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Christiana Care study finds city neighborhoods with minorities have less access to doctors

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Urban neighborhoods with high percentages of African-Americans and Hispanics face poorer access to doctors, according to a study led by a Christiana Care Health System  physician researcher, published in the August issue of the journal Health Affairs.

Focusing on the doctor-to-population ratios in Philadelphia – home to the nation’s first hospital and medical school – the study is the first major one of its kind to drill down to census tract data to ascertain the ratios and consider how geography may create distinct barriers to care within city neighborhoods.

“Primary care is the gateway to improved health outcomes and forms the base of efficient health systems,” said Dr. Elizabeth J. Brown, the Harrington Clinician Scholar at Christiana Care’s Value Institute and a primary care physician with Christiana Care’s Department of Family and Community Medicine.  “Considering the results of our study, policymakers may consider  how accessible primary care is, even in densely-populated neighborhoods, when assessing ways to improve the health of our communities.”

Whereas most research on doctor-to-population ratios has concentrated on those ratios at the city, county or state level, the study in Health Affairs – considered the leading journal of health policy thought and research, with an acceptance rate of less than 15 percent of the 1,400 manuscripts it annually receives – analyzed census tracts.

Census tracts are small territorial units that provide valuable information on the characteristics, economic status and living conditions of their inhabitants. When looking at areas around each tract that can be reached by car within five minutes, which is 1.4 miles on average, the study found that some doctor-to-population ratios were far worse than the long-standing federally-determined ratio for a designated physician-shortage areas of one doctor for every 3,500 individuals.

The study also found that city areas with high concentrations of African Americans and Hispanics had far poorer doctor-to-population ratios than neighboring areas with lower concentrations of those racial minorities.

“As groups of people who have traditionally had poor access to health insurance now gain coverage through the Affordable Care Act’s health insurance marketplace, we should ensure that they also have greater access to care,” Brown said. “Although primary care access has multiple dimensions, making sure that some populations don’t have to travel far from their neighborhoods to access that care is one important consideration.”

Brown joined Christiana Care in October as a Harrington Clinical Investigator. The Charles J. Harrington Fund is named for its benefactor, the late director emeritus of the Christiana Care Board of Directors and former Christiana Care trustee, who was a strong proponent of service and of the importance of philanthropy. Brown completed part of the study as a Robert Wood Johnson Foundation Clinical Scholar with the Perelman School of Medicine at the University of Pennsylvania’s Leonard Davis Institute of Health Economics.

The Harrington Fund supports community partnerships and scholarship to address the social determinants of health. Dr. Brown’s research includes access to care, education and organization of health care delivery, with areas of focus in child and adolescent health, geriatrics and long-term care and health policy.

She also is a scholar with Christiana Care’s Value Institute, which leads the way in conducting real-world research on today’s most pressing health care issues. The Value Institute’s mission is to develop, deliver and evaluate innovative practice and policy solutions that improve the experience, efficiency and effectiveness of health care for patients and providers alike.


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