Miller David C, Gelberg Lillian, Kwan Lorna, Stepanian Sevan, Fink Arlene, Andersen Ronald M, Litwin Mark S
Department of Urology, David Geffen School of Medicine at UCLA, Box 951738, Los Angeles, CA 90095-1738, USA.
J Community Health. 2008 Oct;33(5):318-35. doi: 10.1007/s10900-008-9105-9.
California's IMPACT program provides all its enrollees with health insurance and social service resources. We hypothesized that racial/ethnic disparities in access to care might be attenuated among men served by this program. Our objective was to evaluate racial/ethnic differences in health services utilization and patient-reported health care outcomes among disadvantaged men in a prostate cancer public-assistance program, and to identify modifiable factors that might explain persistent disparities in this health care setting. We performed a retrospective cohort study of 357 low-income men enrolled in IMPACT from 2001 through 2005. We evaluated realized access to care with two health services utilization measures: (1) use of emergency department care without hospitalization and, (2) frequency of prostate-specific antigen testing. We also measured two patient-experience outcomes: (1) satisfaction with care received from IMPACT, and (2) confidence in IMPACT care providers. We observed significant bivariate associations between race/ethnicity and patient-experience outcomes (P<0.05), but not utilization measures. In multivariable models, Hispanic men were more likely than white men to report complete satisfaction with health care received in IMPACT (adjusted OR=5.15, 95% CI 1.17-22.6); however, the association between race/ethnicity and satisfaction was not statistically significant (P=0.11). Language preference and self-efficacy in patient-physician interactions are potentially-modifiable predictors of patient-experience outcomes. We observed no racial/ethnic disparities in health services utilization among disadvantaged men served by a disease-specific public assistance program. The greater satisfaction and confidence among Hispanic men are explained by modifiable variables that suggest avenues for improvement.
加利福尼亚州的“影响”项目为所有参保者提供医疗保险和社会服务资源。我们推测，在参与该项目的男性中，获得医疗服务方面的种族/族裔差异可能会减小。我们的目标是评估前列腺癌公共援助项目中弱势男性在医疗服务利用和患者报告的医疗保健结果方面的种族/族裔差异，并确定可能解释这种医疗保健环境中持续存在的差异的可改变因素。我们对2001年至2005年参与“影响”项目的357名低收入男性进行了一项回顾性队列研究。我们用两项医疗服务利用指标评估实际获得的医疗服务：（1）未住院的急诊护理使用情况，以及（2）前列腺特异性抗原检测的频率。我们还测量了两项患者体验结果：（1）对从“影响”项目获得的护理的满意度，以及（2）对“影响”项目护理提供者的信心。我们观察到种族/族裔与患者体验结果之间存在显著的双变量关联（P<0.05），但与利用指标无关。在多变量模型中，西班牙裔男性比白人男性更有可能报告对在“影响”项目中获得的医疗保健完全满意（调整后的OR=5.15，95%CI 1.17-22.6）；然而，种族/族裔与满意度之间的关联无统计学意义（P=0.11）。患者与医生互动中的语言偏好和自我效能是患者体验结果的潜在可改变预测因素。在一个特定疾病的公共援助项目服务的弱势男性中，我们未观察到医疗服务利用方面的种族/族裔差异。西班牙裔男性更高的满意度和信心可以通过可改变变量来解释，这些变量为改进提供了途径。
