title: Spatial Access to Primary Care Providers in Appalachia: Evaluating Current Methodology.
abstract: The goal of this research was to examine spatial access to primary care physicians in Appalachia using both traditional access measures and the 2-step floating catchment area (2SFCA) method. Spatial access to care was compared between urban and rural regions of Appalachia.
  
  
  
  The study region included Appalachia counties of Pennsylvania, Ohio, Kentucky, and North Carolina. Primary care physicians during 2008 and total census block group populations were geocoded into GIS software. Ratios of county physicians to population, driving time to nearest primary care physician, and various 2SFCA approaches were compared.
  
  
  
  Urban areas of the study region had shorter travel times to their closest primary care physician. Provider to population ratios produced results that varied widely from one county to another because of strict geographic boundaries. The 2SFCA method produced varied results depending on the distance decay weight and variable catchment size techniques chose. 2SFCA scores showed greater access to care in urban areas of Pennsylvania, Ohio, and North Carolina.
  
  
  
  The different parameters of the 2SFCA method-distance decay weights and variable catchment sizes-have a large impact on the resulting spatial access to primary care scores. The findings of this study suggest that using a relative 2SFCA approach, the spatial access ratio method, when detailed patient travel data are unavailable. The 2SFCA method shows promise for measuring access to care in Appalachia, but more research on patient travel preferences is needed to inform implementation.
authors.affiliation: Mountain Pacific Quality Health, Helena, MT, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Donohoe
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Vince
authors.initials: V
authors.lastname: Marshall
authors.affiliation: West Virginia University, Morgantown, WV, USA.
authors.forename: Xi
authors.initials: X
authors.lastname: Tan
authors.affiliation: University of Virginia, Charlottesville, VA.
authors.forename: Fabian T
authors.initials: FT
authors.lastname: Camacho
authors.affiliation: University of Virginia, Charlottesville, VA.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
authors.affiliation: University of Virginia, Charlottesville, VA rbgws@yahoo.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
mesh_terms: D001061:Appalachian Region; D002391:Catchment Area, Health; D006297:Health Services Accessibility; D006801:Humans; D008490:Medical Informatics / Q000379:methods*; D009657:North Carolina; D009820:Ohio; D010414:Pennsylvania; D010820:Physicians; D011320:Primary Health Care; D012424:Rural Population; D062206:Spatial Analysis; D014505:Urban Population
keywords: access to care; medical informatics; primary care; quality improvement; rural health