Direct Primary Care Shows Limited Reach in Shortage Areas

TOPLINE:

Direct Primary Care (DPC) practices are less prevalent in health professional shortage areas (HPSAs) than are primary care physicians, with only 44% of DPC practices located in HPSAs and just 14% in high-priority need areas. DPC practices show higher presence in rural or partially rural HPSAs but lower representation in high-priority urban areas.

METHODOLOGY:

• Analysis included data from Health Resources and Services Administration, DPC Frontier Mapper, and Centers for Medicare and Medicaid Services, collected on October 9, 2023.
• Researchers compared 2125 DPC practices with 422,028 non-DPC primary care physicians across the United States, examining their distribution in HPSAs.
• Priority need scores for HPSAs were categorized as low (1-13), medium (14-17), and high (18-25), with additional stratification by rurality (rural, partially rural, nonrural).
• Statistical analysis employed equality of proportions testing to determine differences between DPC and primary care physician distributions by HPSA characteristics.

TAKEAWAY:

• Among DPC practices in HPSAs, 45% were in low-priority need areas, 47% in medium-priority need areas, and 14% in high-priority need areas (P
• DPC practices showed higher rural presence with 25% in rural areas and 22% in partially rural areas, compared with PCPs at 19% each (P
• Primary care physicians demonstrated greater HPSA presence overall at 47% compared with DPC practices at 44% (P = .02).
• Researchers found that 53% of DPC practices in HPSAs were in nonrural areas, compared to 63% of PCPs (P

IN PRACTICE:

“Optimistically, there is evidence that DPC practices are located in nonurban areas, where there is a need for primary care physicians, yet overall, DPC practices are not as geographically dispersed as PCPs across the United States with respect to HPSAs. However, geographic availability might not equate to accessibility, which is driven by multiple factors such as cost, coverage, distance, patient volume, patient comfort,” wrote the authors of the study.

SOURCE:

The study was led by Neal D. Goldstein, PhD, MBI, Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health in Philadelphia. It was published online in Annals of Family Medicine.

LIMITATIONS:

The volunteer nature of DPC Frontier Mapper data might underestimate the total number of practices, particularly those marketing to businesses rather than individuals. Patient panels tend to be smaller at DPC practices, requiring additional physicians to balance demand if practices transition from traditional fee-for-service models. The self-reported nature of National Provider Identifier taxonomy could result in misclassification of primary care physicians.

DISCLOSURES:

Paul Yerkes, MD, disclosed being co-owner of a direct primary care practice in Pennsylvania and current president of the Delaware Academy of Family Physicians. Neal D. Goldstein, PhD, reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.