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
Wayne J. Katon
MD
Joan Russo
PhD
Suzanne M. Tucker
EdD
Edward Walker
MD

References
- ↵Baker DW, Shapiro MF, Schur CL. Health insurance and access to care for symptomatic conditions. Arch Intern Med 2000; 160: 1269–1274.
- Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med 1991; 114: 325–31.
- Hafner-Eaton C. Physician utilization disparities between the uninsured and insured. Comparisons of the chronically ill, acutely ill, and well nonelderly populations. JAMA 1993; 269: 787–92.
- ↵Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. JAMA 2000; 284: 2061–9.
- ↵Broyles RW, Narine L, Brandt EN Jr. The temporarily and chronically uninsured: does their use of primary care differ? J Health Care Poor Underserved 2002; 13: 95–111.
- ↵Baker DW, Sudano JJ, Albert JM, Borawski EA, Dor A. Lack of health insurance and decline in overall health in late middle age. N Engl J Med 2001; 345: 1106–12.
- ↵US Census Bureau. Poor people without health insurance. Available at: http://www.census.gov/hhes/hlthins/hlthin00/hi00tb.html
- ↵Feinstein JS. The relationship between socioeconomic status and health: a review of the literature. Milbank Q 1993; 71: 279–322.
- ↵Fein O. The influence of social class on health status: American and British research on health inequalities. J Gen Intern Med 1995; 10: 577–86.
- ↵Lynch JW, Kaplan GA, Shema SJ. Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. N Engl J Med 1997; 337: 1889–95.
- Hemingway H, Nicholson A, Stafford M, Roberts R, Marmot M. The impact of socioeconomic status on health functioning as assessed by the SF-36 questionnaire: the Whitehall II Study. Am J Public Health 1997; 87: 1484–90.
- ↵Bruce ML, Takeuchi DT, Leaf PJ. Poverty and psychiatric status. Longitudinal evidence from the New Haven Epidemiologic Catchment Area study. Arch Gen Psychiatry 1991; 48: 470–4.
- ↵Lynch JW, Kaplan GA, Pamuk ER, et al. Income inequality and mortality in metropolitan areas of the United States. Am J Public Health 1998; 88: 1074–80.
- ↵Backlund E, Sorlie PD, Johnson NJ. A comparison of the relationships of education and income with mortality: the National Longitudinal Mortality Study. Soc Sci Med 1999; 49: 1373–84.
- ↵Hayward RA, Shapiro MF, Freeman HE, Corey CR. Inequities in health services among insured Americans. Do working-age adults have less access to medical care than the elderly? N Engl J Med 1988; 318: 1507–12.
- Elofsson S, Unden AL, Krakau I. Patient charges—a hindrance to financially and psychosocially disadvantage groups seeking care. Soc Sci Med 1998; 46: 1375–80.
- ↵Fiscella K. Is lower income associated with greater biopsychosocial morbidity? Implications for physicians working with underserved patients. J Fam Pract 1999; 48: 372–7.
- Woolf SH, Rothemich SF, Johnson RE, Marsland DW. The functional status of inner-city primary care patients. Diminished function in a family practice population and its potential determinants. J Fam Pract 1998; 47: 312–5.
- Miranda J, Azocar F, Komaromy M, Golding JM. Unmet mental health needs of women in public-sector gynecologic clinics. Am J Obstet Gynecol 1998; 178: 212–7.
- Olfson M, Shea S, Feder A, et al. Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice. Arch Fam Med 2000; 9: 876–83.
- ↵Mauksch LB, Tucker SM, Katon WJ, et al. Mental illness, functional impairment, and patient preferences for collaborative care in an uninsured, primary care population. J Fam Pract 2001; 50: 41–7.
- ↵
- ↵Mesa County. Our picture of health. Grand Junction, Colo: Civic Forum, 1998.
- ↵Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282: 1737–44.
- ↵Bernstein DP, Fink L. Childhood Trauma Questionnaire: A retrospective self-report. San Antonio: The Psychological Corporation, 1998.
- ↵Walker EA, Gelfand A, Katon WJ, et al. Adult health status of women with histories of childhood abuse and neglect. Am J Med 1999; 107: 332–9.
- ↵Wells KB, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA 2000; 283: 212–20.
- ↵Rosenblatt RA, Hart LG, Gamliel S, Goldstein B, McClendon BJ. Identifying primary care disciplines by analyzing the diagnostic content of ambulatory care. J Am Board Fam Pract 1995; 8: 34–45.
- ↵International classification of diseases, vols 1 and 2: clinical modification, 9th revision. 5th ed. Salt Lake City: Medicode, 1999.
- ↵
- ↵Katon W, Sullivan M, Walker E. Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits. Ann Intern Med 2001; 134(9 Pt 2): 917–25.
- ↵Sturm R, Gresenz CR. Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey. BMJ 2002; 324: 20–3.
- ↵Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization Study in Primary Care. JAMA 1998; 280: 147–51.
- ↵Von Korff M, Simon G. The relationship between pain and depression. Br J Psychiatry Suppl 1996; 30: 101–8.
- ↵Norquist GS, Regier DA. The epidemiology of psychiatric disorders and the de facto mental health care system. Annu Rev Med 1996; 47: 473–9.
- ↵Regier DA, Goldberg ID, Taube CA. The de facto US mental health services system: a public health perspective. Arch Gen Psychiatry 1978; 35: 685–93.
- ↵Sturm R, Wells K. Health insurance may be improving—but not for individuals with mental illness. Health Serv Res 2000; 35(1 Pt 2): 253–62.
- ↵Druss BG, Rosenheck RA. Mental disorders and access to medical care in the United States. Am J Psychiatry 1998; 155: 1775–7.
- ↵Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 1994; 272: 1741–8.
- ↵Spitzer RL, Kroenke K, Linzer M, et al. Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA 1995; 274: 1511–7.
- ↵
- Ziegelstein RC, Fauerbach JA, Stevens SS, Romanelli J, Richter DP, Bush DE. Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med 2000; 160: 1818–23.
- Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000; 160: 3278–85.
- ↵Lin EH, Simon GE, Katzelnick DJ, Pearson SD. Does physician education on depression management improve treatment in primary care? J Gen Intern Med 2001; 16: 614–9.
- ↵Lin EH, Katon WJ, Simon GE, et al. Achieving guidelines for the treatment of depression in primary care: is physician education enough? Med Care 1997; 35: 831–42.
- ↵Committee on Quality of Health Care in America, Institute of Medicine. Crossing the quality chasm: a new health care system for the 21st century. Washington, DC: National Academy Press, 2001.
- ↵Makoul G. Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med 2001; 76: 390–3.
- ↵Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract 2000; 49: 796–804.
- ↵
- ↵White J, Levinson W, Roter D. “Oh, by the way … ”: the closing moments of the medical visit. J Gen Intern Med 1994; 9: 24–8.
- ↵Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA 1999; 28: 283–7.
- Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med 1999; 14(Suppl 1): S34–40.
- ↵Byrne P, Long B. Doctors talking to patients. London: Her Majesty’s Stationery Office, 1976.
- ↵Hahn SR. Physical symptoms and physician-experienced difficulty in the physician-patient relationship. Ann Intern Med 2001; 134(9 Pt 2): 897–904.
- ↵Lin EH, Katon W, Von Korff M, et al. Frustrating patients: physician and patient perspectives among distressed high users of medical services. J Gen Intern Med 1991; 6: 241–6.
- ↵Mauksch L, Hillenburg L, Robins L. The establishing focus protocol: training for collaborative agenda setting and time management in the medical interview. Fam Syst Health 2001; 19: 147–57.
- ↵Kirmayer LJ, Robbins JM. Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics. Psychol Med 1996; 26: 937–51.
- ↵Feder A, Olfson M, Gameroff M, et al. Medically unexplained symptoms in an urban general medicine practice. Psychosomatics 2001; 42: 261–8.
- ↵Kroenke K, Jackson JL, Chamberlin J. Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. Am J Med 1997; 103: 339–47.
- ↵Pignone MP, Gaynes BN, Rushton JL, et al. Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002; 136: 765–76.
- ↵Jackson JL, Kroenke K. The effect of unmet expectations among adults presenting with physical symptoms. Ann Intern Med 2001; 134(9 Pt 2): 889–97.
- ↵Marple RL, Kroenke K, Lucey CR, Wilder J, Lucas CA. Concerns and expectations in patients presenting with physical complaints. Frequency, physician perceptions and actions, and 2-week outcome. Arch Intern Med 1997; 157: 1482–8.
- ↵Dwight-Johnson M, Unutzer J, Sherbourne C, Tang L, Wells KB. Can quality improvement programs for depression in primary care address patient preferences for treatment? Med Care 2001; 39: 934–44.
- ↵Mauksch L. An evidenced-based recipe for primary care, psychotherapy and patient preferences: Response to “A systematic review of brief psychological therapies in primary health care.” Fam Syst Health 2000; 18: 315–22.
- ↵Katz JN. Patient preferences and health disparities. JAMA 2001; 286: 1506–9.
- ↵Seaburn DB, Gawanski BA, Gunn WB Jr, Lorenz A, Mauksch L. Models of collaboration: a guide for mental health professionals working with physicians and health care practitioners. New York: Basic Books, 1996.
- Blount A. Integrated primary care: the future of medical and mental health collaboration. New York: W. W. Norton, 1998.
- Cummings NA, Cummings JL, Johnson JN, editors. Behavioral health in primary care: a guide for clinical integration. Madison, Wisc: Psychological Press, 1997.
- ↵Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve depression treatment guidelines. J Clin Psychiatry 1997; 58(Suppl 1): 20–3.
- ↵Von Korff M, Katon W, Bush T, et al. Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression. Psychosom Med 1998; 60: 143–9.
- ↵Schoenbaum M, Unutzer J, Sherbourne C, et al. Cost-effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial. JAMA 2001; 286: 1325–30.
- Simon GE, Katon WJ, VonKorff M, et al. Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. Am J Psychiatry 2001; 158: 1638–44.
- ↵Lin EH, VonKorff M, Russo J, et al. Can depression treatment in primary care reduce disability? A stepped care approach. Arch Fam Med 2000; 9: 1052–8.
- ↵Simon GE, Revicki D, Heiligenstein J, et al. Recovery from depression, work productivity, and health care costs among primary care patients. Gen Hosp Psychiatry 2000; 22: 153–62.
- ↵Mental health: a report of the Surgeon General. Department of Health and Human Services. Available at: http://www.surgeongeneral.gov/library/mentalhealth/home.html
- ↵Von Korff M, Moore JC. Stepped care for back pain: activating approaches for primary care. Ann Intern Med 2001; 134(9 Pt 2): 911–7.
- ↵
- ↵Ferguson JA, Weinberger M. Case management programs in primary care. J Gen Intern Med 1998; 13: 123–6.
- ↵Weich S, Lewis G. Poverty, unemployment, and common mental disorders: population based cohort study. BMJ 1998; 317: 115–9.
- ↵
- Katon W, Von Korff M, Lin E, et al. Population-based care of depression: effective disease management strategies to decrease prevalence. Gen Hosp Psychiatry 1997; 19: 169–78.
- Peek CJ, Heinrich R. Building a collaborative care organization: from idea to invention to innovation. Fam Syst Med 1995; 13: 327–42.
- ↵Stange KC, Zyzanski SJ, Jaen CR, et al. Illuminating the ‘black box’. A description of 4,454 patient visits to 138 family physicians. J Fam Pract 1998; 46: 377–89.
- ↵Schneeweiss R, Cherkin DC, Hart GL. The effect of including secondary diagnoses on the description of the diagnostic content of family practice. Med Care 1984; 22: 1058–63.
- ↵Barry CA, Bradley CP, Britten N, Stevenson FA, Barber N. Patients’ unvoiced agendas in general practice consultations: qualitative study. BMJ 2000; 320: 1246–50.
- ↵Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000; 55: 68–78.
- ↵
- ↵Bobak M, Pikhart H, Rose R, Hertzman C, Marmot M. Socioeconomic factors, material inequalities, and perceived control in self-rated health: cross-sectional data from seven post-communist countries. Soc Sci Med 2000; 51: 1343–50.
- ↵Moss N. Socioeconomic disparities in health in the US: an agenda for action. Soc Sci Med 2000; 51: 1627–38.
In this issue
The Journal of the American Board of Family
Practice
Vol. 16, Issue 4
1 Jul 2003
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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