Annals Journal Club: Primary Care Access by Census Tract

Jenna N. Moser; Michael E. Johansen

doi:10.1370/afm.250229

The Annals of Family Medicine encourages readers to develop a learning community to improve health and health care through enhanced primary care. With the Annals Journal Club, we encourage diverse participants—particularly among students, trainees, residents, and interns—to think critically about and discuss important issues affecting primary care, and even consider how their discussions might inform their practice.

HOW IT WORKS

The Annals provides discussion tips and questions related to one original research article in each issue. We welcome you to post a summary of your conversation to our eLetters section, a forum for readers to share their responses to Annals articles. Further information and links to previous Annals Journal Club features can be found on our website.

CURRENT SELECTION

Shadowen HM, Gilbert JL, Webel B, et al. Neighborhood determinants of primary care access in Virginia. Ann Fam Med. 2025; 23(2): 231-239. doi:10.1370/afm.240331

DISCUSSION TIPS

Primary care access is a critical component to population level health outcomes. However, primary care access has long been known to be unevenly distributed to population level need. The article by Shadowen, et al explores the relationship between primary care access and various predisposing, enabling, medical need, and structural factors across different census tracts in Virginia in an effort to better understand gaps in the primary care workforce.

Discussion Questions

What question is asked by this study and why does it matter?
What are the main study findings?
How does this study advance upon or challenge previous research on this topic?
How strong is the study design for answering the question?
What is an enhanced 2-stage floating catchment area method?
To what degree are the findings influenced or accounted for by:
1. The data set used to derive the patient population (all-payers claims database [APCD])?
2. How variables were selected for model inclusion?
3. The definition and dichotomization of the dependent variable (PCP access)?
4. How primary care clinicians were identified?
5. The limitations of the Andersen model of health care use?
6. Historical factors related to social determinants (eg, race, socioeconomic status, urban vs rural)?
Are the study findings generalizable to patients in your practice or region?
What contextual factors are important for interpreting the findings?
How might this study change your practice? Policy? Education? Research?
What are the next steps in interpreting or applying the findings?
What additional research questions arise from the study findings?