The role of academic medical centers in delivery of primary care

Abstract

Despite a rapid rise in services provided at community-based facilities associated with the Columbia-Presbyterian Medical Center, unmet needs continue to be great. A model for provision of service by academic medical centers in underserved urban communities is examined.

Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians

“…The decision to interview patients 6 months after the initial primary care visit was based on prior survey experience with this patient population. 10 The primary care patients served by the medical center are primarily immigrants and frequently change residences, travel between New York and their countries of origin, and have interruptions in telephone service. Attempts were made to locate all enrolled patients for this follow-up, including those who could not be located for the initial satisfaction interview.…”

Availability of Antibiotics without Prescription in New York City

“…Their numbers increased 36% between 1980 and 1990, and this rapid growth has continued over the last decade, with a proliferation of subgroups centering around specific New York City communities. 34 In the study neighborhood, 26% of household do not speak English, and the rate of reportable infectious diseases are substantially higher than in the rest of the city; these diseases include tuberculosis, chlamydia, syphilis, typhoid fever, and cryptosporidiosis (New York City Department of Health, http://www.nyc.gov/html/doh/pdf/data/2000nhp-manhattanj.pdf, accessed September 2003). In many Hispanic subcultures, Western medicine is not fully trusted, and folk remedies and healers play a more central role in treating illnesses.…”

Antibiotic Use in Hispanic Households, New York City

“…The fact that more U.S.-born persons sought medical attention may relate to insurance coverage or other access issues. Although we did not ask respondents about their insurance or immigration status in this study, in a previous survey of this community, Hispanics reported particularly low participation in insurance plans; 47% who had lived in the United States <5 years were uninsured, and the major reported reason for not seeking care was financial concern ( 27 ). In one study, conducted in Colorado and Utah, neither Hispanic ethnicity nor payment source was associated with antibiotic prescription rates ( 28 ), but other studies have shown lower insurance rates among children of immigrant parents than among those with U.S.-born parents ( 29 ).…”