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. 2007 Jan;99(1):22–30.

Examining racial and ethnic disparities in site of usual source of care.

Darrell J Gaskin 1, Jose J Arbelaez 1, Jorielle R Brown 1, Hanno Petras 1, Fernando A Wagner 1, Lisa A Cooper 1
PMCID: PMC2569590  PMID: 17304965

Abstract

Little is known about why minorities have a lower propensity to use private doctors' offices for their usual source of care than non-Hispanic whites. This study used the 2001 Commonwealth Fund's Health Care Quality Survey of adults to determine if this disparity is due to racial and ethnic differences in attitudes about health and healthcare, and perceptions of racial and ethnic discrimination in healthcare. We found that race and ethnic disparities at the site of the usual source of care persisted even after controlling for individuals' attitudes about health and healthcare, and their perceptions about racial and ethnic discrimination in healthcare. We found that the impact of attitudes and perceptions did vary by subgroups. These factors were important for Asians' site of usual source of care but had little impact on African Americans' site of usual of care. However, despite their differential impact by race and ethnicity, attitudes and perceptions were not the source of observed disparities in site of care. Therefore, in addition to focusing on provider-patient relationships, perhaps future research and policymakers should focus on system-level factors to explain and increase minority use of care in private physicians' offices.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen R. M. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995 Mar;36(1):1–10. [PubMed] [Google Scholar]
  2. Andersen R., Aday L. A. Access to medical care in the U.S.: realized and potential. Med Care. 1978 Jul;16(7):533–546. doi: 10.1097/00005650-197807000-00001. [DOI] [PubMed] [Google Scholar]
  3. Ansell David, Schiff Robert, Goldberg David, Furumoto-Dawson Alice, Dick Stuart, Peterson Corinne. Primary care access decreases nonurgent hospital visits for indigent diabetics. J Health Care Poor Underserved. 2002 May;13(2):171–183. doi: 10.1353/hpu.2010.0600. [DOI] [PubMed] [Google Scholar]
  4. Ayanian J. Z., Cleary P. D., Weissman J. S., Epstein A. M. The effect of patients' preferences on racial differences in access to renal transplantation. N Engl J Med. 1999 Nov 25;341(22):1661–1669. doi: 10.1056/NEJM199911253412206. [DOI] [PubMed] [Google Scholar]
  5. Bach Peter B., Pham Hoangmai H., Schrag Deborah, Tate Ramsey C., Hargraves J. Lee. Primary care physicians who treat blacks and whites. N Engl J Med. 2004 Aug 5;351(6):575–584. doi: 10.1056/NEJMsa040609. [DOI] [PubMed] [Google Scholar]
  6. Barnato Amber E., Lucas F. Lee, Staiger Douglas, Wennberg David E., Chandra Amitabh. Hospital-level racial disparities in acute myocardial infarction treatment and outcomes. Med Care. 2005 Apr;43(4):308–319. doi: 10.1097/01.mlr.0000156848.62086.06. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Corbie-Smith Giselle, Flagg Elaine W., Doyle Joyce P., O'Brien Megan A. Influence of usual source of care on differences by race/ethnicity in receipt of preventive services. J Gen Intern Med. 2002 Jun;17(6):458–464. doi: 10.1046/j.1525-1497.2002.10733.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Doescher M. P., Saver B. G., Fiscella K., Franks P. Racial/ethnic inequities in continuity and site of care: location, location, location. Health Serv Res. 2001 Dec;36(6 Pt 2):78–89. [PMC free article] [PubMed] [Google Scholar]
  9. Ettner S. L. The timing of preventive services for women and children: the effect of having a usual source of care. Am J Public Health. 1996 Dec;86(12):1748–1754. doi: 10.2105/ajph.86.12.1748. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fiscella Kevin, Franks Peter. Does the content of primary care visits differ by the racial composition of physicians' practices? Am J Med. 2006 Apr;119(4):348–353. doi: 10.1016/j.amjmed.2005.08.040. [DOI] [PubMed] [Google Scholar]
  11. Forrest C. B., Starfield B. Entry into primary care and continuity: the effects of access. Am J Public Health. 1998 Sep;88(9):1330–1336. doi: 10.2105/ajph.88.9.1330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Franks Peter, Fiscella Kevin, Meldrum Sean. Racial disparities in the content of primary care office visits. J Gen Intern Med. 2005 Jul;20(7):599–603. doi: 10.1111/j.1525-1497.2005.0109.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hargraves J. L., Cunningham P. J., Hughes R. G. Racial and ethnic differences in access to medical care in managed care plans. Health Serv Res. 2001 Oct;36(5):853–868. [PMC free article] [PubMed] [Google Scholar]
  14. Hargraves J. L., Stoddard J. J., Trude S. Minority physicians' experiences obtaining referrals to specialists and hospital admissions. MedGenMed. 2001 Aug 9;3(4):10–10. [PubMed] [Google Scholar]
  15. LaVeist T. A., Nickerson K. J., Bowie J. V. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57 (Suppl 1):146–161. doi: 10.1177/1077558700057001S07. [DOI] [PubMed] [Google Scholar]
  16. Lambrew J. M., DeFriese G. H., Carey T. S., Ricketts T. C., Biddle A. K. The effects of having a regular doctor on access to primary care. Med Care. 1996 Feb;34(2):138–151. doi: 10.1097/00005650-199602000-00006. [DOI] [PubMed] [Google Scholar]
  17. Mayberry R. M., Mili F., Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57 (Suppl 1):108–145. doi: 10.1177/1077558700057001S06. [DOI] [PubMed] [Google Scholar]
  18. Mukamel D. B., Murthy A. S., Weimer D. L. Racial differences in access to high-quality cardiac surgeons. Am J Public Health. 2000 Nov;90(11):1774–1777. doi: 10.2105/ajph.90.11.1774. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Newacheck Paul W., Hung Yun-Yi, Wright Kara K. Racial and ethnic disparities in access to care for children with special health care needs. Ambul Pediatr. 2002 Jul-Aug;2(4):247–254. doi: 10.1367/1539-4409(2002)002<0247:raedia>2.0.co;2. [DOI] [PubMed] [Google Scholar]
  20. Schecter A. D., Goldschmidt-Clermont P. J., McKee G., Hoffeld D., Myers M., Velez R., Duran J., Schulman S. P., Chandra N. G., Ford D. E. Influence of gender, race, and education on patient preferences and receipt of cardiac catheterizations among coronary care unit patients. Am J Cardiol. 1996 Nov 1;78(9):996–1001. doi: 10.1016/s0002-9149(96)00523-1. [DOI] [PubMed] [Google Scholar]
  21. Sedlis S. P., Fisher V. J., Tice D., Esposito R., Madmon L., Steinberg E. H. Racial differences in performance of invasive cardiac procedures in a Department of Veterans Affairs Medical Center. J Clin Epidemiol. 1997 Aug;50(8):899–901. doi: 10.1016/s0895-4356(97)00089-9. [DOI] [PubMed] [Google Scholar]
  22. Weinick R. M., Krauss N. A. Racial/ethnic differences in children's access to care. Am J Public Health. 2000 Nov;90(11):1771–1774. doi: 10.2105/ajph.90.11.1771. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Weinick R. M., Zuvekas S. H., Cohen J. W. Racial and ethnic differences in access to and use of health care services, 1977 to 1996. Med Care Res Rev. 2000;57 (Suppl 1):36–54. doi: 10.1177/1077558700057001S03. [DOI] [PubMed] [Google Scholar]
  24. Whittle J., Conigliaro J., Good C. B., Joswiak M. Do patient preferences contribute to racial differences in cardiovascular procedure use? J Gen Intern Med. 1997 May;12(5):267–273. doi: 10.1046/j.1525-1497.1997.012005267.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Xu K. Tom. Usual source of care in preventive service use: a regular doctor versus a regular site. Health Serv Res. 2002 Dec;37(6):1509–1529. doi: 10.1111/1475-6773.10524. [DOI] [PMC free article] [PubMed] [Google Scholar]

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