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

Article Figures & Data

Table 1.

Demographics of Study Population (n = 500).

Table 2.

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

Health Problem	Total Population (n = 500)	Patients Without Threshold Diagnosis (n = 332)	Patients With Threshold Diagnosis^* (n = 168)	Odds Ratio (95% CI)
Migraine or other severe chronic headaches	33.7	28.1	44.9	2.1^† (1.4–3.1)
Chronic back problems (including disk or spine)	32.6	25.1	48.0	2.8^† (1.8–4.2)
Arthritis or rheumatism	29.2	22.8	42.0	2.4^† (1.6–3.8)
Hypertension or high blood pressure	21.5	18.6	27.6	1.7^‡ (1.1–2.7)
Asthma	19.5	18.6	21.1	1.2 (0.7–1.9)
Stomach ulcer, chronic inflamed bowel, enteritis, colitis	15.2	11.1	23.8	2.5^† (1.5–4.2)
Diabetes or high blood glucose	15.1	12.9	19.7	1.6 (0.9–2.9)
Breathing trouble, caused by emphysema or chronic lung disease	10.4	7.3	16.4	2.5^§ (1.4–4.7)
Problems urinating or bladder infections	10.1	8.2	13.8	1.8 (0.99–3.3)
Women’s health problems (severe cramps, heavy bleeding, problems with menopause) (women only)	26.2	19.3	39.3	2.7^† (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.

Table 3.

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

Concern	Concerns Patient Hoped to Discuss With Provider			Provider List of Problems and Concerns Elicited From Patients
Concern	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 mood	29.2	19.6 /48.2	3.8^† (2.5–5.7)	9.8	6.9 /15.5	2.5^‡ (1.4–4.5)
Hypertension	12.0	12.0 /11.9	1.0 (0.6–1.7)	9.0	8.7 /9.5	1.1 (0.6–2.1)
Anxiety stress	9.2	5.1 /17.3	3.9^† (2.1–7.3)	6.4	1.5 /16.1	12.5^† (4.7–33.2)
Tobacco dependence	8.2	9.6 /5.4	0.5 (0.2–1.1)	1.0	1.2 /0.6	0.5 (0.1–4.4)
Skin concern	8	7.8 /10.1	1.3 (0.7–2.5)	7.0	6.3 /8.3	1.3 (0.7–2.7)
Headaches	7.8	7.8 /7.7	1.0 (0.5–2.0)	8.4	6.6 /11.9	1.9 (1.0–3.6)
Sinusitis	7.8	6.9 /9.5	1.4 (0.7–2.8)	5.2	5.7 /4.2	0.7 (0.03–1.7)
Diabetes	7.4	7.5 /7.1	0.9 (0.5–1.9)	6.4	5.7 /7.7	1.4 (0.7–2.9)
Back Disorders	7.2	5.4 /10.7	2.1^§ (1.1–4.1)	8.0	6.3 /11.3	1.9 (1.0–3.6)
Medication refill or check	7.2	6.3 /8.9	1.4 (0.7–2.9)	10.6	8.4 /14.9	1.9^‡ (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.

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 worries	42.6	30.3	66.7	4.6 (3.1–6.9)
Concerns about weight; how you look	35.3	25.9	53.3	3.6 (2.2–4.9)
Worrying about your health	29.4	18.2	51.5	4.8 (3.2–7.3)
Something bad happened recently	21.7	12.4	39.4	4.6 (2.9–7.3)
No one to turn to when you have problems	19.2	9.3	38.3	6.1 (4.0–10.0)
Stress at work or school	16.9	10.4	29.6	3.6 (2.2–6.0)
Stress in caring for family members	16.7	9.1	31.6	4.6 (2.8–7.7)
Difficulties with spouse or partner	16.5	8.9	31.2	4.6 (2.8–7.8)
Thinking or dreaming about something terrible that happened to you in the past	12.1	3.9	27.8	9.5 (4.9–18.6)
Little or no pleasure during sex	9.2	5.2	17.2	3.8 (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

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 years	52.3	44.5	67.9	2.6 (1.8–3.9)
Forced, unwanted sexual act since 18 years	21.3	16.8	30.5	2.2 (1.4–3.4)
When I was growing up:
My family was (never or rarely) a source of strength and support^†	49.1	41.6	63.5	2.4 (1.7–3.6)
I had a fear of being hurt by family member^‡	22.2	13.0	40.1	4.5 (2.9–7.0)
Someone attempted sexual touching or asked me to touch^‡	19.8	11.3	36.4	4.5 (2.8–7.2)
A family member hated me^‡	16.4	9.6	29.5	3.9 (2.4–6.5)
A family member hit me so hard it left bruises of marks^‡	16.2	9.6	28.9	3.8 (2.3–6.3)
Someone threatened to hurt me or tell lies unless I did something sexual^‡	10.7	5.9	20.0	4.0 (2.2–7.3)
My parents were too drunk or high to take care of the family^‡	8.0	4.7	14.5	3.5 (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.

Table 6.

Item Counts and Relation with Mental Illness.

Variable	Item Counts in Patients Mean (SD)		t Test^*df = 498	Logistic Regression Analysis: Total Counts and Odds of a Threshold Diagnosis
Variable	Without Threshold Disorder	With Threshold Disorder	t Test^*df = 498	Beta Coefficient	Wald’st	Odds^† (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)	4.02	0.23	6.14^‡	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)	2.90	0.49	54.83^§	1.6 (1.4–1.9)
Number of positively endorsed maltreatment items (from Table 5)	1.5 (1.6)	3.3 (2.4)	8.45	0.22	13.48^§	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)	8.43	0.21	10.40^§	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.