PATIENT ATTITUDES REGARDING HEALTHCARE UTILIZATION AND REFERRAL: DISCUSSION part 2

11 Dec
2009

PATIENT ATTITUDES

Important gender and racial differences in attitudes towards pain, health, and healthcare exist. We also found significant racial and gender differences in attitudes and perceptions regarding healthcare and pain management experiences in this study. Regardless of the subject’s gender, there were significant differences in the belief that the patient’s gender affected access to healthcare when stratified by gender—with women agreeing more than men.

Significant differences were also found in the perception that ethnicity affects access to pain treatment after stratifying by gender, where African Americans agreed more than Caucasian Americans. When stratified by gender, African-American women believed more that gender affects access to pain treatment and that ethnicity affects access to healthcare. These results are consistent with research by Chin who found that African Americans, especially African-American women with diabetes, were less satisfied with the ease in obtaining a physician. These perceptions are important considerations, since there is data to suggest that African Americans have less trust in the healthcare system. However, differences in attitudes may be only part of the healthcare disparities story. In general, differences in refusal rates for treatment (believed to be higher among African Americans), overuse of clinical services by Caucasian Americans (for which is rarely accounted), and biological differences in clinical presentation or response to treatment may contribute to racial differences in healthcare. These contradictory results suggest a need to improve healthcare access measurements as well as identifying potential confounding factors.

Morrison provided convincing data that African Americans may have less access to certain pain medications in their neighborhood pharmacies, despite similar health insurance coverage and similar socioeconomic stratification. We did not specifically inquire about the respondents’ pharmacies or the availability of medication, nor did we collect information on current medications, pain severity, or the quality of chronic-pain management. These additional factors may influence healthcare utilization. Future studies directed at the availability of quality pain management as well as treatment modalities are necessary.
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Although we acknowledge several limitations, this study raises important questions regarding healthcare utilization by patients with chronic pain. First, all participants received pain care. Our results may reflect referral patterns to an academic tertiary-care pain center, which may limit the generalizability of our results to other settings. It is possible that healthcare utilization patterns for chronic-pain patients seeking treatment in the community or other pain centers may differ. Second, recall bias is an inherent limitation of all survey research. However, to minimize this potential bias, we limited the time frame to the 12 months prior to study participation. In addition, subjects were encouraged to complete their responses in a confidential manner to enhance truthful responses. Third, incentives were not used, since they have not been shown to reliably improve response rates in African Americans and may also introduce a response bias. Fourth, the data collection instrument developed for this study was critiqued by faculty members for internal validity, but it was not pretested in patients or subjects. Lastly, to ensure that respondents did not differ from the nonrespondents, a survey was conducted among nonrespondents. It is also important to note that the nonresponse survey revealed no demographic differences between responders and nonresponders.

This study highlights several differences in healthcare utilization, referral, and access that impact the chronic-pain experiences in African Americans when compared to Caucasian Americans. Given the personal distress and economic consequences of chronic pain, this problem deserves further study. Future studies should examine how pain severity and specific psychological problems (e.g., depression, anxiety) influence healthcare referral, utilization, and cost in a racially and ethnically diverse chronic-pain population. We have demonstrated that patient attitudes regarding healthcare access differ based on the patient’s race and gender and may influence their willingness to request and accept pain treatment. Healthcare delivery system and trust issues are important to understand in racially and ethnically diverse populations if quality pain care service is to be ensured. Beyond racial and ethnic differences in healthcare access, utilization, and the referral process, future studies must be directed at evaluating the role of gender, aging, and social stratification on the ability to access and utilize pain-management services. Viagra Super Active

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