Separate and unequal: clinics where minority and nonminority patients receive primary care

Authors: Varkey AB et al

Summary: Data were examined from surveys of 96 primary care clinic managers, 388 primary care physicians, and 1701 of their adult patients with hypertension, diabetes mellitus, or congestive heart failure. Clinics were based in New York and in the upper Midwest; data from 27 clinics with ≥30% minority patients were contrasted with data from 69 clinics with <30% minority patients. Compared with clinics serving <30% minority patients, clinics serving ≥30% minority patients have less access to medical supplies (2.7 vs 3.4), referral specialists (3.0 vs 3.5) on a scale of 1 (none) to 4 (great), and examination rooms per physician (2.2 vs 2.7). Their patients are more frequently depressed (22.8% vs 12.1%), are more often covered by Medicaid (30.2% vs 11.4%), and report lower health literacy (3.7 vs 4.4) on a scale of 1 (low) to 5 (high). Physicians from clinics serving higher proportions of minority populations perceive their patients as frequently speaking little or no English (27.1% vs 3.4%), having more chronic pain (24.1% vs 12.9%) and substance abuse problems (15.1% vs 10.1%), and being more medically complex (53.1% vs 39.9%) and psychosocially complex (44.9% vs 28.2%). Regression analyses revealed that clinics with ≥30% minority patients are more likely to have chaotic work environments and to have fewer physicians reporting high work control or high job satisfaction.

Reference: Arch Intern Med. 2009;169(3):243-50.