Racial disparities in access to care for men in a public assistance program for prostate cancer.
Racial disparities in access to care for men in a public assistance program for prostate cancer.
复制标题
前列腺癌公共援助计划中男性获得护理的种族差异。
DOI：
10.1007/s10900-008-9105-9
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发表时间：
2008
影响因子：
5.9
通讯作者：
Litwin,MarkS
中科院分区：
文献类型：
--
作者：
Miller,DavidC;Gelberg,Lillian;Kwan,Lorna;Stepanian,Sevan;Fink,Arlene;Andersen,RonaldM;Litwin,MarkS
加州的IMPACT计划为所有参加者提供医疗保险和社会服务资源。我们假设，种族/民族的差异，在获得医疗服务可能会减弱男性服务的这一计划。我们的目标是评估在前列腺癌公共援助计划中处于不利地位的男性在卫生服务利用和患者报告的卫生保健结果方面的种族/民族差异，并确定可能解释这种卫生保健环境中持续存在差异的可修改因素。我们对2001年至2005年参加IMPACT的357名低收入男性进行了回顾性队列研究。我们通过两个卫生服务利用指标评估了实现的护理可及性：（1）无需住院的急诊护理的使用，（2）前列腺特异性抗原检测的频率。我们还测量了两项患者体验结果：（1）对IMPACT护理的满意度，以及（2）对IMPACT护理提供者的信心。我们观察到种族/民族与患者经验结局之间存在显著的双变量相关性（P< 0.05），但未观察到使用指标。在多变量模型中，西班牙裔男性比白色男性更有可能报告对IMPACT中接受的医疗保健完全满意（调整后OR = 5.15，95% CI 1.17-22.6）;然而，人种/种族与满意度之间的相关性无统计学意义（P= 0.11）。语言偏好和自我效能在病人-医生互动是潜在的，可修改的预测病人的经验成果。我们没有观察到种族/民族的差异，在卫生服务利用弱势男性服务的疾病特异性公共援助计划。西班牙裔男性更大的满意度和信心是由可修改的变量来解释的，这些变量表明了改善的途径。
California’s IMPACT program provides all its enrollees with health insurance and social service resources. We hypothesized that racial/ethnic disparities in access to care might be attenuated among men served by this program. Our objective was to evaluate racial/ethnic differences in health services utilization and patient-reported health care outcomes among disadvantaged men in a prostate cancer public-assistance program, and to identify modifiable factors that might explain persistent disparities in this health care setting. We performed a retrospective cohort study of 357 low-income men enrolled in IMPACT from 2001 through 2005. We evaluated realized access to care with two health services utilization measures: (1) use of emergency department care without hospitalization and, (2) frequency of prostate-specific antigen testing. We also measured two patient-experience outcomes: (1) satisfaction with care received from IMPACT, and (2) confidence in IMPACT care providers. We observed significant bivariate associations between race/ethnicity and patient-experience outcomes (P< 0.05), but not utilization measures. In multivariable models, Hispanic men were more likely than white men to report complete satisfaction with health care received in IMPACT (adjusted OR = 5.15, 95% CI 1.17–22.6); however, the association between race/ethnicity and satisfaction was not statistically significant (P= 0.11). Language preference and self-efficacy in patient-physician interactions are potentially-modifiable predictors of patient-experience outcomes. We observed no racial/ethnic disparities in health services utilization among disadvantaged men served by a disease-specific public assistance program. The greater satisfaction and confidence among Hispanic men are explained by modifiable variables that suggest avenues for improvement.