About: Primary Care Accessibility Effects on Health Care Utilization among Urban Children

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Primary Care Accessibility Effects on Health Care Utilization among Urban Children
Creator	Ma, M Diez-Roux, Ana Forrest, Christopher Lê-Scherban, Félice Maltenfort Phd, Mitchell Maltenfort, Mitchel Maltenfort, Mitchell Melly, Steve Melly, Steven Michael, Yvonne Moore, Kari Ms, Kari Mudd, Abigail Sm, Scd
source	Elsevier; Medline; PMC
abstract	OBJECTIVES: Evidence suggests that spatial accessibility to primary care is a contributing factor to appropriate health care utilization, with limited primary care access resulting in avoidable hospitalizations and emergency department visits which are burdensome on individuals and our healthcare system. Limited research, however, has examined the effects on children. METHODS: We evaluated associations of spatial accessibility to primary care on health care utilization among a sample of 16,709 children aged 0-3 years in Philadelphia who were primarily non-White and publicly insured. Log-Poisson models with generalized estimating equations were used to estimate incidence rate ratios (RR) and 95% confidence intervals (CI) while accounting for three levels of clustering (within individual, within primary care practice, within neighborhood). RESULTS: In age-adjusted models, the lowest level of spatial accessibility was associated with 7% fewer primary care visits (RR 0.93, 95% CI 0.91, 0.95), 15% more emergency department (ED) visits (RR 1.15, 95% CI 1.09, 1.22), and 18% more avoidable hospitalizations (RR 1.18, 95% CI 1.01, 1.37). After adjustment for individual- (race/ethnicity, sex, number of chronic conditions, insurance status) and neighborhood-level (racial composition and proportion of housing units with no vehicle), spatial accessibility was not significantly associated with rate of health care utilization. CONCLUSIONS: Individual-level predisposing factors, such as age, race, and need, attenuate the association between accessibility to primary care and use of primary care, emergency department visits, and avoidable hospitalization. Given the possibility of modifying access to primary care unlike immutable individual factors, a focus on spatial accessibility to primary care may promote appropriate health care utilization.
has issue date	2020-05-31(xsd:dateTime)
bibo:doi	10.1016/j.acap.2020.05.014
bibo:pmid	32492576
has license	no-cc
sha1sum (hex)	ac07405c3bc63fd3e388a9dc025c95d04062bb0d
schema:url	https://doi.org/10.1016/j.acap.2020.05.014
resource representing a document's title	Primary Care Accessibility Effects on Health Care Utilization among Urban Children
has PubMed Central identifier	PMC7261359
has PubMed identifier	32492576
schema:publication	Acad Pediatr
resource representing a document's body	covid:ac07405c3bc63fd3e388a9dc025c95d04062bb0d#body_text
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