VCU Wright Center-funded study finds family medicine physicians often inaccurately estimate patients’ geographic footprint
Geographic locations affect social determinants of health ranging from access to nutritious foods to housing and education quality, but many family medicine physicians cannot accurately estimate where their patients live. In a study published in the Annals of Family Medicine in August, Virginia Commonwealth University researchers found that family medicine physicians overestimated the geographic footprint of their practice by 112 percent on average, or 166 miles. In other words, the physicians perceived their patients were more widely distributed in the region than they actually were.
“The intention of the study was to gain a better understanding of patients’ social determinants of health risks based on where they lived,” said Alex Krist, M.D., study co-investigator and professor of family medicine at the VCU School of Medicine. The study was funded through a pilot grant from the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research, where Krist serves as the co-director of community-engaged research. “We found that patients who come from more disadvantaged communities were less likely to get the care they needed,” he said.
Understanding the communities they serve is a critical first step for physicians to implement a more community-oriented approach to care, according to study co-investigator Winston Liaw, M.D., chair of the Department of Health Systems and Population Health Sciences at the University of Houston College of Medicine. Prior to joining the University of Houston, Liaw served as faculty at the VCU School of Medicine.
“The idea of thinking about where patients live is radical because we’re not trained to ask for that information,” Liaw said, adding that he believes the lack of geospatial awareness among physicians leaves clinicians feeling unprepared and communities underserved. “We need to get providers to integrate geography into their practice data and get them thinking about the health needs of specific communities.”
To address this gap, more practices are moving services out of the clinic and into the community. The changing care model makes it even more vital for clinicians to understand a community’s needs so that they can identify patients who need additional care, engage potential community partners and consider novel community-based interventions, the study authors argue.
Liaw further contends that information about the health challenges faced by specific communities should be integrated into electronic health records and used to develop strategic interventions.
“If I wanted to push a diabetic educator into the community, for example, then I need to know where to put them,” he said. “I need to know the neighborhoods my clinic serves and more specifically, where diabetic patients are living. Otherwise, we’re just guessing.”
Krist said the study quantitatively reinforced what he has observed through interactions with patients at the family medicine clinic where he practices in Northern Virginia.
“It is important for a doctor to know where their patient comes from,” he said. “This study revealed that doctors don’t understand the footprint of where their patients came from as well as they thought.”
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