescents seldom visit physicians to discuss health-related behaviors. Instead, physicians must incorporate health counseling into the exams for which the adolescents do come. We studied the frequency and duration of adolescents' consultations with family physicians and pediatricians involving counseling about diet and nutrition, exercise, weight reduction, cholesterol reduction, HIV transmission, injury prevention, and tobacco use. METHODS: Data were analyzed from the National Ambulatory Medical Care Survey for the 3-year period from 1995 through 1997. This survey uses a multistate national probability sample of patient visits to nonfederal, office-based physicians. We described patterns of counseling provided to adolescents and compared patterns for family physicians/general practitioners and pediatricians. RESULTS: Of 91,395 physician-reported visits analyzed, 4,242 (4.6%) were by adolescents ages 12-19. Visits to family physicians and pediatricians accounted for 1,846 (43.5%) of these visits. Counseling about any of the seven areas studied was included in 15.8% of family physician visits and 21.6% of pediatrician visits. The length of consultation increased from 13.8 to 17.6 minutes if counseling was included. CONCLUSION: Adolescents visit physicians infrequently. When they do, few receive counseling on critical adolescent health issues. Both family physicians and pediatricians have room for improvement.

  • The Importance of Primary Care Physicians as the Usual source of Health Care in the Achievement of Prevention Goals

    One Pagers | Nov 01, 2000 | Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD

    Having a usual source of care enhances achieving clinical prevention goals for both children and adults. There is room for improvement, and differences between the practices of internists and family physicians suggest that slightly longer visits and having health insurance might contribute to achieving proven prevention strategies.

  • The Importance of Having a Usual Source of Health Care

    One Pagers | Aug 01, 2000 | Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD

    Most people (82%) in the United States have and use for much of their health care a usual source of care, and a majority of them name a particular primary care physician as that source. Regardless of self-reported health status, people benefit from having a usual source of health care even if they are uninsured.

  • Multi-Method Assessment of Access to Primary Medical Care in Rural Colorado

    Articles | Mar 15, 1999 | 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.