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OtherFamily Medicine And The Health Care System

Comprehending Care in a Medical Home: A Usual Source of Care and Patient Perceptions about Healthcare Communication

Jennifer E. DeVoe, Lorraine S. Wallace, Nancy Pandhi, Rachel Solotaroff and George E. Fryer
The Journal of the American Board of Family Medicine September 2008, 21 (5) 441-450; DOI: https://doi.org/10.3122/jabfm.2008.05.080054
Jennifer E. DeVoe
MD, DPhil
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Lorraine S. Wallace
PhD
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Nancy Pandhi
MD, MPH
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Rachel Solotaroff
MD
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George E. Fryer Jr
PhD
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  • Article
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Article Figures & Data

Tables

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    Table 1.

    Demographic Characteristics of American Adults Who Have a Usual Source of Care

    Demographic CharacteristicsPatients with a Usual Source of Care (weighted %)*P†
    Total Adults in US78.3
    Sex
        Male73.2<.0001
        Female83.0
    Age (years)
        18–2465.1<.0001
        25–4470.5
        45–6485.1
        ≥6594.0
    Race
        White79.3<.0001
        Black74.3
        American Indian74.4
        Asian69.9
        Native Hawaiian77.5
        Multiple Races72.9
    Ethnicity
        Hispanic59.9<.0001
        Non-Hispanic80.8
    Family income
        Poor70.0<.0001
        Near poor71.5
        Low income72.0
        Middle income77.7
        High income83.4
    Completed high school
        Yes79.5<.0001
        No73.2
    Geographic residence
        Northeast85.6<.0001
        Midwest81.4
        South74.9
        West74.2
    Residence location
        Metropolitan atatistical area77.5<.001
        Non-metropolitan statistical area81.8
    Health Insurance
        Any private82.5<.0001
        Public85.8
        Uninsured46.7
    • Data Source: 2002 Medical Expenditure Panel Survey.

    • * Unweighted N = 25,851. Note that percentages have been rounded to nearest tenth.

    • † P in the χ2 analysis for overall differences between subcategories of each demographic characteristic.

    • View popup
    Table 2.

    Differences in Patient Perceptions about Physician Communication among Patients With and Without a Usual Source of Care

    Survey Questions Regarding Physician CommunicationPatients Responding "Always" to Questions Regarding Physician Communication (weighted % ± SE)*Odds of Responding "Always" to the Key Questions (Multivariate OR [95% CI])†
    Provider listened carefully to them (n = 16,699)
        US adults with a USC56.4 ± 0.581.31 (1.16–1.48)
        US adults without a USC47.1 ± 1.381.00
    Provider explained things so they understood (n = 16,700)
        US adults with a USC57.9 ± 0.591.26 (1.13–1.41)
        US adults without a USC51.3 ± 1.231.00
    Provider showed respect for what they had to say (n = 16,781)
        US adults with a USC59.9 ± 0.551.24 (1.10–1.40)
        US adults without a USC52.3 ± 1.341.00
    Provider spent enough time with them (n = 16,773)
        US adults with a USC46.7 ± 0.571.20 (1.07–1.35)
        US adults without a USC39.0 ± 1.311.00
    • Data Source: 2002 Medical Expenditure Panel Survey.

    • * Weighted percentages pertain to the total civilian, non-institutionalized US adult population who had visited a healthcare provider in the previous 12 months (unweighted n varies slightly by category, as noted).

    • † Adjusted for sex, age, race, ethnicity, family income, education, geographic region, MSA status, health insurance status.

    • Statistical significance indicated by bolded values.

    • View popup
    Table 3.

    Demographic Characteristics of Those with a Usual Source of Care and Their Perceptions About Their Degree of Health Decision-Making Autonomy

    Demographic CharacteristicsProvider “Always” Gives Person Control of Treatment (n = 18,087)Provider “Always” Asks Person to Help Make Health Care Decisions (n = 17,674)
    Weighted %*Multivariate OR (95% CI)Weighted %*Multivariate OR (95% CI)
    Total50.152.2
    Sex
        Male49.70.95 (0.91–1.00)51.80.95 (0.89–1.00)
        Female50.41.0052.61.00
    Age (years)
        18–2448.00.88 (0.74–1.04)48.00.78 (0.66–0.92)
        25–4450.90.92 (0.81–1.03)50.90.85 (0.75–0.96)
        45–6453.50.99 (0.87–1.13)53.50.91 (0.80–1.03)
        ≥6554.71.0054.71.00
    Race
        White51.11.56 (1.09–2.23)53.21.39 (0.96–2.01)
        Black47.11.37 (0.95–1.96)50.41.28 (0.87–1.89)
        American Indian46.61.36 (0.80–2.33)46.21.09 (0.63–1.88)
        Asian39.01.04 (0.66–1.65)41.00.95 (0.59–1.53)
        Native Hawaiian37.20.98 (0.36–2.63)36.10.77 (0.29–2.02)
        Multiple Races38.51.0043.21.00
    Ethnicity
        Hispanic42.60.83 (0.72–0.95)46.00.88 (0.76–1.01)
        Black/non-Hispanic50.81.0052.91.00
    Family income
        Poor43.70.80 (0.69–0.93)46.90.84 (0.72–0.98)
        Near poor54.21.17 (0.94–1.47)56.41.16 (0.93–1.45)
        Low income47.80.88 (0.77–1.01)50.40.90 (0.78–1.04)
        Middle income48.80.87 (0.79–0.97)51.50.90 (0.81–1.00)
        High income52.61.0054.11.00
    Completed high school
        Yes51.01.09 (0.98–1.21)52.91.06 (0.95–1.18)
        No46.01.0049.31.00
    Census region
        Northeast53.41.41 (1.17–1.70)54.71.36 (1.14–1.62)
        Midwest50.71.21 (1.01–1.43)52.81.20 (1.02–1.42)
        South51.51.29 (1.07–1.55)54.21.30 (1.09–1.55)
        West43.71.0046.01.00
    Urban/rural
        MSA49.90.81 (0.68–0.96)51.10.81 (0.68–0.96)
        Non-MSA54.61.0056.91.00
    Health insurance
        Any private51.41.16 (1.02–1.32)53.41.16 (1.01–1.34)
        Public45.40.98 (0.83–1.17)48.70.99 (0.84–1.16)
        Uninsured46.01.0048.01.00
    • Data Source: 2002 Medical Expenditure Panel Survey.

    • * Weighted percentages pertain to the total civilian, non-institutionalized US adult population who reported having a USC in 2002.

    • Statistical significance indicated by bolded values.

    • OR, odds ratio; CI, confidence interval; MSA, metropolitan statistical area.

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The Journal of the American Board of Family Medicine: 21 (5)
The Journal of the American Board of Family Medicine
Vol. 21, Issue 5
September-October 2008
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Comprehending Care in a Medical Home: A Usual Source of Care and Patient Perceptions about Healthcare Communication
Jennifer E. DeVoe, Lorraine S. Wallace, Nancy Pandhi, Rachel Solotaroff, George E. Fryer
The Journal of the American Board of Family Medicine Sep 2008, 21 (5) 441-450; DOI: 10.3122/jabfm.2008.05.080054

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Comprehending Care in a Medical Home: A Usual Source of Care and Patient Perceptions about Healthcare Communication
Jennifer E. DeVoe, Lorraine S. Wallace, Nancy Pandhi, Rachel Solotaroff, George E. Fryer
The Journal of the American Board of Family Medicine Sep 2008, 21 (5) 441-450; DOI: 10.3122/jabfm.2008.05.080054
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