February 1, 2010
Dana Gelb Safran
H. P. Rodriguez, T. von Glahn, D. E. Grembowski et al., “Physician Effects on Racial and Ethnic Disparities in Patients’ Experiences of Primary Care,” Journal of General Internal Medicine, July 24, 2008 23(10):1666–72.
Racial and ethnic disparities in patients’ primary care experiences are present even when health insurance coverage is comparable. A Commonwealth Fund–supported study published in the Journal of General Internal Medicine
investigated the extent to which such disparities can be attributed to differences within
physician practices—meaning they are potentially related to discrimination or differential treatment—or to differences between
practices, an indication that minority patients tend to receive treatment in low-performing practices.
The researchers surveyed patients of 1,588 primary care physicians at 27 California medical groups, asking questions related to patient–physician interaction, health promotion support, organizational access, care coordination, and office staff. The findings showed that patients were generally clustered in practices with others of their own ethnicity. Most disparities between white and Latino, black, and American Indian/Alaska Native patients related to differences between practices, and were thus likely attributable to the fact that these minority groups clustered in practices that performed poorly on the survey. On the other hand, differences within practices accounted for most disparities reported by Asians and Pacific Islanders, with these groups reporting worse experiences than whites in the same practices.
The overall findings suggest that efforts to improve patient experiences in low-performing practices could address many racial and ethnic health disparities. Further research is needed, however, to investigate the differing experiences reported by Asian and white patients within the same practices.