Disparities/Minority Health

Underresourced clinics with more challenging patients may underlie poor chronic disease outcomes of minorities

Primary care clinics serving minority patients have less access to medical resources, an often chaotic work environment, and challenging patients compared with clinics serving predominantly white patients, finds a new study. This may play a role in the poorer chronic disease outcomes of minority patients, suggest the study authors. They analyzed survey responses of 96 clinic managers, 388 primary care physicians, and 1,701 of their adult patients with hypertension, diabetes, or congestive health failure. They compared data from 27 clinics with at least 30 percent minority patients with data from 69 clinics with less than 30 percent minority patients.

On a scale of 1 (none) to 4 (great), clinics serving at least 30 percent minority patients had less access to medical supplies (2.7 vs. 3.4), referral specialists (3.0 vs. 3.5), and examination rooms per physician (2.2 vs. 2.7) than clinics treating fewer minorities. Clinics serving more minorities had patients who were more often depressed (22.8 vs. 12.1 percent), were more often covered by Medicaid (30.2 vs. 11.4 percent), and reported lower health literacy (3.7 vs. 4.4 on a 5-point scale).

Physicians from clinics serving higher proportions of minority populations perceived their patients as frequently speaking little or no English (27.1 vs. 3.4 percent), suffering more chronic pain (24.1 vs. 12.9 percent) and substance abuse problems (15.1 vs. 10.1 percent), and being more medically complex (53.1 vs. 39.8 percent) and psychosocially complex (44.9 vs. 28.2 percent). Finally, clinics with at least 30 percent minority patients were more likely to have chaotic work environments and to have fewer physicians reporting high work control or high job satisfaction. The study was supported in part by the Agency for Healthcare Research and Quality (HS11955).

More details are in "Separate and unequal: Clinics where minority and nonminority patients receive primary care," by Anita B. Varkey, M.D., Linda Baier Manwell, M.S., Eric S. Williams, Ph.D., and others, in the February 9, 2009, Archives of Internal Medicine 169(3), pp. 243-250.

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