Abstract 19668: Primary Care Physician Density and Heart Failure Hospitalization Rates: The Atherosclerosis Risk in Communities (ARIC) Study -Community Surveillance

Abstract

Background: Prior research has demonstrated an association between the density of primary care physicians and avoidable hospitalizations. We aimed to determine the association of primary care physician density on rates of acute decompensated heart failure (ADHF) admissions among residents of the four communities in the Atherosclerosis Risk in Communities (ARIC) Study.

Methods: We examined hospitalization rates for ADHF from 2005-2008 among Primary Care Service Areas (PCSA) included in the ARIC community surveillance areas. Validated ADHF hospitalizations were assigned to a PCSA based on the patients’ address. We calculated age, sex and race-adjusted rates for each PCSA using indirect standardization, weighted to account for the stratified random sample. Physician density was defined as the age and sex-adjusted rate of primary care physicians per 100,000 population in 2005, from the AMA Masterfile and centered on the US average. We used GEE Poisson models to examine the association of ADHF hospitalization rates with physician density taking into account the nested structure of the data and adjusted for median family income.

Results: This study included 7,233 ADHF hospitalizations from the 3 ARIC surveillance areas (Jackson, MS; Minneapolis, MN; Washington Co., MD) which included more than 1 PCSA. Adjusted physician densities ranged from 55.6 - 92.8 primary physicians per 100,000 pop. Adjusted ADHF hospitalization rates decreased with increasing primary care physician density (see figure). For every increase in the density of primary care physicians of 10 physicians per 100,000 the adjusted rate of ADHF decreased by 24% (p<0.0001). Findings were consistent when family practitioners and internal medicine physician densities were examined separately.

Conclusion: Primary care physician densities are associated with heart failure hospitalization with PCSAs. Increasing the availability of primary care physicians may improve heart failure outcomes in the US.