Separate and Unequal

Varkey, Anita B.; Manwell, Linda Baier; Williams, Eric S.; Ibrahim, Said A.; Brown, Roger; Bobula, James A.; Horner-Ibler, Barbara A.; Schwartz, Mark D.; Konrad, Thomas R.; Wiltshire, Jacqueline; Linzer, Mark

doi:10.1001/archinternmed.2008.559

Cited by 98 publications

(43 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The copay to see a physician in public clinics ranges from none required to over $70, with most patients falling at the lower end of the income-based sliding-fee scale. Concerns about copayments, in addition to pharmacy costs, could influence patient decisions about nonprescription use (15).…”

Section: Discussionmentioning

confidence: 99%

Nonprescription Antimicrobial Use in a Primary Care Population in the United States

Zoorob

Grigoryan

Nash

et al. 2016

Antimicrob Agents Chemother

View full text Add to dashboard Cite

c Community antimicrobial resistance rates are high in communities with frequent use of nonprescription antibiotics. Studies addressing nonprescription antibiotic use in the United States have been restricted to Latin American immigrants. We estimated the prevalence of nonprescription antibiotic use in the previous 12 months as well as intended use (intention to use antibiotics without a prescription) and storage of antibiotics and examined patient characteristics associated with nonprescription use in a random sample of adults. We selected private and public primary care clinics that serve ethnically and socioeconomically diverse patients. Within the clinics, we used race/ethnicity-stratified systematic random sampling to choose a random sample of primary care patients. We used a self-administered standardized questionnaire on antibiotic use. Multivariate regression analysis was used to identify independent predictors of nonprescription use. The response rate was 94%. Of 400 respondents, 20 (5%) reported nonprescription use of systemic antibiotics in the last 12 months, 102 (25.4%) reported intended use, and 57 (14.2%) stored antibiotics at home. These rates were similar across race/ethnicity groups. Sources of antibiotics used without prescriptions or stored for future use were stores or pharmacies in the United States, "leftover" antibiotics from previous prescriptions, antibiotics obtained abroad, or antibiotics obtained from a relative or friend. Respiratory symptoms were common reasons for the use of nonprescription antibiotics. In multivariate analyses, public clinic patients, those with less education, and younger patients were more likely to endorse intended use. The problem of nonprescription use is not confined to Latino communities. Community antimicrobial stewardship must include a focus on nonprescription antibiotics.

show abstract

Section: Discussionmentioning

confidence: 99%

Nonprescription Antimicrobial Use in a Primary Care Population in the United States

Zoorob

Grigoryan

Nash

et al. 2016

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…These findings may explain some of the segregation in care that has been observed in other studies. 4,5,7,8,15–17 More research is needed on how these selection strategies (or lack thereof) affect the quality of care patients receive and how we can best intervene to guarantee excellent and equal care for all patients with breast cancer. Assuring thoughtful decision-making for provider and hospital selection may be an important element in addressing treatment disparities in cancer and has the potential to be an important focus for interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Research suggests that differences in treatment and outcomes may occur in part because of differences in the providers and institutions where patients receive their care. 4–14 Minority patients are more likely than white patients to receive medical care in lower quality hospitals, 4,5,7,8,15–17 from providers caring for higher proportions of minority patients, 18,19 and from physicians who are less well trained than those treating white patients. 19 Among patients with breast cancer, black women are more likely than white women to undergo breast surgery at hospitals with lower rates of radiation following breast conservation.…”

Section: Introductionmentioning

confidence: 99%

Racial/Ethnic Differences in Patients’ Selection of Surgeons and Hospitals for Breast Cancer Surgery

et al. 2015

View full text Add to dashboard Cite

Importance Racial differences in breast cancer treatment may result in part from differences in the providers from whom patients receive their care. However, little is known about differences in patients’ selection of providers. Objective To examine racial/ethnic differences in how women selected their surgeons and hospitals for breast cancer surgery. Design, Setting, Participants We surveyed 500 women (222 non-Hispanic white, 142 non-Hispanic black, 89 English-speaking Hispanic, and 47 Spanish-speaking Hispanic) from northern California cancer registries with stage 0–III breast cancer diagnosed during 2010–2011 (participation rate=68.5%). We used multivariate logistic regression to assess the reasons for surgeon and hospital selection by race/ethnicity, adjusting for other patient characteristics. We also assessed the association between reasons for physician selection and patients’ ratings of their surgeon and hospital. Main Outcome Reasons for surgeon and hospital selection, ratings of surgeon and hospital. Results The most frequently-reported reason for surgeon selection was referral by another doctor (77.6%); the most frequently-reported reason for hospital selection was because it was a part of a patient’s health plan (58.4%). After adjustment, 78.6%–86.5% of black and Spanish-speaking Hispanic women reported selecting their surgeon based on a doctor’s referral versus 75.7% of white women (P=.007). Black and Hispanic patients were less likely than white patients to report selecting their surgeon based on reputation (adjusted rates=17.5–22.1% of blacks and Hispanics vs. 31.9% of whites; P=.02). Black and Hispanic women were also less likely than white women to select their hospital based on reputation (adjusted rates=7.2%–15.0% vs. 23.2%, P=.003). Women who selected their surgeon based on reputation more often rated the care from their surgeon excellent (adjusted odds ratio [OR]=2.21, 95%CI=1.24–3.93); those reporting their surgeon was one of the only surgeons available through the health plan less often reported excellent quality of surgical care (OR=0.56, 95%CI=0.34–0.91). Conclusions and Relevance Compared with white breast cancer patients, minority patients were less actively involved in physician and hospital selection, relying more on physician referral and health plans rather than reputation. Interventions to promote involvement in provider selection may have potential for addressing disparities related to care from lower-quality providers.

show abstract

“…Variation across studies may be seen because being a minority-serving provider may be associated with measured and unmeasured characteristics related to practice type that can affect quality, such as, organizational structure and staffing, provider training, payer mix, geography and residential segregation, work environment, and the availability of health information technology and other resources. 2, 4, 10, 29, 30 Practice-level factors, such as having policies to promote access and continuity and the use of reports to clinicians, have been shown to be associated with greater use of preventive asthma medications for children. 21 Safety net practices serving large numbers of uninsured and Medicaid-insured patients may have fewer resources to devote to policies that promote adherence to guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…8, 9 Possible explanations for the latter are that providers who serve larger minority patient populations encounter more complex medical and social issues, language barriers, and lower health literacy. 4,10 While most studies in this area have been in adult populations, there is some evidence that suggests that minority infants are more likely to receive care at underperforming hospitals. However, data for pediatric care in the ambulatory setting are lacking.…”

Section: Introductionmentioning

confidence: 99%

Asthma Care Quality for Children With Minority-Serving Providers

Galbraith

Smith²,

Bokhour³

et al. 2010

Arch Pediatr Adolesc Med

View full text Add to dashboard Cite

Separate and Unequal

Abstract: Clinics serving higher proportions of minority patients have more challenging workplace and organizational characteristics.

Cited by 98 publications

References 21 publications

Nonprescription Antimicrobial Use in a Primary Care Population in the United States

Nonprescription Antimicrobial Use in a Primary Care Population in the United States

Racial/Ethnic Differences in Patients’ Selection of Surgeons and Hospitals for Breast Cancer Surgery

Asthma Care Quality for Children With Minority-Serving Providers

Contact Info

Product

Resources

About