PATIENT ATTITUDES REGARDING HEALTHCARE UTILIZATION AND REFERRAL: RESULTS part 2

9 Dec
2009

Healthcare Utilization

Healthcare Sources: The majority of the participants (89%) reported having a primary care physician. Although not significant, African Americans were less likely to have a regular primary care physician compared to Caucasian Americans (87% versus 91%). The African Americans were more likely to use the emergency room as a regular source for healthcare than the Caucasian Americans (11.5% versus 3.0%,/?<0.01; OR=0.24, p< 0.05).

Table 2. Health Services Utilization Frequency by Race

Variable

N

Number of Visits (%)

p-value

None

1-4

5-8

9-12

13+

Number of inpatient days African Americans Caucasian Americans

231

61.6 69.726.3 17.45.1 3.81.0 1.56.1 7.60.53
Number of visits to primary care physician African Americans Caucasian Americans

220

11.8 12.632.3 33.118.3 18.915.1 15.022.6 20.50.99
Number of emergency room visits (ER) African Americans Caucasian Americans

223

53.0 70.734.0 22.69.0 3.82.0 2.32.0 0.80.06
Number of visits to company clinic African Americans Caucasian Americans

150

76.6 88.49.4 8.16.3 1.27.8 2.3

0.10
Number of visits to specialist African Americans Caucasian Americans

203

23.3 29.929.1 24.815.1 16.212.8 12.019.8 17.10.84
Number of non-ER visits African Americans Caucasian Americans

229

36.4 47.733.3 31.519.2 8.55.1 4.66.1 2.70.14
Number of mental health visits African Americans Caucasian Americans

227

57.3 71.024.0 15.38.3 6.95.2 3.15.2 3.80.37
Number of other ER visits African Americans Caucasian Americans

233

56.6 64.929.3 31.39.1 2.25.1 1.5

0.04

Utilization of Healthcare Services: As shown in Table 2, African Americans with chronic pain reported significantly more visits to the emergency room for pain care in the last 12 months than the Caucasian Americans (1.7±0.9 versus 1.4±0.7, /?<0.001), although there were no differences in the number of visits made to the emergency room for nonpain care. They were also more likely to wait longer to see a healthcare provider after the onset of their pain than Caucasian Americans (/?<0.05). Use of diagnostic tests (e.g., x-rays, CAT scans, MRIs) was not statistically different between the groups. Figure 2 shows that the number of surgeries during their lifetime was not significantly different, but Caucasian Americans tended to have a higher number of surgeries. cialis professional

Figure 2. Number of Surgeries

Figure 2. Number of Surgeries in Lifetime Among Patients With Chronic Pain

Patient Perceptions and Attitudes

Caucasian Americans were less likely to agree that gender affects healthcare when compared to African Americans (26.3% versus 42.2%; p<0.05), although there were no differences between the two groups in their belief that gender affects access to pain management (27.5% versus 15.3%). When compared to Caucasian Americans, African Americans agreed more that ethnicity and culture affects access to healthcare (OR=0.12, 95% CI=0.04-0.35; /?<0.001) and pain management (OR=0.15; 95% CI=0.05-0.43; p<0.00l). Although not significant, the trend shows that African Americans tended to agree with the statements that pain medications cannot control pain and that good patients avoid talking about pain more than Caucasian Americans. Table 3 shows the subjects’ opinions regarding other aspects of pain and healthcare. When you need your medication buy aciphex

Table 3. Study Population’s Attitudes Regarding Chronic Pain and Healthcare by Race

Level of Agreement

Variable

N

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

p-value

Gender affects healthcare African Americans Caucasian Americans21529.3 48.812.0 12.216.3 22.828.3 13.014.1 3.30.00
Gender affects access to pain management African Americans Caucasian Americans21535.2 47.615.4 12.922.0 24.217.6 10.59.9 4.80.18
Ethnicity/culture affects access to healthcare African Americans Caucasian Americans22017.9 39.213.7 10.423.2 28.025.3 16.80.00 20.0 5.6
Ethnicity/culture affects access to pain management African Americans Caucasian Americans21925.0 47.67.6 12.918.5 24.230.4 10.518.5 4.80.00
Complaints of pain distract physicians African Americans Caucasian Americans21935.5 27.818.3 19.021.5 29.417.2 18.37.5 5.60.61
Pain medication should be saved African Americans Caucasian Americans22346.8 43.420.2 18.612.8 14.712.8 18.67.4 4.70.69
Pain is sign that things are worse African Americans Caucasian Americans2170.08 26.1 13.621.7 29.621.7 24.018.5 25.612.0 7.2
People do not get addicted easily 219 African Americans Caucasian Americans29.5 26.623.2 28.225.3 24.213.7 14.58.4 6.50.90

Perceptions and Attitudes by Gender: There were significant differences in the perception that gender affects access to healthcare between African- and Caucasian Americans regardless of gender (men: /?<0.05, women: p<0.001). When gender was controlled, this difference remained significant only among women (i.e., African-American and Caucasian -American women (13% versus 42%, /?<0.01). African-American women were more likely to agree that ethnicity/culture affected access to pain treatment than Caucasian-American women (21% versus 2%, /?<0.05). When the perception that ethnicity/culture affected access to healthcare was tested in both African- and Caucasian Americans, African-American women were more likely than Caucasian American women (27% versus 5%, /?<0.001) to agree. Throughout the entire study sample, there were no racial differences in the belief among the respondents that pain medication can control pain. Yet when stratified by gender, African-American men agreed more than Caucasian-American men with this statement (p<0.05). There were no differences in the response among African- and Caucasian-American women. buy protonix online

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