TY - JOUR
T1 - Addressing the unique challenges of inner-city practice
T2 - A direct observation study of inner-city, rural, and suburban family practices
AU - Blankfield, Robert P.
AU - Goodwin, Meredith
AU - Jaén, Carlos R.
AU - Stange, Kurt C.
N1 - Funding Information:
Drs. Blankfield and Stange and Ms. Goodwin are from the Department of Family Medicine, Dr. Stange and Ms. Goodwin are from the Department of Epidemiology and Biostatistics, and Dr. Stange is from the Department of Sociology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Dr. Jaén is from the Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio; Dr. Blankfield is from the University Hospitals Primary Care Physician Practice, Berea, Ohio; and Dr. Stange is from the Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University School of Medicine, Cleveland, Ohio.
Funding Information:
This research was supported by grants from the National Cancer Institute (1R01 CA 60862 and 2R01 CA 60862) and Robert Wood Johnson Generalist Physician Faculty Scholars Awards. Robin Gotler provided manuscript assistance. Without the participation of the physician members of the Research Association of Practicing Physicians, their office staff, and patients, this study would not have been possible.
PY - 2002
Y1 - 2002
N2 - Previous research on geographic variations in health care contains limited information regarding inner-city medical practice compared with suburban and rural settings. Our main objective was to compare patient characteristics and the process of providing medical care among family practices in inner-city, suburban, and rural locations. A cross-sectional multimethod study was conducted emphasizing direct observation of outpatient visits by trained research nurses involving 4,454 consecutive patients presenting for outpatient care to 138 family physicians during 2 days of observation at 84 community family practices in northeast Ohio. Time use during office visits was assessed with the Davis Observation Code; satisfaction was measured with the Medical Outcomes Study nine-item Visit Rating Scale; delivery of preventive services was as recommended by the US Preventive Services Task Force; and patient-reported domains of primary care were assessed with the Components of Primary Care Instrument. Results show that inner-city patients had more chronic medical problems, more emotional problems, more problems evaluated per visit, higher rates of health habit counseling, and longer and more frequent office visits. Rural patients were older, more likely to be established with the same physician, and had higher rates of satisfaction and patient-reported physician knowledge of the patient. Suburban patients were younger, had fewer chronic medical problems, and took fewer medications chronically. Inner-city family physicians in northeast Ohio appear to see a more challenging patient population than their rural and suburban counterparts and have more complex outpatient office visits. These findings have implications for health system organization along with the reimbursement and recruitment of physicians in medically underserved inner-city areas.
AB - Previous research on geographic variations in health care contains limited information regarding inner-city medical practice compared with suburban and rural settings. Our main objective was to compare patient characteristics and the process of providing medical care among family practices in inner-city, suburban, and rural locations. A cross-sectional multimethod study was conducted emphasizing direct observation of outpatient visits by trained research nurses involving 4,454 consecutive patients presenting for outpatient care to 138 family physicians during 2 days of observation at 84 community family practices in northeast Ohio. Time use during office visits was assessed with the Davis Observation Code; satisfaction was measured with the Medical Outcomes Study nine-item Visit Rating Scale; delivery of preventive services was as recommended by the US Preventive Services Task Force; and patient-reported domains of primary care were assessed with the Components of Primary Care Instrument. Results show that inner-city patients had more chronic medical problems, more emotional problems, more problems evaluated per visit, higher rates of health habit counseling, and longer and more frequent office visits. Rural patients were older, more likely to be established with the same physician, and had higher rates of satisfaction and patient-reported physician knowledge of the patient. Suburban patients were younger, had fewer chronic medical problems, and took fewer medications chronically. Inner-city family physicians in northeast Ohio appear to see a more challenging patient population than their rural and suburban counterparts and have more complex outpatient office visits. These findings have implications for health system organization along with the reimbursement and recruitment of physicians in medically underserved inner-city areas.
KW - Inner City
KW - Office Visit Characteristics
KW - Patient Characteristics
KW - Rural
KW - Suburban
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U2 - 10.1093/jurban/79.2.173
DO - 10.1093/jurban/79.2.173
M3 - Article
C2 - 12023493
AN - SCOPUS:0036267465
SN - 1099-3460
VL - 79
SP - 173
EP - 185
JO - Journal of Urban Health
JF - Journal of Urban Health
IS - 2
ER -