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      Access to Pediatric Ophthalmological Care by Geographic Distribution and US Population Demographic Characteristics in 2022

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          Abstract

          Importance

          The geographic distribution of pediatric ophthalmological care has not been reported on since 2007; understanding this distribution could shed light on potential avenues to increase access, which is a necessary first step in addressing the pediatric ophthalmological needs of underserved areas.

          Objective

          To analyze the number and location (ie, geographic distribution) of pediatric ophthalmologists in relation to US population demographic characteristics.

          Design, Setting, and Participants

          In this cross-sectional study, public databases from the American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus were used to identify pediatric ophthalmologists in the US as of March 2022.

          Main Outcomes and Measures

          Geographic distribution of pediatric ophthalmologists listed in public databases and any association between pediatric ophthalmologist distribution and US population demographic characteristics. Addresses were geocoded using ArcGIS Pro (Esri).

          Results

          A total of 1056 pediatric ophthalmologists (611 men [57.9%]) were identified. States with the most pediatric ophthalmologists were California (n = 116 [11.0%]), New York (n = 97 [9.2%]), Florida (n = 69 [6.5%]), and Texas (n = 62 [5.9%]), the 4 most populous states. A total of 2828 of 3142 counties (90.0%) and 4 of 50 states (8.0%) had 0 pediatric ophthalmologists. In 314 counties (10.0%) with 1 or more pediatric ophthalmologists, the mean (range) pediatric ophthalmologists per million persons was 7.7 (0.4-185.5). The range of practitioner to million persons has increased since 2007. Counties with 1 or more pediatric ophthalmologists had a higher median (SD) household income compared with counties with 0 pediatric ophthalmologists ($70 230.59 [$18 945.05] vs $53 263.62 [$12 786.07]; difference, −$16 966.97; 95% CI, −$18 544.57 to −$14 389.37; P < .001). Additionally, the proportion of families in each county without internet service (8.0% vs 4.7%; difference, 3.4%; 95% CI, 3.0%-3.7%; P < .001), the proportion of persons younger than 19 years without health insurance (5.7% vs 4.1%; difference, 1.6%; 95% CI, 1.1%-2.2%; P < .001), and the proportion of households without vehicle access (2.1% vs 1.8%; difference, 0.3%; 95% CI, 0.6%-5.2%; P = .001) were greater in counties with 0 compared with counties with 1 or more pediatric ophthalmologists.

          Conclusion and Relevance

          This cross-sectional study found that disparities in access to pediatric ophthalmological care have increased over the past 15 years and are associated with lower socioeconomic status. As patients may rely on online sources to identify the nearest pediatric ophthalmologist, accurate publicly available databases are important.

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          Most cited references14

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          Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review

          Objectives To investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients' health outcomes and assimilate the methodologies used to measure this. Design Systematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC and EBM Reviews for studies up to 7 September 2016. Studies were excluded that included children (including maternity), emergency medical travel or countries classed as being in the global south. Settings A wide range of settings within primary and secondary care (these were not restricted in the search). Results 108 studies met the inclusion criteria. The results were mixed. 77% of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (eg, survival rates, length of stay in hospital and non-attendance at follow-up) than those who lived closer. 6 of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients' geographical locations and the healthcare facilities attended, and the methods used to calculate travel times and distances were not consistent across studies. Conclusions The review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate.
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            Preclinical medical student training in radiology: the effect of early exposure.

            The purpose of this study was to determine whether an integrated radiology curriculum in the first year of medical school changes medical students' attitudes toward radiology or affects their knowledge of radiologic principles. The first-year medical curriculum of a medical school was revised between the 2003 and 2004 academic years to introduce more didactic radiology teaching. Dedicated radiology lectures were introduced, and radiology consult sessions became integral to problem-based learning sessions. A survey was administered between the first and second years of training to assess first-year medical students' attitudes toward radiology and their knowledge of basic radiologic principles. Students who had undertaken the revised curriculum (class of 2008) were compared with students who had undertaken the traditional curriculum (class of 2007). Survey responses were compared with Mann-Whitney rank sum tests. Students exposed to the new curriculum stated that they were more familiar with radiology as a specialty and believed that radiology had greater importance to the overall practice of medicine. They stated that they were more likely to select radiology as a clinical elective, and more of them were considering radiology as a career option. The students who had been exposed to radiology performed better on the test of basic radiologic knowledge. All results were statistically significant. Exposing students to radiology in the first year of medical school improves their impression of radiology as a specialty and increases their interest in radiology as a career. Follow-up surveys will determine whether this effect persists through the clinical years of training and improves the overall impression of radiology within the medical community.
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              The geographic alignment of primary care Health Professional Shortage Areas with markers for social determinants of health

              Background The Health Resources and Services Administration (HRSA), an agency within the U.S. Department of Health and Human Services (HHS), works to ensure accessible, quality, health care for the nation’s underserved populations, especially those who are medically, economically, or geographically vulnerable. HRSA-designated primary care Health Professional Shortage Areas (pcHPSAs) provide a vital measure by which to identify underserved populations and prioritize locations and populations lacking access to adequate primary and preventive health care–the foundation for advancing health equity and maintaining health and wellness for individuals and populations. However, access to care is a complex, multifactorial issue that involves more than just the number of health care providers available, and pcHPSAs alone cannot fully characterize the distribution of medically, economically, and geographically vulnerable populations. Methods and findings In this county-level analysis, we used descriptive statistics and multiple correspondence analysis to assess how HRSA’s pcHPSA designations align geographically with other established markers of medical, economic, and geographic vulnerability. Reflecting recognized social determinants of health (SDOH), markers included demographic characteristics, race and ethnicity, rates of low birth weight births, median household income, poverty, educational attainment, and rurality. Nationally, 96 percent of U.S. counties were either classified as whole county or partial county pcHPSAs or had one or more established markers of medical, economic, or geographic vulnerability in 2017, suggesting that at-risk populations were nearly ubiquitous throughout the nation. Primary care HPSA counties in HHS Regions 4 and 6 (largely lying within the southeastern and south central United States) had the most pervasive and complex patterns in population risk. Conclusion HHS Regions displayed unique signatures with respect to SDOH markers. Descriptive and analytic findings from our work may help inform health workforce and health care planning at all levels, and, by illustrating both the complexity of and differences in county-level population characteristics in pcHPSA counties, our findings may have relevance for strengthening the delivery of primary care and addressing social determinants of health in areas beset by provider shortages.
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                Author and article information

                Journal
                JAMA Ophthalmology
                JAMA Ophthalmol
                American Medical Association (AMA)
                2168-6165
                January 26 2023
                Affiliations
                [1 ]University of Miami Miller School of Medicine, Miami, Florida
                [2 ]University of Miami, Miami, Florida
                [3 ]Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
                Article
                10.1001/jamaophthalmol.2022.6010
                36701149
                18c36d7c-2606-415d-a3b2-b3db7f473355
                © 2023
                History

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