Quantitative determinants of need and demand for primary care in the district of Columbia

Abstract

This study, quantitative determinants of need and demand for primary health care in the District of Columbia (DCPC), analysed data over a twenty-year period from 1985 to 2004, on 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 attempted to answer 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 distributions, primary care service index (PCSI) and composite need scores (CNS) to explain variations in primary care visits shortages? Primary care visits shortages and priority scores (PCPS) were calculated, analysed and presented for CTGs in the District of Columbia from 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 demand decreased, from 2.62 (1985) to 1.80 (in 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 physician distribution analytical methods appear to be useful for small area analysis of urban primary care shortage areas and for setting priorities. Physician rates per 1,000 pop may be a necessary but not sufficient statistic for estimating urban primary health care needs