Skip to main content

Advertisement

Log in

Racial disparities in the content of primary care office visits

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND: Little is known about racial disparities in primary care at the level of the office visit.

OBJECTIVE: To assess racial disparities in the receipt of commonly performed/recommended procedures during routine primary care office visits and examine trends in disparities over time.

DESIGN, SETTING, AND PATIENTS: The sample included 88,303 visits by adults to 3,260 primary care physicians in office-based practices in the National Ambulatory Medical Care Surveys, 1985, 1989, 1990, 1991, 1992, and 1995 to 2001.

MEASUREMENTS: Adjusted odds for receipt or recommendation of commonly performed office procedures.

RESULTS: During the years 1985 to 2001, African Americans, compared with whites, had lower odds of receiving a Pap test (odds ratio (OR) 0.81; 95% confidence interval (CI) 0.70 to 0.93), rectal exam (OR 0.67; 95% CI 0.56 to 0.80), smoking cessation counseling (OR 0.80; 95% CI 0.66 to 0.96), and mental health advice (OR 0.51; 95% CI 0.38 to 0.69), but had higher odds for visual screening (OR 1.38; 95% CI 1.08 to 1.77), weight advice counseling (OR 1.27; 95% CI 1.13 to 1.44) and receiving a follow-up appointment (OR 1.45; 95% CI 1.29 to 1.64). These findings were not appreciably altered by adjustment for physician practice characteristics including percent African American or Medicaid patients. Disparities disfavoring African Americans in cholesterol testing and smoking cessation observed during 1985 to 1992 were not observed in 1995 to 2001.

CONCLUSIONS: The findings suggest that race is associated with the type of primary care received by patients, at least for selected procedures, with evidence that some disparities have diminished over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2002.

    Google Scholar 

  2. Academy of Health Services Research and Health Policy. Contributions of New Technologies to Racial Disparities in Healthcare. Washington, DC: Academy of Health Services Research and Health Policy; 2002.

    Google Scholar 

  3. Escarce JJ, McGuire TG. Changes in racial differences in use of medical procedures and diagnostic tests among elderly persons: 1986–1997. Am J Public Health. 2004;94:1795–9.

    PubMed  Google Scholar 

  4. Williams RL, Flocke SA, Stange KC. Race and preventive services delivery among black patients and white patients seen in primary care. Med Care. 2001;39:1260–7.

    Article  PubMed  CAS  Google Scholar 

  5. Oliver MN, Goodwin MA, Gotler RS, Gregory PM, Stange KC. Time use in clinical encounters: are African-American patients treated differently? J Natl Med Assoc. 2001;93:380–5.

    PubMed  CAS  Google Scholar 

  6. Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.

    Article  PubMed  CAS  Google Scholar 

  7. Wang TJ, Stafford RS. National patterns and predictors of beta-blocker use in patients with coronary artery disease. Arch Intern Med. 1998;158:1901–6.

    Article  PubMed  CAS  Google Scholar 

  8. Stafford RS, Blumenthal D, Pasternak RC. Variations in cholesterol management practices of U.S. physicians. J Am Coll Cardiol. 1997;29:139–46.

    Article  PubMed  CAS  Google Scholar 

  9. Taira DA, Safran DG, Seto TB, et al. Do patient assessments of primary care differ by patient ethnicity? Health Serv Res. 2001;36:1059–71.

    PubMed  CAS  Google Scholar 

  10. O’Malley MS, Earp JA, Harris RP. Race and mammography use in two North Carolina counties. Am J Public Health. 1997;87:782–6.

    PubMed  CAS  Google Scholar 

  11. Weiner JP, Starfield BH, Steinwachs DM, Mumford LM. Development and application of a population-oriented measure of ambulatory care case-mix. Med Care. 1991;29:452–72.

    Article  PubMed  CAS  Google Scholar 

  12. Blumenthal D, Causino N, Chang YC, et al. The duration of ambulatory visits to physicians. J Fam Pract. 1999;48:264–71.

    PubMed  CAS  Google Scholar 

  13. Forrest CB, Reid RJ. Prevalence of health problems and primary care physicians’ specialty referral decisions. J Fam Pract. 2001;50:427–32.

    PubMed  CAS  Google Scholar 

  14. Forrest CB, Whelan EM. Primary care safety-net delivery sites in the United States: a comparison of community health centers, hospital outpatient departments, and physicians’ offices. JAMA. 2000;284:2077–83.

    Article  PubMed  CAS  Google Scholar 

  15. Franks P, Bertakis KD. Physician gender, patient gender, and primary care. J Women Health. 2003;12:73–80.

    Article  Google Scholar 

  16. Perkins AJ, Kroenke K, Unutzer J, et al. Common comorbidity scales were similar in their ability to predict health care costs and mortality. J Clin Epidemiol. 2004;57:1040–8.

    Article  PubMed  Google Scholar 

  17. Chernof BA, Sherman SE, Lanto AB, Lee ML, Yano EM, Rubenstein LV. Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics. Med Care. 1999;37:738–47.

    Article  PubMed  CAS  Google Scholar 

  18. Binder DA. On the variances of asymptotically normal estimators from complex surveys. Int Statist Rev. 1983;51:279–92.

    Article  Google Scholar 

  19. King G, Polednak A, Bendel RB, Vilsaint MC, Nahata SB. Disparities in smoking cessation between African Americans and whites: 1990–2000. Am J Public Health. 2004;94:1965–71.

    PubMed  Google Scholar 

  20. Malat J. Social distance and patients’ rating of healthcare providers. J Health Soc Behav. 2001;42:360–72.

    Article  PubMed  CAS  Google Scholar 

  21. Bottero W, Prandy K. Social interaction distance and stratification. Br J Sociol. 2003;54:177–97.

    Article  PubMed  Google Scholar 

  22. Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–84.

    Article  PubMed  CAS  Google Scholar 

  23. Laveist TA, Carroll T. Race of physician and satisfaction with care among African Americans. J Natl Med Assoc. 2002;94:937–4.

    PubMed  Google Scholar 

  24. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159:997–1004.

    Article  PubMed  CAS  Google Scholar 

  25. Saha S, Arbelaez JJ, Cooper LA. Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health. 2003;93:1713–9.

    PubMed  Google Scholar 

  26. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139:907–15.

    PubMed  Google Scholar 

  27. Stevens GD, Shi L, Cooper LA. Patient-provider racial and ethnic concordance and parent reports of the primary care experiences of children. Ann Fam Med. 2003;1:105–12.

    Article  PubMed  Google Scholar 

  28. Laveist TA, Nuru-Jeter A, Jones KE. The association of doctor-patient race concordance with health services utilization. J Public Health Policy. 2003;24:312–23.

    Article  PubMed  Google Scholar 

  29. Doescher MP, Saver BG. Physicians’ advice to quit smoking. The glass remains half empty. J Fam Pract. 2000;49:543–7.

    PubMed  CAS  Google Scholar 

  30. Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003;97:1528–40.

    Article  PubMed  Google Scholar 

  31. Martin LM, Calle EE, Wingo PA, Heath CW Jr. Comparison of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: are we closing the gaps? Am J Prev Med. 1996;12:82–90.

    PubMed  CAS  Google Scholar 

  32. May DS, Trontell AE. Mammography use by elderly women: a methodological comparison of two national data sources. Ann Epidemiol. 1998;8:439–44.

    Article  PubMed  CAS  Google Scholar 

  33. McGovern PG, Lurie N, Margolis KL, Slater JS. Accuracy of self-report of mammography and Pap smear in a low-income urban population. Am J Prev Med. 1998;14:201–8.

    Article  PubMed  CAS  Google Scholar 

  34. Champion VL, Menon U, McQuillen DH, Scott C. Validity of self-reported mammography in low-income African-American women. Am J Prev Med. 1998;14:111–7.

    Article  PubMed  CAS  Google Scholar 

  35. Caplan LS, Mandelson MT, Anderson LAHealth Maintenance Organization. Validity of self-reported mammography: examining recall and covariates among older women in a Health Maintenance Organization. Am J Epidemiol. 2003;157:267–72.

    Article  PubMed  Google Scholar 

  36. McPhee SJ, Nguyen TT, Shema SJ, et al. Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Prev Med. 2002;35:463–73.

    Article  PubMed  Google Scholar 

  37. Zapka JG, Bigelow C, Hurley T, et al. Mammography use among sociodemographically diverse women: the accuracy of self-report. Am J Public Health. 1996;86:1016–21.

    Article  PubMed  CAS  Google Scholar 

  38. Fiscella K, Franks P, Meldrum S. Estimating racial/ethnic disparity in mammography rates: it all depends on how you ask the question. Prev Med. 2004;39:399–403.

    Article  PubMed  Google Scholar 

  39. Chiang YP, Wang F, Javitt JC. Office visits to ophthalmologists and other physicians for eye care among the U.S. population, 1990. Public Health Rep. 1995;110:147–53.

    PubMed  CAS  Google Scholar 

  40. Congdon N, O’Colmain B, Klaver CC, et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004;122:477–85.

    Article  PubMed  Google Scholar 

  41. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care. 1998;21:518–24.

    Article  PubMed  CAS  Google Scholar 

  42. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 2003;290:199–206.

    Article  PubMed  Google Scholar 

  43. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among U.S. adults, 1999–2000. JAMA. 2002;288:1723–7.

    Article  PubMed  Google Scholar 

  44. Greenblatt J. Statistical Brief #14 Trends in Access to Routine Care and Experiences with Care: 2001. Rockville, MD: Agency for Healthcare Research and Quality; 2003.

    Google Scholar 

  45. Gilchrist VJ, Stange KC, Flocke SA, McCord G, Bourguet CC. A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits. Med Care. 2004;42:276–80.

    Article  PubMed  Google Scholar 

  46. Jaen CR, Stange KC, Tumiel LM, Nutting P. Missed opportunities for prevention: smoking cessation counseling and the competing demands of practice. J Fam Pract. 1997;45:348–54.

    PubMed  CAS  Google Scholar 

  47. Nutting PA, Rost K, Smith J, Werner JJ, Elliot C. Competing demands from physical problems: effect on initiating and completing depression care over 6 months. Arch Fam Med. 2000;9:1059–64.

    Article  PubMed  CAS  Google Scholar 

  48. Nutting PA, Baier M, Werner JJ, Cutter G, Conry C, Stewart L. Competing demands in the office visit: what influences mammography recommendations? J Am Board Fam Pract. 2001;14:352–61.

    PubMed  CAS  Google Scholar 

  49. Burgess DJ, Fu SS, van Ryn M. Why do providers contribute to disparities and what can be done about it? J Gen Intern Med. 2004;19:1154–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter Franks MD.

Additional information

The authors have no conflicts of interest to report.

Grant Support: Agency for Health care Research and Quality R01 HS 10910-01A2.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Franks, P., Fiscella, K. & Meldrum, S. Racial disparities in the content of primary care office visits. J GEN INTERN MED 20, 599–603 (2005). https://doi.org/10.1007/s11606-005-0106-4

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-005-0106-4

Key words

Navigation