M L Parchman1, S Culler. 1. Department of Family Medicine, Indiana University, Indianapolis.
Abstract
BACKGROUND: The rate of admission for avoidable hospital conditions (AHCs) has been proposed as a measure of the ability of a population to access health care. The purpose of this study was to determine the relationship between the availability of primary care physicians and the rate of avoidable hospitalizations. METHODS: Statewide hospital discharge data for general acute care hospitals in Pennsylvania were used to determine age- and sex-adjusted AHC rates in the 26 health service areas (HSAs) in Pennsylvania. The number and type of primary care physician as well as the per capita income for each HSA were obtained from the Area Resource File. Correlations of number and type of physician with AHC rates were obtained. RESULTS: Only the number of family and general practice physicians (FPs/GPs) per population was significantly correlated with adult and pediatric AHC rates. As the number of FPs/GPs in each HSA increased, the AHC rate decreased. The significant relationship between FPs/GPs and the AHC rate remained after controlling for the effect of per capita income. No significant correlation was found between either the number of general internists and the adult AHC rate or the number of general pediatricians and the pediatric AHC rate. CONCLUSIONS: The availability of FPs/GPs is related to lower rates of hospitalization for certain conditions. Family physicians may provide more effective first-contact access to health care than is provided by either general internists or pediatricians in Pennsylvania. Future studies should address whether care by family physicians is more cost-effective as a result of this reduction in avoidable hospitalizations.
BACKGROUND: The rate of admission for avoidable hospital conditions (AHCs) has been proposed as a measure of the ability of a population to access health care. The purpose of this study was to determine the relationship between the availability of primary care physicians and the rate of avoidable hospitalizations. METHODS: Statewide hospital discharge data for general acute care hospitals in Pennsylvania were used to determine age- and sex-adjusted AHC rates in the 26 health service areas (HSAs) in Pennsylvania. The number and type of primary care physician as well as the per capita income for each HSA were obtained from the Area Resource File. Correlations of number and type of physician with AHC rates were obtained. RESULTS: Only the number of family and general practice physicians (FPs/GPs) per population was significantly correlated with adult and pediatric AHC rates. As the number of FPs/GPs in each HSA increased, the AHC rate decreased. The significant relationship between FPs/GPs and the AHC rate remained after controlling for the effect of per capita income. No significant correlation was found between either the number of general internists and the adult AHC rate or the number of general pediatricians and the pediatric AHC rate. CONCLUSIONS: The availability of FPs/GPs is related to lower rates of hospitalization for certain conditions. Family physicians may provide more effective first-contact access to health care than is provided by either general internists or pediatricians in Pennsylvania. Future studies should address whether care by family physicians is more cost-effective as a result of this reduction in avoidable hospitalizations.
Authors: Leiyu Shi; James Macinko; Barbara Starfield; Robert Politzer; John Wulu; Jiahong Xu Journal: Am J Public Health Date: 2005-04 Impact factor: 9.308