District of Columbia Primary Care Needs Assessment (DCPC): An analytical and quantitative method for determining community-based need and demand for primary care

This study, District of Columbia Primary Care Needs Assessment (DCPC), analyzed over a twenty year period from 1985 to 2004, the need and demand for primary care using standard and epidemiologically innovative statistical measures for physician distributions and socio-demographic characteristics in the District of Columbia (DC). The study answered the question: Using U.S census-based small area aggregations, Census Tract Groupings (CTGs), that are not zip-code areas or legislative/political boundaries, can a multivariate predictive model be developed using physician ratios, primary care service index (PCSI) and composite need scores (CNS) to explain variations in primary care visits? Primary care priority scores (PCPS) were calculated, analyzed and presented for CTGs in the District of Columbia over the twenty-year period, 1985 to 2004. Results indicated that the abundant supply of DC-based physicians – indicated by decreasing population per physician ratios of 239 (1985) to 146 (2004) – appear to be a long-term trend. As raw physician counts increased, the ratio of satisfied visits to visits demanded decreased, from 2.62 (1985) to 1.80 (2004). This result appears to indicate that, due to inequities in distribution of primary care physicians in DC's small areas, the increasing numbers of primary care physicians were by themselves, not sufficient to address the city's overall primary care visits need. Epidemiological profiles and primary care analytical methods appear to be useful for small area analysis of urban health and socio-economic characteristics. Physician rates per 1,000 population may be a necessary but not sufficient statistic for estimating urban primary health care needs.