185232 Impact of Primary Care Workforce Distribution on Health Outcomes

Tuesday, October 28, 2008: 8:30 AM

Carolyn Muegge, MS, MPH , Department of Family Medicine, Indiana University, Indianapolis, IN
Azita Chehresa, MD, PhD , Department of Family Medicine, Indiana University, Indianapolis, IN
Nicholas Countryman, MD , Office of Graduate Medical Education, Indiana University, Indianapolis, IN
Komal Kochhar, MBBS, MHA , Bowen Research Center, Indiana University, Indianapolis, IN
James J. Brokaw, PhD , Office of Medical Student Affairs, Indiana University, Indianapolis, IN
Peter Nalin, MD , Office of Graduate Medical Education, Indiana University, Indianapolis, IN
Angela Holloway, MHA , Department of Family Medicine, Indiana University, Indianapolis, IN
Deborah Allen, MD , Department of Family Medicine, Indiana University, Indianapolis, IN
Terrell W. Zollinger, DrPH , Department of Family Medicine, Indiana University, Indianapolis, IN
     
Background: This study investigated the impact of the mal-distribution of the primary care health workforce among the Indiana counties on the health indices of the subpopulations.

Methods: The number of primary care providers in Indiana counties was based on licensure data linked to the AMA master file. Health indices were provided by the Indiana State Department of Health. Correlation studies on the data performed using SPSS, adjusted for county location and socioeconomic status.

Results: There were significant differences in the population ratios of general internists, general pediatricians, and nurse practitioners by rural, suburban and urban areas, but not family physicians. No significant relationships were detected between ratios of primary care providers compared to the percent of pregnant women who received care early in pregnancy, percent of low birth weight deliveries or overweight children in the community. A significant negative correlation was noted in percent of smokers during pregnancy with the higher rate of primary care givers in the county. A significantly higher rate of Chlamydia was detected in areas with higher rate of primary care givers. Mortality rates due to preventable and chronic uncontrolled diseases were not affected by higher rates of primary care givers in the counties.

Conclusion: Although there is a mal-distribution of the primary care health workforce, urban, suburban and rural areas have similar rates of family physicians. The mal-distribution affected few health indices, supporting the important role of family physicians. Data on more direct preventive quality indicators may clarify the extent of the impact.

Learning Objectives:
Describe the impact of primary care workforce distribution on health outcomes. Apply the methods to examine the relationships between primary care workforce distribution and health outcomes at the county level. Describe the mix of providers needed in a county to provide optimim level of primary care.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have and will continue to work with the Health Workforce team in Indiana and will make every effort to be honest, accurate and ethical. I have been a member of several research teams and have worked on several abstracts, posters, and presentations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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