Needs assessment for access to primary health care services in Colorado

Background: Colorado's rural population faces special challenges in health care access. Approximately 80% of Colorado is rural and is inhabited by 15% of the population. Only 92 hospitals and health clinics exist to fulfill the health care needs of the state; the majority of these facilities are concentrated in urbanized areas; and one-third of the state's counties have no health care facility. Methods: Perceived need throughout Colorado was assessed statewide through an online survey during a four-week interval using chain sampling. Actual need was assessed by calculating a “need” ratio (supply/demand). This ratio expresses access to primary care services as the supply of primary care physicians divided by the estimated utilization for primary care services (by visits) calculated for each county in Colorado. Findings: 65.6% of respondents suggested services such as, dental and preventive and/or health screening capabilities, primary care, mental health services, chronic care, and access to specialty care as needed in rural Colorado. 59.9% identified a specific population needed primary care services. Tabulation of actual need (need ratio) varied by county, but when comparing Planning and Management Region (PMR) need ratio means, most of the PMRs showed an average unmet need of 43%. Limitations: Data sources such as the American Medical Association (AMA) and the American Osteopathic Association (AOA) Masterfiles are limited by the accessibility of recent years' data. Neither nurse practitioners nor physician assistants were included in the analyses of this study. Consideration of these mid-level providers should improve the health need ratios.