There are State Primary Care Offices (PCO) programs located in every state and territory of the United States. The PCO program is funded by the Health Resources and Services Administration (HRSA). In Delaware, the PCO program is located within the Bureau of Health Planning and Resources Management of the Division of Public Health. The PCO program facilitates the coordination of activities to assess the need for primary care, dental health, and mental health providers and services, promote recruitment and retention of providers to fulfill identified needs, work to identify Health Professional Shortage Area designations, and reduce healthcare provider shortages.
One of the key aspects of the PCO program is Health Professional Shortage Area (HPSA) designations. HPSA designations denote geographic areas, populations, and facilities without adequate providers and services (shortages) in the disciplines of primary care, dental health, and mental health. The purpose of HPSA designations is to improve healthcare service delivery and workforce availability, in each of the disciplines, to meet the needs of underserved populations in the designated areas. Determining which areas should be shortage designations is central to prioritizing and focusing resources to the areas of highest need.
To determine if an area is experiencing a shortage of health professionals, the PCO reviews several data elements that are sourced from the American Community Survey, Centers for Disease Prevention and Control, Census Tiger Geometry Data, ESRI 2020 ArcGIS, Uniform Data System, and the National Provider Identifier data file. These data elements are assigned a point value and combined to determine an overall score – the higher the score the higher the need. The data elements and their point values for each of the disciplines is outlined in table 1 below.
Table 1. HPSA Scoring.
| Data Elements | HPSA Disciplines | ||
|---|---|---|---|
| Primary Care | Dental Health | Mental Health | |
| Rational Service Area | Census Tract(s) County |
Census Tract(s) County |
Census Tract(s) County |
| Population to Provider Ratio | 10 | 10 | 7 |
| Percent of Population below 100% Federal Poverty Area | 5 | 10 | 5 |
| Travel Time to the Nearest Source of Care | 5 | 5 | 5 |
| Infant Health Index (Low birth weight or Infant Mortality Rate) |
5 | 0 | 0 |
| Water Fluoridation Status | 0 | 1 | 0 |
| Elderly Ratio (percent of people over age 65) | 0 | 0 | 3 |
| Youth Ratio (percent of people under age 18) | 0 | 0 | 3 |
| Substance Abuse Prevalence | 0 | 00 | 1 |
| Alcohol Abuse Prevalence | 0 | 1 | |
| HRPA Score | 25 | 26 | 25 |
Once the analysis is complete for each of the rational service areas and disciplines, the information is submitted to the HRSA for review and approval. If the request is denied, the PCO and HRSA work together to determine if the information can be revised to obtain a designation and if a designation is not possible – the request is denied. If the request for designation is approved, the HRSA issues a formal notice approving the designation and the designation is valid for a minimum of one year or until the data sources are updated with new information to request a designation update. Delaware has HPSA designations for primary care (figure 1), dental health (figure 2), and mental health (figure 3).
Figure 1.
Delaware HPSA Designations – Primary Care
Figure 2.
Delaware HPSA Designations – Dental Health
Figure 3.
Delaware HPSA Designations – Mental Health
HPSAs are prerequisites for various Federal and State programs. Providers rendering service in HPSA designated areas are eligible to participate in medical education loan repayment programs; National Health Service Corps (NHSC) Loan Repayment Programs; Traditional, Substance Use Disorder, and Rural Community; NHSC Scholarship Program; Delaware State Loan Repayment and Healthcare Provider Loan Programs; Nurse Corps and Nurse Scholar Programs; and the j1 Visa Waiver Program. And there is potential for grants residency and training programs across the primary care, dental health, and mental health disciplines, public health projects, and nurse training and education programs.