Minority Health Care Clinics Separate But Unequal

News Archive February 09, 2009

Minority Health Care Clinics Separate But Unequal

New Study Evaluates Role of Clinic Environment in Health Care Disparities
MAYWOOD - A study published today in the Archives of Internal Medicine may shed new light on why minority Americans have poorer health outcomes from chronic conditions such as hypertension, heart disease and diabetes. Researchers found that clinics serving higher proportions of these minority patients tend to have more challenging work environments and organizational characteristics. "Unfavorable patient and physician outcomes may be attributable to disparities in work conditions at these clinics," said Anita Varkey, MD, lead author, assistant professor in the department of medicine, Loyola University Chicago Stritch School of Medicine and medical director of general medicine at Loyola Outpatient Center, Loyola University Health System. "When you have limited access to medical supplies, referral specialists, and examination rooms, coupled with a more complex patient mix, you can start to see the challenges involved with providing high quality primary care." Few studies have examined the influence of physician workplace conditions on health care disparities. This study compared 96 primary care clinics in five regions, including Chicago. Data were collected from 388 primary care physicians and 1,701 adult patients with chronic diseases. Researchers compared 27 clinics (41.8 percent of physicians) that had at least 30 percent minority patients with 69 clinics (45.9 percent of physicians) that had less than 30 percent. The clinics with larger proportions of minority patients were four times more likely to have a chaotic work environment, and their physicians were half as likely to report job satisfaction. These physicians also had a tendency to report higher stress and intention to leave. "All of these factors can contribute to health care disparities," said Varkey. "Challenges in workplace characteristics exacerbate time pressures already complicated by disadvantaged patients with chronic medical and psychosocial issues." Patients in clinics with higher proportions of minorities were more frequently depressed (22.8 percent vs. 12.1 percent), more often covered by Medicaid (30.2 percent vs. 11.4 percent), and had lower health literacy (3.7 vs. 4.4, on a scale where one is lowest and five is highest). Physicians from these clinics reported that more of their patients spoke little to no English (27.1 percent vs. 3. 4 percent), had more chronic pain (24.1 percent vs. 12.9 percent), substance abuse problems (15.1 percent vs. 10.1 percent), and complex medical cases. The authors indicated that strategies to improve patient care for these clinics should go beyond efforts to improve health care coverage and reimbursement. Interventions also should target measures to reduce physician burnout, clinic chaos and work control measures. "While further research is needed, health care reform strategies should consider the role that work environment plays in quality of care," said Varkey. Varkey is an internist who specializes in primary care, preventive medicine and women's health. She sees patients at Loyola Outpatient Center. Co-authors of the Archives study include Linda Baier Manwell, MS, James A. Bobula, PhD, Mark Linzer, MD, Roger L. Brown, PhD, Jacqueline C. Wiltshire, PhD, of the University of Wisconsin-Madison; Eric S. Williams, PhD, of the University of Alabama; Said A. Ibrahim, MD, MPH, of the University of Pittsburgh; Barbara A. Horner-Ibler, MD, MASW, of the University of Wisconsin-Milwaukee; Mark D. Schwartz, MD, of New York University Medical School and Veterans Affairs New York Harbor Health Care System; and Thomas R. Konrad, PhD, of University of North Carolina, Chapel Hill.
Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.
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