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Cited by 112Primary Care and Health OutcomesHealth disparities and outcomesCultural Competency in Health Care

Separate and Unequal: Clinics Where Minority and Nonminority Patients Receive Primary Care

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Varkey, Anita B.·2009·Archives of Internal Medicine
DOI 10.1001/archinternmed.2008.559PMC PMC13012804
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Abstract

BACKGROUND: Few studies have examined the influence of physician workplace conditions on health care disparities. We compared 96 primary care clinics in New York, New York, and in the upper Midwest serving various proportions of minority patients to determine differences in workplace organizational characteristics. METHODS: Cross-sectional data are from surveys of 96 clinic managers, 388 primary care physicians, and 1701 of their adult patients with hypertension, diabetes mellitus, or congestive heart failure participating in the Minimizing Error, Maximizing Outcome (MEMO) study. Data from 27 clinics with at least 30% minority patients were contrasted with data from 69 clinics with less than 30% minority patients. RESULTS: Compared with clinics serving less than 30% minority patients, clinics serving at least 30% minority patients have less access to medical supplies (2.7 vs 3.4, P < .001), referral specialists (3.0 vs 3.5, P < .005) on a scale of 1 (none) to 4 (great), and examination rooms per physician (2.2 vs 2.7, P =.002) . Their patients are more frequently depressed (22.8% vs 12.1%), are more often covered by Medicaid (30.2% vs 11.4%), and report lower health literacy (3.7 vs 4.4) on a scale of 1 (low) to 5 (high) (P < .001 for all). Physicians from clinics serving higher proportions of minority populations perceive their patients as frequently speaking little or no English (27.1% vs 3.4%, P =.004), having more chronic pain (24.1% vs 12.9%, P < .001) and substance abuse problems (15.1% vs 10.1%, P =.005), and being more medically complex (53.1% vs 39.9%) and psychosocially complex (44.9% vs 28.2%) (P < .001 for both). In regression analyses, clinics with at least 30% minority patients are more likely to have chaotic work environments (odds ratio, 4.0; P =.003) and to have fewer physicians reporting high work control (0.2; P =.003) or high job satisfaction (0.4; P =.01). CONCLUSION: Clinics serving higher proportions of minority patients have more challenging workplace and organizational characteristics.

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  • Historically disadvantaged groups may be more likely to receive care in clinics that may lack the resources for the trained operators necessary to be a study site.

    “Historically disadvantaged groups may be more likely to receive care in clinics that may lack the resources for the trained operators necessary to be a study site55.”

    From Considerations for addressing bias in artificial intelligence for health equity (2023) · cites this paper as [55]

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Research works printed but not linked: 2

  1. Executive Office of the President, Office of Management and Budget (OMB), Office of Information and Regulatory Affairs. Recommendations from the Interagency Committee for the Review of the Racial and Ethnic Standards to the Office of Management and Budget concerning changes to the standards for the classification of federal data on race and ethnicity. Fed Regist. 1994;59:36873- 36946.
  2. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach. J R Stat Soc Bull. 1995;57:289-300.

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Authors
Varkey, A. B.
Affiliations
Loyola University Medical Center (US)
Corresponding author
Varkey, Anita B.
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2009-02-09
Volume
169
Issue
3
Pages
243
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinternmed.2008.559
PMC
PMC13012804
OpenAlex
W2146641608
Cited by
112
References
23
Citations by year
2026: 3 · 2025: 4 · 2024: 4 · 2023: 8 · 2022: 8 · 2021: 4 · 2020: 2 · 2019: 6 · 2018: 2 · 2017: 4 · 2016: 9 · 2015: 11 · 2014: 7 · 2013: 4 · 2012: 10
FWCI
21.12
Type
journal article
Language
en
Open access
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Funders
  • U.S. Department of Health and Human Services
  • University of Wisconsin-Madison
  • Helsingin Yliopisto
  • York University
  • Agency for Healthcare Research and Quality (R01 HS 011955, 5R01 HS 011955)
  • University of North Carolina at Chapel Hill
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
Keywords
health care disparities, primary health centers, minority patients, organizational characteristics, work environment, job satisfaction, job control, health literacy, Medicaid, chronic disease, language barriers, New York, Upper Midwest, hypertension, diabetes mellitus, congestive heart failure, patient depression, substance abuse, chronic pain, medically complex patients, medical supplies
MeSH terms
Adult, Ambulatory Care Facilities, Burnout, Professional, Chronic Disease, Communication Barriers, Cross-Sectional Studies, Depression, Educational Status, Equipment and Supplies, Female, Health Education, Health Facility Size, Health Services Accessibility, Humans, Job Satisfaction, Language Arts, Male, Medicaid, Minority Groups, Pain, Physicians, Primary Health Care, Referral and Consultation, Regression Analysis, United States, Professional Autonomy, Workplace, Substance-Related Disorders

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