Abstract
OBJECTIVE: To determine if patient assessments (reports and ratings) of primary care differ by patient ethnicity. DATA SOURCES/STUDY DESIGN: A self-administered patient survey of 6,092 Massachusetts employees measured seven defining characteristics of primary care: (1) access (financial, organizational); (2) continuity (longitudinal, visit based); (3) comprehensiveness (knowledge of patient, preventive counseling); (4) integration; (5) clinical interaction (communication, thoroughness of physical examinations); (6) interpersonal treatment; and (7) trust. The study employed a cross-sectional observational design. PRINCIPAL FINDINGS: Asians had the lowest primary care performance assessments of any ethnic group after adjustment for socioeconomic and other factors. For example, compared to whites, Asians had lower scores for communication (69 vs. 79, p = .001) and comprehensive knowledge of patient (56 vs. 48, p = .002), African Americans and Latinos had less access to care, and African Americans had less longitudinal continuity than whites. CONCLUSIONS: We do not know what accounts for the observed differences in patient assessments of primary care. The fact that patient reports as well as the more subjective ratings of care differed by ethnicity suggests that quality differences might exist that need to be addressed.
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Selected References
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- Boult L., Boult C. Underuse of physician services by older Asian-Americans. J Am Geriatr Soc. 1995 Apr;43(4):408–411. doi: 10.1111/j.1532-5415.1995.tb05816.x. [DOI] [PubMed] [Google Scholar]
- Carp F. M., Kataoka E. Health care problems of the elderly of San Francisco's Chinatown. Gerontologist. 1976 Feb;16(1 PT1):30–38. doi: 10.1093/geront/16.1_part_1.30. [DOI] [PubMed] [Google Scholar]
- Chen M. S., Jr, Hawks B. L. A debunking of the myth of healthy Asian Americans and Pacific Islanders. Am J Health Promot. 1995 Mar-Apr;9(4):261–268. doi: 10.4278/0890-1171-9.4.261. [DOI] [PubMed] [Google Scholar]
- Choi K. H., Coates T. J., Catania J. A., Lew S., Chow P. High HIV risk among gay Asian and Pacific Islander men in San Francisco. AIDS. 1995 Mar;9(3):306–308. [PubMed] [Google Scholar]
- Cohen J. J. Transforming the size and composition of the physician work force to meet the demands of health care reform. N Engl J Med. 1993 Dec 9;329(24):1810–1812. doi: 10.1056/NEJM199312093292412. [DOI] [PubMed] [Google Scholar]
- Franks P., Nutting P. A., Clancy C. M. Health care reform, primary care, and the need for research. JAMA. 1993 Sep 22;270(12):1449–1453. [PubMed] [Google Scholar]
- Haywood L. J. Coronary heart disease mortality/morbidity and risk in blacks. II: Access to medical care. Am Heart J. 1984 Sep;108(3 Pt 2):794–796. doi: 10.1016/0002-8703(84)90673-2. [DOI] [PubMed] [Google Scholar]
- Keil J. E., Sutherland S. E., Knapp R. G., Tyroler H. A. Does equal socioeconomic status in black and white men mean equal risk of mortality? Am J Public Health. 1992 Aug;82(8):1133–1136. doi: 10.2105/ajph.82.8.1133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Klatsky A. L., Armstrong M. A. Cardiovascular risk factors among Asian Americans living in northern California. Am J Public Health. 1991 Nov;81(11):1423–1428. doi: 10.2105/ajph.81.11.1423. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lin-Fu J. S. Population characteristics and health care needs of Asian Pacific Americans. Public Health Rep. 1988 Jan-Feb;103(1):18–27. [PMC free article] [PubMed] [Google Scholar]
- Mahoney F. J., Lawrence M., Scott C., Le Q., Lambert S., Farley T. A. Continuing risk for hepatitis B virus transmission among Southeast Asian infants in Louisiana. Pediatrics. 1995 Dec;96(6):1113–1116. [PubMed] [Google Scholar]
- Meredith L. S., Siu A. L. Variation and quality of self-report health data. Asians and Pacific Islanders compared with other ethnic groups. Med Care. 1995 Nov;33(11):1120–1131. doi: 10.1097/00005650-199511000-00005. [DOI] [PubMed] [Google Scholar]
- Murray-García J. L., Selby J. V., Schmittdiel J., Grumbach K., Quesenberry C. P., Jr Racial and ethnic differences in a patient survey: patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000 Mar;38(3):300–310. doi: 10.1097/00005650-200003000-00007. [DOI] [PubMed] [Google Scholar]
- Phillips K. A., Mayer M. L., Aday L. A. Barriers to care among racial/ethnic groups under managed care. Health Aff (Millwood) 2000 Jul-Aug;19(4):65–75. doi: 10.1377/hlthaff.19.4.65. [DOI] [PubMed] [Google Scholar]
- Pérez-Stable E. J., Otero-Sabogal R., Sabogal F., McPhee S. J., Hiatt R. A. Self-reported use of cancer screening tests among Latinos and Anglos in a prepaid health plan. Arch Intern Med. 1994 May 23;154(10):1073–1081. doi: 10.1001/archinte.1994.00420100041007. [DOI] [PubMed] [Google Scholar]
- Safran D. G., Kosinski M., Tarlov A. R., Rogers W. H., Taira D. H., Lieberman N., Ware J. E. The Primary Care Assessment Survey: tests of data quality and measurement performance. Med Care. 1998 May;36(5):728–739. doi: 10.1097/00005650-199805000-00012. [DOI] [PubMed] [Google Scholar]
- Saha S., Komaromy M., Koepsell T. D., Bindman A. B. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999 May 10;159(9):997–1004. doi: 10.1001/archinte.159.9.997. [DOI] [PubMed] [Google Scholar]
- Taira D. A., Safran D. G., Seto T. B., Rogers W. H., Kosinski M., Ware J. E., Lieberman N., Tarlov A. R. Asian-American patient ratings of physician primary care performance. J Gen Intern Med. 1997 Apr;12(4):237–242. doi: 10.1046/j.1525-1497.1997.012004237.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Taira D. A., Safran D. G., Seto T. B., Rogers W. H., Tarlov A. R. The relationship between patient income and physician discussion of health risk behaviors. JAMA. 1997 Nov 5;278(17):1412–1417. [PubMed] [Google Scholar]
- Tanjasiri S. P., Wallace S. P., Shibata K. Picture imperfect: hidden problems among Asian Pacific islander elderly. Gerontologist. 1995 Dec;35(6):753–760. doi: 10.1093/geront/35.6.753. [DOI] [PubMed] [Google Scholar]
- Valdez R. B., Morgenstern H., Brown R., Wyn R., Wang C., Cumberland W. Insuring Latinos against the costs of illness. JAMA. 1993 Feb 17;269(7):889–894. [PubMed] [Google Scholar]
- Welte J. W., Barnes G. M. Alcohol use among adolescent minority groups. J Stud Alcohol. 1987 Jul;48(4):329–336. doi: 10.15288/jsa.1987.48.329. [DOI] [PubMed] [Google Scholar]
- Woolhandler S., Himmelstein D. U., Silber R., Bader M., Harnly M., Jones A. A. Medical care and mortality: racial differences in preventable deaths. Int J Health Serv. 1985;15(1):1–22. doi: 10.2190/90P3-LEFF-WNU0-GLY6. [DOI] [PubMed] [Google Scholar]
- Wright R. A. Community-oriented primary care. The cornerstone of health care reform. JAMA. 1993 May 19;269(19):2544–2547. [PubMed] [Google Scholar]
- Yu E. S., Cypress B. K. Visits to physicians by Asian/Pacific Americans. Med Care. 1982 Aug;20(8):809–820. doi: 10.1097/00005650-198208000-00005. [DOI] [PubMed] [Google Scholar]