Minority Clinics Tougher on Doctors

Physicians face more challenging cases with fewer resources, study suggests

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MONDAY, Feb. 9 (HealthDay News) -- U.S. doctors in clinics that serve primarily minority patients often face challenging workplace conditions, which may affect patient care, a new study finds.

Researchers analyzed data from surveys of 96 clinic managers, 388 primary care doctors and more than 1,700 adult patients with chronic diseases. Minority patients accounted for at least 30 percent of the patient base at 27 of the 96 clinics that took part in the surveys conducted between 2001 and 2005.

"Physicians from 27 clinics with at least 30 percent minority patients reported less access to medical supplies and to referral specialists than physicians from other clinics," wrote Dr. Anita B. Varkey, of Loyola University Medical Center in Maywood, Ill., and colleagues. "These 27 clinics had poorer access to pharmacy services, fewer patient examination rooms per physician and limited written educational materials for patients with hypertension and congestive heart failure."

The study also found that doctors at the 27 clinics were four times more likely to report having a chaotic work environment and half as likely to report having high job satisfaction, compared to doctors at the other clinics.

Also, physicians at the 27 clinics were more likely to report that their patients: speak little to no English (27.1 percent vs. 3.4 percent); have chronic pain (24.1 percent vs. 12.9 percent); and involve cases that are medically (53.1 percent vs. 39.9 percent) and psychologically (44.9 percent vs. 28.2 percent) complex.

Patients at the 27 clinics were also 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 percent vs. 4.4 percent, on a scale where one is the lowest and five is the highest).

The findings were published Feb. 9 in the journal Archives of Internal Medicine.

"This study provides evidence of resource and workplace organizational disparities between clinics that serve large numbers of minority patients and clinics that do not," the study authors wrote. "These deficiencies may contribute to physician stress and time pressure, thereby complicating interactions with disproportionately higher percentages of medically and psychosocially complex patients. The combination of time pressure, insufficient resources and complex patients likely constitutes a 'perfect storm' that contributes to the challenges that physicians face in providing quality care to large proportions of minority patients."

"National strategies to examine and intervene in health care disparities should consider the work environment as a potential determinant of disparities and as a target for interventions to reduce physician burnout, increase work control and reduce clinic chaos," the researchers concluded.

More information

The U.S. Centers for Disease Control and Prevention has more about minority health.

SOURCE: JAMA/Archives journals, news release, Feb. 9, 2009


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