The geographic alignment of primary care Health Professional Shortage Areas with markers for social determinants of health
The geographic alignment of primary care Health Professional Shortage Areas with markers for social determinants of health
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DOI：
10.1371/journal.pone.0231443
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发表时间：
2020-04-24
期刊：
影响因子：
3.7
通讯作者：
Washko, Michelle M.
中科院分区：
文献类型：
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作者：
Streeter, Robin A.;Snyder, John E.;Washko, Michelle M.
卫生资源和服务管理局（HRSA）是美国卫生与公众服务部（HHS）的一个机构，致力于确保全国服务不足的人群，特别是那些在医学上，经济上或地理上脆弱的人群获得高质量的医疗保健。HRSA指定的初级保健卫生专业人员短缺地区（pcHPSAs）提供了一个重要的措施，通过它来确定服务不足的人群，并优先考虑无法获得足够的初级和预防性卫生保健的地区和人群，这是促进健康公平和维护个人和人群健康的基础。然而，获得医疗服务是一个复杂的多因素问题，涉及的不仅仅是可用的医疗保健提供者的数量，并且单独的pcHPSA不能完全表征医学，经济和地理上脆弱人群的分布。我们使用描述性统计和多重对应分析来评估HRSA的pcHPSA名称在地理上与其他已建立的医学、经济和地理脆弱性的标志。反映公认的健康的社会决定因素（SDOH），标志包括人口特征，种族和民族，低出生体重率，家庭收入中位数，贫困，教育程度和农村。在全国范围内，2017年，96%的美国县被归类为整个县或部分县的pcHPSA，或者有一个或多个医疗，经济或地理脆弱性的既定标志，这表明高危人群几乎无处不在。初级保健HPSA县在HHS地区4和6（主要是位于美国东南部和中南部）的人口risk.ConclusionHHS地区显示了独特的签名相对于SDOH标志物最普遍和复杂的模式。我们工作的描述性和分析性结果可能有助于为各级卫生工作者和卫生保健规划提供信息，并且通过说明pcHPSA县县级人口特征的复杂性和差异，我们的研究结果可能与加强初级保健的提供和解决受供应商短缺困扰的地区健康的社会决定因素有关。
BackgroundThe Health Resources and Services Administration (HRSA), an agency within the U.S. Department of Health and Human Services (HHS), works to ensure accessible, quality, health care for the nation's underserved populations, especially those who are medically, economically, or geographically vulnerable. HRSA-designated primary care Health Professional Shortage Areas (pcHPSAs) provide a vital measure by which to identify underserved populations and prioritize locations and populations lacking access to adequate primary and preventive health care-the foundation for advancing health equity and maintaining health and wellness for individuals and populations. However, access to care is a complex, multifactorial issue that involves more than just the number of health care providers available, and pcHPSAs alone cannot fully characterize the distribution of medically, economically, and geographically vulnerable populations.Methods and findingsIn this county-level analysis, we used descriptive statistics and multiple correspondence analysis to assess how HRSA's pcHPSA designations align geographically with other established markers of medical, economic, and geographic vulnerability. Reflecting recognized social determinants of health (SDOH), markers included demographic characteristics, race and ethnicity, rates of low birth weight births, median household income, poverty, educational attainment, and rurality. Nationally, 96 percent of U.S. counties were either classified as whole county or partial county pcHPSAs or had one or more established markers of medical, economic, or geographic vulnerability in 2017, suggesting that at-risk populations were nearly ubiquitous throughout the nation. Primary care HPSA counties in HHS Regions 4 and 6 (largely lying within the southeastern and south central United States) had the most pervasive and complex patterns in population risk.ConclusionHHS Regions displayed unique signatures with respect to SDOH markers. Descriptive and analytic findings from our work may help inform health workforce and health care planning at all levels, and, by illustrating both the complexity of and differences in county-level population characteristics in pcHPSA counties, our findings may have relevance for strengthening the delivery of primary care and addressing social determinants of health in areas beset by provider shortages.