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The US federal government uses health provider shortage areas (HPSAs) to define patient accessibility to primary care physicians. It is unclear whether HPSAs can be applied to eye care providers (ECP). Our study determined the applicability of federal HPSA designations to ECP availability in the U.S.Cross-sectional study SUBJECTS: United States (US) general population and ophthalmologists/optometrists in the Medicare database.The primary care HPSA score, visual impairment prevalence, and ECP location were determined for each census tract or county using data from the US Department of Health and Human Services (DHHS), the Centers for Disease Control and Prevention (CDC), and Centers for MedicareMedicaid Services (CMS).Association of HPSA with vision loss and ECP density was examined. The two-step floating catchment area (2SFCA) approach was used to newly define eye care shortage areas [patient accessibility score (PAS), higher being worse accessibility)] for every county in the US, by weighting the 2SFCA scores by prevalence of vision loss and ECP density. Multivariable logistic regression was used to identify sociodemographic variables associated with areas of ECP shortage.Among 72,735 census tracts included, there were statistically significant but weak correlations of HPSA score with visual impairment (VI) (r=0.38, p0.0001) and ECP density per county population (r=-0.18, p0.0001). Only 54.0% of census tracts with25Current HPSAs only weakly correlate with ECP supply. We propose a new approach to identify counties with high need but limited access to eye care. |
