Abstract
BACKGROUND: Little is known about racial disparities in primary care at the level of the office visit.
OBJECTIVE: To assess racial disparities in the receipt of commonly performed/recommended procedures during routine primary care office visits and examine trends in disparities over time.
DESIGN, SETTING, AND PATIENTS: The sample included 88,303 visits by adults to 3,260 primary care physicians in office-based practices in the National Ambulatory Medical Care Surveys, 1985, 1989, 1990, 1991, 1992, and 1995 to 2001.
MEASUREMENTS: Adjusted odds for receipt or recommendation of commonly performed office procedures.
RESULTS: During the years 1985 to 2001, African Americans, compared with whites, had lower odds of receiving a Pap test (odds ratio (OR) 0.81; 95% confidence interval (CI) 0.70 to 0.93), rectal exam (OR 0.67; 95% CI 0.56 to 0.80), smoking cessation counseling (OR 0.80; 95% CI 0.66 to 0.96), and mental health advice (OR 0.51; 95% CI 0.38 to 0.69), but had higher odds for visual screening (OR 1.38; 95% CI 1.08 to 1.77), weight advice counseling (OR 1.27; 95% CI 1.13 to 1.44) and receiving a follow-up appointment (OR 1.45; 95% CI 1.29 to 1.64). These findings were not appreciably altered by adjustment for physician practice characteristics including percent African American or Medicaid patients. Disparities disfavoring African Americans in cholesterol testing and smoking cessation observed during 1985 to 1992 were not observed in 1995 to 2001.
CONCLUSIONS: The findings suggest that race is associated with the type of primary care received by patients, at least for selected procedures, with evidence that some disparities have diminished over time.
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References
Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002.
Academy of Health Services Research and Health Policy. Contributions of New Technologies to Racial Disparities in Healthcare. Washington, DC: Academy of Health Services Research and Health Policy; 2002.
Escarce JJ, McGuire TG. Changes in racial differences in use of medical procedures and diagnostic tests among elderly persons: 1986–1997. Am J Public Health. 2004;94:1795–9.
Williams RL, Flocke SA, Stange KC. Race and preventive services delivery among black patients and white patients seen in primary care. Med Care. 2001;39:1260–7.
Oliver MN, Goodwin MA, Gotler RS, Gregory PM, Stange KC. Time use in clinical encounters: are African-American patients treated differently? J Natl Med Assoc. 2001;93:380–5.
Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.
Wang TJ, Stafford RS. National patterns and predictors of beta-blocker use in patients with coronary artery disease. Arch Intern Med. 1998;158:1901–6.
Stafford RS, Blumenthal D, Pasternak RC. Variations in cholesterol management practices of U.S. physicians. J Am Coll Cardiol. 1997;29:139–46.
Taira DA, Safran DG, Seto TB, et al. Do patient assessments of primary care differ by patient ethnicity? Health Serv Res. 2001;36:1059–71.
O’Malley MS, Earp JA, Harris RP. Race and mammography use in two North Carolina counties. Am J Public Health. 1997;87:782–6.
Weiner JP, Starfield BH, Steinwachs DM, Mumford LM. Development and application of a population-oriented measure of ambulatory care case-mix. Med Care. 1991;29:452–72.
Blumenthal D, Causino N, Chang YC, et al. The duration of ambulatory visits to physicians. J Fam Pract. 1999;48:264–71.
Forrest CB, Reid RJ. Prevalence of health problems and primary care physicians’ specialty referral decisions. J Fam Pract. 2001;50:427–32.
Forrest CB, Whelan EM. Primary care safety-net delivery sites in the United States: a comparison of community health centers, hospital outpatient departments, and physicians’ offices. JAMA. 2000;284:2077–83.
Franks P, Bertakis KD. Physician gender, patient gender, and primary care. J Women Health. 2003;12:73–80.
Perkins AJ, Kroenke K, Unutzer J, et al. Common comorbidity scales were similar in their ability to predict health care costs and mortality. J Clin Epidemiol. 2004;57:1040–8.
Chernof BA, Sherman SE, Lanto AB, Lee ML, Yano EM, Rubenstein LV. Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics. Med Care. 1999;37:738–47.
Binder DA. On the variances of asymptotically normal estimators from complex surveys. Int Statist Rev. 1983;51:279–92.
King G, Polednak A, Bendel RB, Vilsaint MC, Nahata SB. Disparities in smoking cessation between African Americans and whites: 1990–2000. Am J Public Health. 2004;94:1965–71.
Malat J. Social distance and patients’ rating of healthcare providers. J Health Soc Behav. 2001;42:360–72.
Bottero W, Prandy K. Social interaction distance and stratification. Br J Sociol. 2003;54:177–97.
Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–84.
Laveist TA, Carroll T. Race of physician and satisfaction with care among African Americans. J Natl Med Assoc. 2002;94:937–4.
Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159:997–1004.
Saha S, Arbelaez JJ, Cooper LA. Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health. 2003;93:1713–9.
Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139:907–15.
Stevens GD, Shi L, Cooper LA. Patient-provider racial and ethnic concordance and parent reports of the primary care experiences of children. Ann Fam Med. 2003;1:105–12.
Laveist TA, Nuru-Jeter A, Jones KE. The association of doctor-patient race concordance with health services utilization. J Public Health Policy. 2003;24:312–23.
Doescher MP, Saver BG. Physicians’ advice to quit smoking. The glass remains half empty. J Fam Pract. 2000;49:543–7.
Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003;97:1528–40.
Martin LM, Calle EE, Wingo PA, Heath CW Jr. Comparison of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: are we closing the gaps? Am J Prev Med. 1996;12:82–90.
May DS, Trontell AE. Mammography use by elderly women: a methodological comparison of two national data sources. Ann Epidemiol. 1998;8:439–44.
McGovern PG, Lurie N, Margolis KL, Slater JS. Accuracy of self-report of mammography and Pap smear in a low-income urban population. Am J Prev Med. 1998;14:201–8.
Champion VL, Menon U, McQuillen DH, Scott C. Validity of self-reported mammography in low-income African-American women. Am J Prev Med. 1998;14:111–7.
Caplan LS, Mandelson MT, Anderson LAHealth Maintenance Organization. Validity of self-reported mammography: examining recall and covariates among older women in a Health Maintenance Organization. Am J Epidemiol. 2003;157:267–72.
McPhee SJ, Nguyen TT, Shema SJ, et al. Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Prev Med. 2002;35:463–73.
Zapka JG, Bigelow C, Hurley T, et al. Mammography use among sociodemographically diverse women: the accuracy of self-report. Am J Public Health. 1996;86:1016–21.
Fiscella K, Franks P, Meldrum S. Estimating racial/ethnic disparity in mammography rates: it all depends on how you ask the question. Prev Med. 2004;39:399–403.
Chiang YP, Wang F, Javitt JC. Office visits to ophthalmologists and other physicians for eye care among the U.S. population, 1990. Public Health Rep. 1995;110:147–53.
Congdon N, O’Colmain B, Klaver CC, et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004;122:477–85.
Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care. 1998;21:518–24.
Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 2003;290:199–206.
Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among U.S. adults, 1999–2000. JAMA. 2002;288:1723–7.
Greenblatt J. Statistical Brief #14 Trends in Access to Routine Care and Experiences with Care: 2001. Rockville, MD: Agency for Healthcare Research and Quality; 2003.
Gilchrist VJ, Stange KC, Flocke SA, McCord G, Bourguet CC. A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits. Med Care. 2004;42:276–80.
Jaen CR, Stange KC, Tumiel LM, Nutting P. Missed opportunities for prevention: smoking cessation counseling and the competing demands of practice. J Fam Pract. 1997;45:348–54.
Nutting PA, Rost K, Smith J, Werner JJ, Elliot C. Competing demands from physical problems: effect on initiating and completing depression care over 6 months. Arch Fam Med. 2000;9:1059–64.
Nutting PA, Baier M, Werner JJ, Cutter G, Conry C, Stewart L. Competing demands in the office visit: what influences mammography recommendations? J Am Board Fam Pract. 2001;14:352–61.
Burgess DJ, Fu SS, van Ryn M. Why do providers contribute to disparities and what can be done about it? J Gen Intern Med. 2004;19:1154–9.
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Grant Support: Agency for Health care Research and Quality R01 HS 10910-01A2.
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Franks, P., Fiscella, K. & Meldrum, S. Racial disparities in the content of primary care office visits. J GEN INTERN MED 20, 599–603 (2005). https://doi.org/10.1007/s11606-005-0106-4
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DOI: https://doi.org/10.1007/s11606-005-0106-4