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Research ArticleOriginal Article

The Content of a Low-income, Uninsured Primary Care Population: Including the Patient Agenda

Larry B. Mauksch, Wayne J. Katon, Joan Russo, Suzanne M. Tucker, Edward Walker and Janet Cameron
The Journal of the American Board of Family Practice July 2003, 16 (4) 278-289; DOI: https://doi.org/10.3122/jabfm.16.4.278
Larry B. Mauksch
MEd
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Wayne J. Katon
MD
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Joan Russo
PhD
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Suzanne M. Tucker
EdD
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Edward Walker
MD
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Janet Cameron
MSW
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  • Article
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Article Figures & Data

Tables

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    Table 1.

    Demographics of Study Population (n = 500).

    CharacteristicValue
    Mean (range)
    Age, years38 (18–64)
    Percent
    Female68.0
    Marital status
     Single23.6
     Married31.8
     Divorced31.0
     Separated7.4
     Widowed4.0
    Education
     <8th grade6.6
     Some highschool17.8
     High school graduate37.2
     College30.8
     College graduate5.6
    Ethnicity
     White74.6
     Hispanic14.2
     Native5.2
     Other3.0
    Personal income ($)
     0–5,00041.0
     5,000–10,00031.0
     10,000–15,00016.0
     15,000–20,0008.0
     >20,0004.0
    • View popup
    Table 2.

    Percentage of Patients Responding to the Request to Indicate Whether They Now Have Any of the Following Health Problems.

    Health ProblemTotal Population (n = 500)Patients Without Threshold Diagnosis (n = 332)Patients With Threshold Diagnosis* (n = 168)Odds Ratio (95% CI)
    Migraine or other severe chronic headaches33.728.144.92.1† (1.4–3.1)
    Chronic back problems (including disk or spine)32.625.148.02.8† (1.8–4.2)
    Arthritis or rheumatism29.222.842.02.4† (1.6–3.8)
    Hypertension or high blood pressure21.518.627.61.7‡ (1.1–2.7)
    Asthma19.518.621.11.2 (0.7–1.9)
    Stomach ulcer, chronic inflamed bowel, enteritis, colitis15.211.123.82.5† (1.5–4.2)
    Diabetes or high blood glucose15.112.919.71.6 (0.9–2.9)
    Breathing trouble, caused by emphysema or chronic lung disease10.47.316.42.5§ (1.4–4.7)
    Problems urinating or bladder infections10.18.213.81.8 (0.99–3.3)
    Women’s health problems (severe cramps, heavy bleeding, problems with menopause) (women only)26.219.339.32.7† (1.6–4.5)
    • * Threshold diagnosis means the patient has at least one of the following diagnoses: major depression or generalized anxiety or panic disorder or bulimia.

    • ‡ P < .05.

    • † P < .001.

    • § P < .01.

    • View popup
    Table 3.

    What Patients Want to Discuss and What Providers Elicit from Their Patients.

    ConcernConcerns Patient Hoped to Discuss With ProviderProvider List of Problems and Concerns Elicited From Patients
    Percent of Patients (n = 500)Percent of Patients Without/With Threshold* Diagnoses (n = 332/168)Odds Ratio (95% CI)Percent of Patients (n = 500)Percent of Patients Without/With Threshold* Diagnoses (n = 332/168)Odds Ratio (95% CI)
    Problems with mood29.219.6 /48.23.8† (2.5–5.7)9.86.9 /15.52.5‡ (1.4–4.5)
    Hypertension12.012.0 /11.91.0 (0.6–1.7)9.08.7 /9.51.1 (0.6–2.1)
    Anxiety stress9.25.1 /17.33.9† (2.1–7.3)6.41.5 /16.112.5† (4.7–33.2)
    Tobacco dependence8.29.6 /5.40.5 (0.2–1.1)1.01.2 /0.60.5 (0.1–4.4)
    Skin concern87.8 /10.11.3 (0.7–2.5)7.06.3 /8.31.3 (0.7–2.7)
    Headaches7.87.8 /7.71.0 (0.5–2.0)8.46.6 /11.91.9 (1.0–3.6)
    Sinusitis7.86.9 /9.51.4 (0.7–2.8)5.25.7 /4.20.7 (0.03–1.7)
    Diabetes7.47.5 /7.10.9 (0.5–1.9)6.45.7 /7.71.4 (0.7–2.9)
    Back Disorders7.25.4 /10.72.1§ (1.1–4.1)8.06.3 /11.31.9 (1.0–3.6)
    Medication refill or check7.26.3 /8.91.4 (0.7–2.9)10.68.4 /14.91.9‡ (1.1–3.4)
    • * Threshold diagnosis means the patient has at least one of the following diagnoses: major depression or generalized anxiety or panic disorder or bulimia.

    • † P < .001.

    • ‡ P < .01.

    • § P < .05.

    • View popup
    Table 4.

    Patients Indicating Whether They Have Been Bothered by Any of the Following Problems (Stressors) in the Last 4 Weeks.

    Problem (Stressor)Percent of Total Population (n = 500)Percent of Patients Without Threshold Diagnoses (n = 332)Percent of Patients With Threshold Diagnosis (n = 168)Odds Ratio* (95% CI)
    Financial problems or worries42.630.366.74.6 (3.1–6.9)
    Concerns about weight; how you look35.325.953.33.6 (2.2–4.9)
    Worrying about your health29.418.251.54.8 (3.2–7.3)
    Something bad happened recently21.712.439.44.6 (2.9–7.3)
    No one to turn to when you have problems19.29.338.36.1 (4.0–10.0)
    Stress at work or school16.910.429.63.6 (2.2–6.0)
    Stress in caring for family members16.79.131.64.6 (2.8–7.7)
    Difficulties with spouse or partner16.58.931.24.6 (2.8–7.8)
    Thinking or dreaming about something terrible that happened to you in the past12.13.927.89.5 (4.9–18.6)
    Little or no pleasure during sex9.25.217.23.8 (1.9–7.2)
    • Note: Response options were “not bothered,” “bothered a little,” and “bothered a lot.” Only patients endorsing “bothered a lot” are included in the table.

    • * All odds were significant at P < .001

    • View popup
    Table 5.

    Patient Reports of Maltreatment During Adulthood or Childhood.

    Form of Maltreatment*Percent of Total Population (n = 500)Percent of Patients Without a Threshold Diagnosis (n = 332)Percent of Patients With a Threshold Diagnoses (n = 168)Odds Ratio (95% CI)
    Ever been hit, slapped, kicked or other hurt since age 18 years52.344.567.92.6 (1.8–3.9)
    Forced, unwanted sexual act since 18 years21.316.830.52.2 (1.4–3.4)
    When I was growing up:
     My family was (never or rarely) a source of strength and support†49.141.663.52.4 (1.7–3.6)
     I had a fear of being hurt by family member‡22.213.040.14.5 (2.9–7.0)
     Someone attempted sexual touching or asked me to touch‡19.811.336.44.5 (2.8–7.2)
     A family member hated me‡16.49.629.53.9 (2.4–6.5)
     A family member hit me so hard it left bruises of marks‡16.29.628.93.8 (2.3–6.3)
     Someone threatened to hurt me or tell lies unless I did something sexual‡10.75.920.04.0 (2.2–7.3)
     My parents were too drunk or high to take care of the family‡8.04.714.53.5 (1.8–6.8)
    • Note: All threshold percentages are significantly greater than nonthreshold percentages, P < .001.

    • * Response options included: never true, rarely true, sometimes true, often true, and very often true.

    • † Only responses marked as never true or rarely true.

    • ‡ Only responses marked as often true or very often true.

    • View popup
    Table 6.

    Item Counts and Relation with Mental Illness.

    VariableItem Counts in Patients Mean (SD)t Test*df = 498Logistic Regression Analysis: Total Counts and Odds of a Threshold Diagnosis
    Without Threshold DisorderWith Threshold DisorderBeta CoefficientWald’stOdds† (95% CI)
    Patient report of current chronic health problems (from Table 1)1.7 (1.7)3.1 (2.3)6.71–––
    Number of concerns that patients hoped to discuss with their health provider (from Table 2)2.4 (1.3)2.9 (1.4)4.020.236.14‡1.3 (1.1–1.5)
    Number of problems and concerns elicited by providers (from Table 3)1.7 (1.3)2.5 (1.4)5.51–––
    Bothered a lot in the last 4 weeks by one or more stressors (from Table 4)1.3 (1.6)3.7 (2.2)2.900.4954.83§1.6 (1.4–1.9)
    Number of positively endorsed maltreatment items (from Table 5)1.5 (1.6)3.3 (2.4)8.450.2213.48§1.3 (1.1–1.4)
    In the last 4 weeks, the number of symptoms bothering patients a lot (from PRIME-MD PHQ symptom checklist)1.3 (1.5)2.9 (2.2)8.430.2110.40§1.2 (1.1–1.4)
    • * All threshold means are significantly greater than nonthreshold percentages, P < .001.

    • † Odds increase per 1-point increase in total score.

    • ‡ P < .01.

    • § P < .001.

    • PRIME-MD PHQ—Primary Care Evaluation of Mental Disorders Patient Health Questionnaire.

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The Journal of the American Board of Family Practice: 16 (4)
The Journal of the American Board of Family Practice
Vol. 16, Issue 4
1 Jul 2003
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The Content of a Low-income, Uninsured Primary Care Population: Including the Patient Agenda
Larry B. Mauksch, Wayne J. Katon, Joan Russo, Suzanne M. Tucker, Edward Walker, Janet Cameron
The Journal of the American Board of Family Practice Jul 2003, 16 (4) 278-289; DOI: 10.3122/jabfm.16.4.278

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The Content of a Low-income, Uninsured Primary Care Population: Including the Patient Agenda
Larry B. Mauksch, Wayne J. Katon, Joan Russo, Suzanne M. Tucker, Edward Walker, Janet Cameron
The Journal of the American Board of Family Practice Jul 2003, 16 (4) 278-289; DOI: 10.3122/jabfm.16.4.278
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