Methodologies for the Delineation of Primary Medical Care Manpower Shortage Areas in Oregon Subarea IV

摘要

This report presents three methodologies that were developed to identify shortages of physicians, physician assistants, and nurse practitioners in three western Oregon counties in order for these areas to qualify for Federal aid. In each methodology, primary care practitioners were located, travel times in all directions were measured, and population distribution for the area was determined. In the Manual Unadjusted Method, 30 - minute travel distances were measured outward from primary care practitioner locations, forming service area polygons which overlapped when practitioners were located within 60 - minutes travel time from each other. The Manual Adjusted Method was a preferable tool because it accounted for the overlap by assuming that if patients had two choices, they would travel to the nearest physician. However, the use of straight - line travel distances resulted in some distortion of the data. The third method was conceptually no different from the Manual Adjusted Method except that a computer was used to develop the node and network system. Although this method was most costly, it can be easily updated. Accurate physician locations were difficult to ascertain because State licensure records and medical association lists were often out of date or failed to reflect actual practice location. The report commented that the Manual Adjusted and Computer Assisted Methodologies were not meant to supercede investigation at the local level, but were useful means of identifying areas which warranted detailed local evaluations. The report begins with the summary chapter for the general reader and then provides detailed accounts of the three methodologies. Each approach is evaluated, and costs are detailed for manpower, computer time, and materials. Several maps and tables are included. The appendices contain Federal regulations for the designation of primary care manpower shortage areas, the populations of the counties studied, and instructions for the computer programs.