The way to eliminate disparities may be to improve access to family physicians.
Fam Pract Manag. 2002 Jan;9(1):46.
In recent years, numerous research studies have brought to light a disturbing fact: Racial minorities are less likely than whites to receive a variety of health care services. This growing awareness of racial disparities within health care has led to calls for change from consumers, policymakers and the medical community. Indeed, one of the goals of Healthy People 2010, the U.S. Department of Health and Human Services’ public health agenda, is the elimination, not just the reduction, of health disparities for all minority groups.
Because many racial minority groups have disproportionately high rates of preventable health problems, the issue of disparities in the delivery of preventive services is of particular concern. A number of studies focusing on the population at large suggest there are racial disparities in the delivery of preventive services. However, there has been little direct study of this issue in primary care settings, where most preventive services are provided. This lack of research led us to investigate the following question:
Do racial disparities in preventive service delivery occur among patients seeing family physicians?
ILLUMINATING THE ‘BLACK BOX’ OF PRIMARY CARE
This article continues our series on the Direct Observation of Primary Care (DOPC) Study, which was funded by the National Institutes of Health and conducted by the Center for Research in Family Practice and Primary Care, with support from the AAFP. The study demonstrates the complexities of the patient visit, the demands of real-world practice and the value of primary care, issues that policymakers, the public and even clinicians have not fully understood.
To learn more about the relationship between race and preventive service delivery in family practice, we analyzed data from the Direct Observation of Primary Care (DOPC) Study. By directly observing 4,454 patient visits to 138 family physicians in Northeast Ohio, the DOPC Study sought to better understand the inner-workings of family practice. For this analysis, we examined the delivery of preventive services to both African-American and white patients.1 These services, recommended by the U.S. Preventive Services Task Force, included screening services (such as blood pressure checks, mammography and sigmoidoscopy), immunizations (such as DPT, tetanus and flu vaccinations), and health habit counseling (on topics such as diet, sexually transmitted diseases, tobacco, alcohol and drugs).
The study found that, within family practices, African-American patients and white patients were equally “up-to-date” (i.e., equally likely to receive services within the recommended periods) on both screening and immunization services. However, African-American patients were significantly more likely than white patients to be up-to-date on health habit counseling. These findings stand in stark contrast to studies of the general population, in which African Americans receive fewer recommended services.
Access to care within the family practice setting appears to play an important role in reducing disparities in the delivery of preventive services. These results support calls for improving quality of care by increasing the population’s access to primary care. They also suggest that access to family practice and primary care must be a key component of any effort to ensure racial equity in the delivery of preventive services.
Robin Gotler is project coordinator in the Family Medicine Research Division of Case Western Reserve University/University Hospitals of Cleveland.
Dr. Williams is an associate professor of family and community medicine at the University of New Mexico, Albuquerque.
Dr. Flocke is an assistant professor of family medicine and epidemiology and biostatistics at CWRU.
Dr. Kikano is an associate professor and acting chairman of family medicine at CWRU.
Dr. Stange is a professor of family medicine, epidemiology and biostatistics, oncology and sociology at CWRU. He is also director of the Center for Research in Family Practice and Primary Care, one of three family practice research centers funded by the AAFP.
Conflicts of interest: none reported.
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1. Williams RL, Flocke SA, Stange KC. Race and preventive services delivery among black patients and white patients seen in primary care. Med Care. 2001;11(39):1260–1267.
Copyright © 2002 by the American Academy of Family Physicians.
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