Researchers and policymakers have attributed the poorer health of minority Americans in part to their reduced access to care and the lower quality of primary care they receive. Indeed, when asked about the primary care they receive, minority patients—particularly Asians—give the primary care they receive lower marks than white patients do, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08841). These ethnicity-based differences in patients' primary care experiences call attention to health care quality differences that need to be addressed. To do so will require that we ask the hard questions about how and why these differences arise, notes principal investigator Dana Gelb Safran, Sc.D., of the New England Medical Center and Tufts University.
The researchers surveyed 6,092 Massachusetts employees about their impression of the primary care they receive in seven areas: access (ability to pay for and get an appointment), continuity (length of relationship with doctor and number of visits), comprehensiveness (knowledge of the patient, preventive counseling), integration of care (coordination of specialist or hospital care), clinical interaction (communication, thoroughness of exams), interpersonal treatment, and trust.
After adjustment for socioeconomic and other factors, Asians gave their primary care significantly lower scores (out of 100 total) than whites for communication (69 vs. 79) and comprehensive knowledge of patients (48 vs. 56), as well as all other areas of primary care except continuity of care and integration of care. Blacks and Hispanics reported significantly less financial access to care than whites (60 and 56, respectively, vs. 65), and blacks reported significantly less continuity of care than whites (74 vs. 78), but their assessments of other aspects of primary care did not differ significantly from whites. This study agrees with others showing that Asian Americans tend to be the least satisfied with quality of care. However, this study was limited by the small number of Asian and Hispanic patients surveyed, as well as the lack of patient's country of origin and physician's ethnicity, factors that may affect patient evaluations of primary care.
See "Do patient assessments of primary care differ by patient ethnicity?" by Deborah A. Taira, Sc.D., Dr. Safran, Todd B. Seto, M.D., and others, in the December 2001 Health Services Research 36(6), pp. 1059-1071.