November 18, 2020
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Density of US primary care clinicians increases, particularly in urban counties

The density of primary care clinicians throughout the United States recently increased, but more so in urban counties, according to a cross-sectional study published in JAMA Network Open.

The “prevalence of chronic disease is one of the major contributors to rising health care costs in the U.S.,” Donglan Zhang, PhD, an assistant professor of health policy and management at the University of Georgia College of Public Health, and colleagues wrote.

 The quote is: "This study by Zhang and colleagues shows, once again, that there is still more work to do." The source of the quote is Carrie Henning-Smith, PhD, MPH, MSW.

Previous studies have shown that greater access to primary care clinicians in rural areas would improve care coordination and health outcomes for patients, the researchers noted.

Zhang and colleagues analyzed the density and type of all primary care clinicians — specifically, PCPs, nurse practitioners and physician assistants — per 3,500 residents for 3,143 counties (urban = 1,167) in the United States between 2009 and 2017. The Health Resources and Services Administration uses the same criteria to define areas where there are primary care health professional shortages, according to researchers.

Results showed that the number of primary care clinicians increased significantly in rural counties (2009 median density: 2.04; interquartile range [IQR] = 1.43-2.76; and 2017 median density: 2.29; IQR = 1.57-3.23; P < .001). Urban counties also experienced an increase (2009 median density: 2.26; IQR = 1.52-3.23; and 2017 median density: 2.66; IQR = 1.72-4.02; P < .001).

In rural counties, the average annual percentage change in the mean density of PCPs was 1.7% (95% CI, 0.84-2.57), compared with 5.14% (95% CI, 3.91-6.37) among physician assistants and 8.37% (95% CI, 7.11-9.63) among nurse practitioners. In urban areas, the average annual percentage change in the mean density of PCPs was 2.4% (95% CI, 1.19-3.61), compared with 6.42% (95% CI, 5.34-7.5) among physician assistants and 8.64% (95% CI, 7.72-9.55) among nurse practitioners.

Further analysis showed that the density of primary care clinicians in urban counties increased faster than in rural counties ( = 0.04; 95% CI, 0.03-0.05). The researchers wrote that the difference continued to be “substantial and significant” after adjusting for county-level sociodemographic variables.

“Reducing urban-rural disparities in access to primary care clinicians requires policy and intervention efforts that can meaningfully increase the supply of primary care clinicians in rural areas,” Zhang and colleagues added.