Low-income Primary Care Patients Research Articles

Predictors of Cancer Screening Among Low-Income Primary Care Patients

Although population-based studies report lower rates of cancer screening among racial/ethnic minorities than among Whites in the U.S., few studies have examined predictors of screening among low-income Hispanic, Black, and Chinese primary care patients. We examined utilization of mammography, Pap smear, digital rectal examination, fecal occult blood testing, sigmoidoscopy/colonoscopy, and prostate-specific antigen testing in 833 patients from 2 community health centers in New York City, ascertaining relationships between use of screening and race/ethnicity, income, education, years in the U.S., insurance, cancer risk perception, family disease history, and physician recommendation. Despite similar access to primary care, Hispanics and Blacks reported higher utilization rates of all screening tests than Chinese (p<.01). Physician recommendation and more years in the U.S. were associated with greater use of all screening services (p<.001), with physician recommendation most strongly associated with screening. Interventions to enhance screening by at-risk groups should emphasize both physician recommendation and culturally-sensitive patient education.

Social Support and the Association of Type 2 Diabetes and Depressive and Anxiety Disorders Among Low-income Adults Seen in Primary Care Clinics

This study examined the association of social support (SS) and affective disturbance among low-income primary care patients with no chronic illnesses vs. those with type 2 diabetes vs. those with other chronic illnesses. The sample was predominantly middle aged (47.2 years old), African American (74%) and female (80%), with an average individual monthly income of approximately $500. Participants (N = 326) were administered the Diagnostic Interview Schedule, IV and the Interpersonal Support Evaluation List. Logistic regression results indicated that each standard deviation decrease in SS, increased the odds of having a depressive or anxiety disorder diagnosis by .618 OR (CI .472, .808, p < .000) for all study participants; .438 OR (95% CI .195, .987, p = .046) for those with hypertension, asthma and/or arthritis; and .326 OR (95% CI .141, .755, p = .009) for those with type 2 diabetes. Results suggest that SS may serve an important role in the association between stress and depression/anxiety diagnoses among low-income, primary care patients.

Generalized anxiety disorder, somatic pain and health care costs

Objective To evaluate the extent to which pain severity contributes to the health care costs of low-income primary care patients with generalized anxiety disorder (GAD). Methods Primary care patients ( N=1029) were assessed with the PRIME-MD PHQ and a measure of pain interference with daily activities, classified as high (extremely or quite a bit) or low (moderately, a little bit or not at all). Medical charges were also assessed for the 6 months before and after the research interview. Patients with and without GAD were first compared and then mean predicted medical care charges were compared among patient groups with and without GAD and high pain interference. Results Compared to patients without GAD ( n=919), patients with GAD ( n=110) had significantly higher median medical care charges ($2375 vs. $1448, z=−2.8, P=.006) and significantly higher pain interference ratings ( z=7.4, P<.0001). After controlling for patient age and gender, mean predicted medical care costs were highest for patients with GAD/high pain interference ($42,620, n=59) followed by no GAD/high pain interference ($9601, n=196), no GAD/low pain interference ($6757, n=709) and GAD/low pain interference ($3204, n=50). Conclusions In this setting, patients with GAD and high pain interference are common and have especially high health care costs.

Cultural Sensitivity in Physician-Patient Relationships: Perspectives of an Ethnically Diverse Sample of Low-income Primary Care Patients

Cultural Sensitivity in Physician-Patient Relationships: Perspectives of an Ethnically Diverse Sample of Low-income Primary Care Patients Vol. 41, No. 7, pp. 859-870 In the article cited above, copyediting errors caused racial and ethnic labels to be used interchangeably. The authors intended to use distinct ethnic labels to describe participants of the study throughout the paper. In particular, the racial label “white” was used instead of the ethnic label “European American.” The authors preferred the latter term for accuracy and to be consistent with the ethnic labels used to describe the other participants in the study (African American and Latino American). Additionally, on p. 863 in the section Results and subsection African Americans, the paragraph under the heading “People Skills” implies that the entire quote that is half way through the paragraph was given by the same participant. In fact, the paragraph contains separate quotes given by two participants. The separators (a and b) were removed during copyediting. The marker (a) should appear before the sentence beginning “But the day I was going to surgery,…” and the marker (b) should appear before the sentence beginning “She said, ’I’m right here…’ ” and it is part of the second participant’s quote. The publisher apologizes for these errors.

The Long-term Effects of a Self-management Program for Inner-city Primary Care Patients With Acute Low Back Pain

We evaluated the effect of a self-management program for low-income primary care patients with acute low back pain (ALBP) from inner-city neighborhood health centers. We conducted a randomized controlled trial of a self-management program compared with usual care at university-affiliated neighborhood health centers and an emergency department of an inner-city public teaching hospital. We enrolled 211 patients who visited a physician for ALBP (<90 days' duration). The self-management program consisted of 3 group sessions and telephone follow-up that focused on understanding back pain, increasing physical activity, and dealing with fears and frustrations. At baseline, 4 months, and 12 months, blinded interviewers assessed back pain physical function (Roland Disability Questionnaire), health status (Arthritis Impact Measurement Scales), self-efficacy, and time spent in physical activity. Compared with patients receiving usual care, intervention patients reported significantly better scores on the Roland Disability Questionnaire (P =.009), mental functioning (P =.009), self-efficacy to manage ALBP (P =.03), time spent in physical activity (P =.047), and reduced fears of movement/reinjury (P =.005) after 12 months. A self-management program can improve and maintain functional status, mental functioning, and self-efficacy to manage future symptoms for 1 year among primary care patients with ALBP living in the urban, inner city.

Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients.

Health care providers and health care training institutions need more specific, relevant, and useful information for providing culturally sensitive health care. We sought to determine what patients considered to be culturally sensitive health care. We conducted 20 focus group interviews with 135 mostly low-income primary care patients from three different ethnic/cultural groups (African American, European American, and Latino American). Focus group interviews were recorded, transcribed, and analyzed into themes by two researchers using the constant comparative method. Participants' responses were grouped into primary and secondary themes. Results revealed the following universal themes of health care delivery by physicians that all three racial or ethnic groups identified as indicators of culturally sensitive health care: people skills, individualized treatment, effective communication, and technical competence. Results also revealed some ethnic group-specific themes. Other factors including physical environment characteristics (eg, culturally sensitive art, pictures, music, and reading materials) and office staff behaviors were unique indicators of culturally sensitive health care identified by African American and Latino American participants but not by European American participants. These findings can be incorporated into training programs for health care providers, possibly resulting in more effective health care delivery to patients from diverse cultural backgrounds. Future research is needed to evaluate the impact of incorporating patient-identified cultural sensitivity into health care delivery on important outcome measures such as patient satisfaction and treatment adherence.