PATIENT ATTITUDES REGARDING HEALTHCARE UTILIZATION AND REFERRAL: RESULTS

8 Dec
2009

Demographic Characteristics

Complete responses were obtained from 46% of the sample (N=286). Data obtained from racial and ethnic persons who did not identify themselves as either African American or Caucasian American (n=8) and those subjects who did not provide racial or ethnic information (N=41) were not analyzed. The final sample analyzed included self-identified African- or Caucasian Americans, (N=237). The majority of the sample (57%) was Caucasian American (n=136). Women (68.3%) were equally distributed between African- (68.0%) and Caucasian Americans (68.4%). The African Americans were significantly younger than the Caucasian Americans (mean years±SD; 47±13 versus 53±15; /7<0.001). As shown in Table 1, when other sociodemographic variables were analyzed, Caucasian Americans reported significantly (p<0.05) higher annual household income, employment, and education when compared to the African Americans. A minority of the sample (3%) was involved in litigation. The duration of pain prior to treatment at the MPC was not different between the two groups. However, when comparing the respondents who had waited years prior to seeking pain treatment to those who waited a few months, African Americans were more likely to wait years than Caucasian Americans (18.5% versus 9.2%; p=0.02).

Data from the 33 nonrespondents, revealed that the majority were African Americans (54%) and women (70%). The most common reasons non-respondents cited for not completing the survey included being: 1) too busy (33%), 2) too ill (22%), and 3) in too much pain (22 %). Table 1 provides further demographic characteristics of the sample population.
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Figure 1. Reasons Subjects Cited for Not Asking

Figure 1. Reasons Subjects Cited for Not Asking to Be Referred to the Pain Center

Referral Patterns

The majority (58%) of the participants asked their physician to refer them to a pain physician, which was not different based upon the subject’s race or ethnicity. Figure 1 provides further information regarding the main reasons why the participants did not ask to be referred. Overall, most subjects (61%) felt that they should have been referred earlier for pain treatment, although African Americans seem to feel that they should have been referred earlier more frequently when compared to Caucasian Americans (68.1% versus 55.6%; p=0.06). Most of the respondents (78%) reported that they had never been to a pain center before. Respondents that were previously seen in another pain center prior to coming to the MPC were more likely to be African American (OR=1.98, 95% CI=1.06-3.69; p=0.03). No differences were found in referral patterns to the pain center based upon the physicians’ race for the sample. However, African Americans were more likely to have been referred by a woman physician when compared to Caucasian Americans (9.8% versus 21.5%; OR=0.34; CI=0.18-0.85;/?=0.01). levitra plus

Table 1. Demographic and Socioeconomic Characteristics for the Population

Variables

African Americans (N=101)

Caucasian Americans (N=136)

p-value

Age (mean years±SD)

47±13

53±15

0.00

Gender (% F)

68.0

68.4

0.095

Number of People in Household (mean±SD)      2.7+1.6

2.3+1.1

0.04

Marital Status

Single (% yes)

25.0

14.3

0.09

Married (% yes)

36.7

61.5

0.00

Divorced (% yes)

31.7

8.8

0.00

Separated (% yes)

5.0

2.2

0.34

Significant other (% yes)

8.3

3.3

0.17

Widowed (% yes)

1.7

9.9

0.04

Education

0.03

< High school (%)

29.1

36.7

High school graduates (%)

39.8

26.0

College graduates (%)

31.1

37.3

Household Income (%)

0.02

<$19,999 (%)

57.2

33.3

$20,000-$34,999 (%)

13.2

19.7

$35,000-$69/999 (%)

22.0

28.2

$70,000-$99,999 (%)

3.3

6.8

$100,000 plus (%)

4.4

12.0

Employment (% yes)

28.3

40.9

0.04

Healthcare Access

Financial Access to Pain Management: The majority of respondents (90%) reported having healthcare insurance. African Americans were more likely to have Medicaid than Caucasian Americans (33.3% versus 11.9%; /?<0.001). No significant differences were found between the groups in the distribution for other types of healthcare insurance coverage. Caucasian Americans reported less difficulty paying for healthcare within the last 12 months (OR=0.44; 95% CI; 0.25-0.75;/кО.001) as well as less problems affording medical care (OR=0.51; 95% CI: 0.30-0.88; ^=0.01). African Americans were more likely to report that chronic pain was a major reason for financial problems when compared to Caucasian Americans (OR=0.39; 95% CI; 0.21-0.72,p<0.001). viagra plus

Physical Access to Pain Treatment: Although not significant, Caucasian Americans traveled longer distances to the pain center than African Americans (mean miles±SD; 65±15 versus 50±10), respectively. Most subjects (>53%) reported driving themselves to the MPC. Other primary sources of transportation included being driven to the appointment (Caucasians vs. African Americans; 49% versus 46%) and taking a taxi (3% versus 5%).

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