Introduction: A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access.Methods: GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization.Results: Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services.Conclusions: Applying GIS to commonly available community-and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access. (J Am Board Fam Med 2010;23:13-21.)

This paper provides an empirical analysis of the multidimensional, spatio-temporal quality of life (QoL) trends followed by neighbourhoods in Charlotte, NC, between 2000 and 2010. Employing a combined geocomputational and visual technique based on the self-organising map, the study addresses which types of neighbourhood experienced the most change or stability, where (in attribute and geographical spaces) did neighbourhoods that began the decade with a particular set of characteristics evolve to, and where did neighbourhoods that concluded the decade transition from? Results indicate that the highest QoL neighbourhoods were most stable, while those with lower homeownership, closer to the city centre, exhibited the sharpest longitudinal trajectories. Lower-income neighbourhoods are found to be heterogeneous in terms of their social problems, dividing between high crime concentrations and youth-related social problems. An exchange of these social issues over time is observed as well as a geographical spread of crime to middle-ring suburbs.

Over the past six years hog farming in North Carolina has undergone a significant restructuring. For most of this century raising hogs was a casual farm activity found throughout the state. During the past decade hog farming has been transformed along industrial-corporate lines. In the process, the swine population has expanded rapidly (exploded) and simultaneously collapsed in geographical bounds (imploded). This paper examines the linkage between the development of the industrial-corporate hog farming regime, the rapid growth in hog populations, and the geographical concentration of hog production in a newly emerging high-density hog production district in the south central area of the Coastal Plain region.

Background: Hispanics are the largest and fastest growing minority group in the United States. Charlotte, NC, had the 4th fastest growing Hispanic community in the nation between 1990 to 2000. Gaining understanding of the patterns of health care use for this changing population is a key step toward designing improved primary care access and community health.Methods: The Multiple Attribute Primary Care Targeting Strategy process was applied to key patientand community-level attributes describing the Charlotte Hispanic community. Maps were created based on socioeconomic status, population density, insurance status, and use of the emergency department as a primary care safety net. Each of these variables was weighed and added to create a single composite map.Results: Individual attribute maps and the composite map identified geographic locations where Hispanic community members would most benefit from increased access to primary care services.Conclusions: Using the Multiple Attribute Primary Care Targeting Strategy process we were able to identify geographic areas within our community where many Hispanic immigrants face barriers to accessing appropriate primary care services. These areas can subsequently be targeted for interventions that improve access to primary care and reduce emergency department use. The geospatial model created through this process can be monitored over time to determine the effectiveness of these interventions. (J Am Board Fam Med 2010;23:109 -120.)

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