RT Journal Article
SR Electronic
T1 Neighborhood Determinants of Primary Care Access in Virginia
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 231
OP 239
DO 10.1370/afm.240331
VO 23
IS 3
A1 Shadowen, Hannah M.
A1 Gilbert, Jennifer L.
A1 Webel, Benjamin
A1 Funk, Adam
A1 Lee, Jong Hyung
A1 Strayer, Scott M.
A1 Sabo, Roy T.
A1 Walker, Lauryn S.
A1 Topmiller, Michael
A1 Mitchell, Andrew
A1 Britz, Jacqueline B.
A1 Barnes, Andrew J.
A1 Krist, Alex H.
YR 2025
UL http://www.annfammed.org/content/23/3/231.abstract
AB PURPOSE Primary care is the foundation of any health care system. Primary care improves the health of communities and decreases health inequities. Yet, workforce shortages have worsened in the United States. Understanding characteristics of where workforce gaps are greatest is key to developing effective workforce solutions.METHODS We used the 2019 Virginia All-Payers Claims Database to identify primary care physicians (PCPs) and the number of distinct patients seen by each physician. These data were used to identify PCP access by census tract measured using an enhanced 2-stage floating catchment method. Guided by the Andersen model of health care utilization, we identified predisposing, enabling, need, and structural community characteristics from public data sources. We assessed associations between PCP access and these characteristics using spatial autoregressive models with lagged independent variables. Analyses were performed from 2023 to 2024.RESULTS In Virginia, 56.0% of census tracts had adequate PCP access. No association was found between PCP access and predisposing factors. Multiple enabling factors (ie, marital status, education, English language proficiency) were significantly associated with PCP access. Among need measures, PCP access was only positively associated with diagnosis of depression per 1,000 residents (0.01; P <.001). Structural factors had the greatest association with access. Neighborhoods with disproportionately greater numbers of Black residents had significantly greater PCP access compared with neighborhoods with disproportionately greater numbers of White residents (−0.35; P <.05). Rural communities had less PCP access than suburban neighborhoods (−0.53; P <.001).CONCLUSIONS There is an inadequate primary care workforce in Virginia. Structural factors, rather than predisposing, enabling, or need factors, contribute most to PCP access. Whereas Black segregated communities might have greater PCP access, rural communities are significantly disadvantaged.