Multi-method assessment of access to primary medical care in rural Colorado

The objectives of this study include conducting an analysis of access to pr imary medical care in rural Colorado through simultaneous consideration of primary care physician-to-population and distance-to-nearest provider indic es. Analyses examined the potential development and implications of excessi vely large, perhaps unmanageable patient caseloads that might result from e very rural Coloradoan's exclusive use of the nearest generalist physician a s a regular source of care. Using American Medical Association Physician Ma sterfile data for 1995 and coordinates for latitude and longitude from U.S. Census files (Census of Population and Housing, 1990), the authors calcula ted distance to the nearest primary care physician for residents of each of the 1,317 block groups in Colorado's 52 rural counties. Caseloads for each generalist physician were computed assuming the population used the neares t provider for care. Straight-line mileage to primary medical care was mode st for rural Coloradoans-a median distance of 2.5 miles. Almost two-thirds (65 percent) of the population resided within 5 miles, and virtually all re sidents (99 percent) were within 30 miles of a generalist physician. Howeve r, had everyone traveled the shortest possible distance to care, demand for service from many of the 343 primary care doctors in rural regions of the state would have been overwhelming. The results of simultaneous application of distance-to-care and provider-to-population techniques unrestricted by geographic boundaries depict access to primary medical care and correspondi ng consumer difficulty more fully than in previous studies. Further combina tion of methods of needs assessment such as those used in this analysis may better inform the future efforts of organizations mandated to address heal th care underservice in rural areas.