Vulnerability and the Patient–Practitioner Relationship: The Roles of Gatekeeping and Primary Care Performance

Shi, Leiyu; Forrest, Christopher B.; Schrader, Sarah von; Ng, Judy

doi:10.2105/ajph.93.1.138

Cited by 42 publications

(38 citation statements)

References 28 publications

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“…Ngo-Metzger, Legedza, and Phillips (2004) recommended that providers must try to understand and incorporate cultural understanding into their health care practice. These problems were exacerbated in a managed care setting employing gatekeepers in which ethnic minorities were less likely than White patients to receive appropriate care (Cooper et al, 2003;Hargraves, Cunningham, & Hughes, 2001;Shi, Forrest, von Schrader, & Ng, 2003;Van Ryn & Fu, 2003).…”

Section: Introductionmentioning

confidence: 99%

The Effects of Discrimination and Acculturation to Service Seeking Satisfaction for Latina and Asian American Women: Implications for Mental Health Professions

Huang

Appel

2011

Social Work in Public Health

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Section: Introductionmentioning

confidence: 99%

The Effects of Discrimination and Acculturation to Service Seeking Satisfaction for Latina and Asian American Women: Implications for Mental Health Professions

Huang

Appel

2011

Social Work in Public Health

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“…A large study reported that requiring patients to select a primary care provider and obtain referral authorization did not affect racial disparities in the quality of primary care. 9 However, better continuity was associated with reduced disparities, suggesting that encouraging patients to go through their primary care providers before visiting a specialist might be desirable. In short, continuity is the friendly face of gatekeeping.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Relative Clinical Efficiency of Family Medicine Satellite Clinics

Rohrer

Bernard

Adamson

et al. 2007

The Health Care Manager

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A study was conducted to evaluate the impact of decentralization in family medicine clinic services by comparing utilization of services in 3 satellite clinics to utilization patterns of patients served at the hub clinic. It was expected that a hub clinic would be more efficient than satellite clinics because of tighter administrative control and economies of scale. Stable chronically ill patients were used as a homogeneous tracer condition in a secondary analysis of 12 months of archival data. Three types of service use were analyzed: laboratory visits, x-ray visits, and visits to specialists. Among 1,410 stable chronically ill family medicine patients, 303 (21.5%) had 10 more laboratory visits, 222 (15.7%) had 2 or more x-ray visits, and 617 (43.8 %) had 2 or more visits to a specialist. Patients at one of the satellite clinics had greater odds of receiving 2 or more x-rays but lower odds of receiving 10 or more laboratory visits, in comparison with the hub clinic. Patients at the other 2 satellite clinics did not differ from hub patients for any type of service use. Overall, stable chronically ill patients were treated with approximately equal clinical efficiency in our satellite clinics. Some differences in efficiency may occur in some clinics, but these appear to be idiosyncratic rather than due to clinic size or distance from central control.

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“…This became known, mostly pejoratively, as "gatekeeping." The PCPs' function as gatekeepers was perceived by the majority of PCPs as a cause of damaged relationships between doctors and patients, contributing to poorer patient outcomes (Feldman et al, 1998;Hadley et al, 1999;Shi et al, 2003), as well as diminished trust and patient satisfaction (Shi et al, 2003).…”

Section: Primary Care Physicians' Professional Environmentmentioning

confidence: 99%

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

DeWood¹

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DEDICATIONThis work is dedicated to my family. My husband, Gary DeWood, has provided far more encouragement and support throughout the duration of this project than either of us thought would be necessary, and has done so with grace and forbearance. My children, Patricia, Dale, and Kathryn, made many sacrifices and contributions that were material to my being able to be in school, for which I am more grateful than I can express. While it may be impossible to quantify the benefits of prayer, I am certain that the maximum of those benefits have been bestowed on me due to the fact that my mother, Alice Davis, has made countless petitions heavenward on my behalf. (Any answering of prayers that has occurred is because my mother deserves to have her prayers answered, not because I do. In any case, because of the probable reduction in requests for help, I dare say even God is relieved that my dissertation is finally complete.) The example set by my late father, Dr. Dale Davis, whose work as an adult PhD candidate I remember, exhorted me to sustain my efforts during times when it seemed that this enterprise was ill-advised for anyone who could be otherwise gainfully employed. iv ACKNOWLEDGEMENTSFirst and foremost, I thank Dr. James Vaden for being my advocate, providing encouragement, and for being a mentor without peer. I do not know by what luck it is that I was able to find such a friend.I would also like to thank all the faculty members who gave me instruction and guidance. In particular I appreciate the efforts of my committee members, Drs. Lawrence Brown, Cyril Chang, Joy Clay, Doug Imig, and Junling Wang, but most especially for those of Dr. Lawrence Brown, who had the unenviable task of assuming chairmanship of my dissertation committee late in the game. No one knows better than I do that accomplishing all that is required to obtain a Ph.D. cannot be done alone.v ABSTRACT Purpose. The purpose of this study is to examine the influence of patientperceived provider availability on nonurgent emergency department use (NUEDU). The study population consists of a nationally-representative population of non-elderly adults who were continuously privately insured (CPI) for at least a year before an emergency department visit that was determined to be nonurgent, and who reported having a regular source of care (RSC).Methods. Data were obtained from a nationally-representative longitudinal survey, the Medical Expenditure Panel Survey (MEPS). The classification of ED visits as nonurgent was based on patient report using a method developed for this study. Patient-perceived provider availability was based on patient report of how difficult it was to contact their RSC by phone for medical advice during office hours (Regular Hours Contact), how difficult it was to reach their RSC after hours in case of an urgent problem (After Hours Contact), and whether their RSC had office hours at night or on weekends (Night or Weekend Hours). Multiple logistic regression analysis was used to determine whether the patient-reported provider ava...

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Vulnerability and the Patient–Practitioner Relationship: The Roles of Gatekeeping and Primary Care Performance

Cited by 42 publications

References 28 publications

The Effects of Discrimination and Acculturation to Service Seeking Satisfaction for Latina and Asian American Women: Implications for Mental Health Professions

The Effects of Discrimination and Acculturation to Service Seeking Satisfaction for Latina and Asian American Women: Implications for Mental Health Professions

Evaluating the Relative Clinical Efficiency of Family Medicine Satellite Clinics

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

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