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Differences in referral patterns for rural primary care physicians from 2005 to 2016

机译：2005年至2016年农村初级保健医师推荐模式的差异

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Abstract Objective To examine differences in referral patterns in a nationally representative sample between primary care physicians (PCP) practicing in rural vs nonrural areas and changes over time. Study Design Using the 2005‐2016 National Ambulatory Medical Care Survey and multivariate logit regression models, I compare referral patterns of PCPs in rural vs nonrural areas. Data Collection Multiple years of data were combined. Principal Findings A PCP visit was 1.9 percentage points (95% confidence interval: 0.1?pp, 3.8?pp) more likely to result in a referral in nonrural areas than rural areas, controlling for physician and patient characteristics, a 17 percent increase. This difference is driven by a widening gap in referral rates between nonrural and rural areas over time, with large differences in later periods. The regression‐adjusted predicted probability of a PCP visit resulting in a referral was 71 percent higher in nonrural than rural areas in 2013‐2014 and 92 percent higher in 2015‐2016. Conclusions Recognizing that the optimal PCP referral rate is unknown, referrals are less common in rural areas with a widening gap in recent years. This difference may reflect specialist availability, distance to care, or patient preferences. As changes occur to health care financing and delivery, continuing to monitor practice patterns is important to ensure patients are receiving appropriate levels of care across geographic regions.
机译：摘要目的探讨农村初级护理医师（PCP）在农村初级护理医师（PCP）之间推荐模式的差异及随着时间的变化。研究设计使用2005-2016国家外流医疗调查和多变量Logit回归模型，我比较了农村VS Nonrural领域的PCP转介模式。组合数据收集多年数据。 PCP访问的主要结果是1.9个百分点（95％的置信区间：0.1？PP，3.8？PP）更有可能导致非rrural领域的推荐，而不是农村地区，控制医生和患者特征，增加17％。这种差异是由于随着时间的推移和农村地区的推荐率的扩大差距而导致，后期差异很大。在2013-2014年，在2013 - 2014年的农村地区，PCP访问的回归调整预测的概率在2013 - 2014年的农村地区比农村地区更高71％，而2015-2016年的92％。结论认识到最佳PCP推荐率未知，近年来差距扩大的农村地区的推荐不太常见。这种差异可以反映专业的可用性，小心距离或患者偏好。随着卫生保健融资和交付对卫生融资和交付的变化，继续监测实践模式对于确保患者在地理区域接受适当的护理水平是重要的。

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