Increasing PCP Density Could ‘Dramatically Improve’ Life Expectancy
March 22, 2021
2 minutes to read
Source / Disclosures
Disclosures: Basu claims to have received grants from NIH and CDC, and personal fees from Collective Health, HealthRight 360, PLOS Medicine and The New England Journal of Medicine outside of the submitted work.
Residents of the United States in counties with fewer primary care physicians to serve their population could potentially see their life expectancy increase dramatically with the addition of more PCP, the researchers wrote.
“A major question has been how much we can hope to improve the health of the population with our current workforce”, Sanjay Basu, MD, PhD, research director for the Harvard Medical School Primary Care Center, said Healio Primary Care. “We wanted to understand how the concentration of the workforce in high density areas affects this problem, and therefore how we might need to focus our efforts on the parameters of low availability. “
Basu and his colleagues wrote in Annals of Internal Medicine that federal and state efforts to increase the density of the PCP have been unsuccessful. Instead, there has been a decrease in PCP density over the past decade, they added.
Researchers conducted a study using generalized additive models, mixed-effect models and generalized estimating equations to assess how reducing PCP shortages might affect age-modified life expectancy, all-cause mortality. confused and cancer deaths. CVD, infectious diseases, injuries, respiratory illnesses and substance use among residents of 3,104 counties in the United States from 2010 to 2017.
According to the researchers, the average life expectancy of residents in areas with fewer than one doctor per 3,500 people – which the Health Resources and Services Administration (HRSA) defines as an “area of primary health care shortage” – in 2017 (number of counties = 1,218) was 310.9 days shorter than residents of areas that had more PCP.
Basu and colleagues also reported that if those 1,218 counties add 17,651 physicians to their population – about 14.5 more physicians for each county with a PCP shortage – it could increase the average life expectancy of their residents by 22.4 days (median = 19.4 days; 95% CI, 0.9-45.6). If the 2,636 counties with less than one doctor per 1,500 residents added 95,754 doctors – or about 36.3 more doctors for each county in shortage – the life expectancy of these residents would increase by 56.3 days (median = 55.6 days; 95% CI: 4.2-105.6).
The researchers concluded that increasing the density of PCP could “dramatically improve life expectancy.”
“The study is quite robust in that we found similar results using several different statistical approaches, and inferred our results based on how the counties themselves experienced a particular history of increase or decrease. decrease in providers – rather than extrapolating from county to county, ”Basu said.
The results underscore the need for more physician recruitment efforts such as loan repayment programs, according to Basu.
“We also hope to look ahead by encouraging more educational opportunities in rural areas and low availability, and coordinating with the national body of service providers to increase PCP density through early education programs that help create a workforce passionate about caring for the underserved, ”he said. he adds.
In a press release, the researchers provided other suggestions to encourage more PCPs to practice in rural areas, such as increasing salaries and supporting efforts to increase the number of medical trainees from areas underserved. Other efforts to improve access to primary care include supplementing the existing workforce with physician assistants and nurse practitioners and assess the role of telehealth, according to the researchers.
The study also raises the question of whether areas of PCP shortage should be defined by the current designation of HRSA or by a recommendation from an expert group that proposed “to broaden the definition of areas of low availability. ”Basu said.
“By following the panel of experts, we find that a greater portion of the inequalities in the health of our country’s population are exposed, and therefore the take-home message becomes that of marrying the need for more primary care providers. with the need for a broader program to respond to the health inequalities that are so glaring in our country ”, he declared.