title: Predictors of first-contact care in a poor urban community.
abstract: OBJECTIVE
  The aim of the study was to identify predictors of first-contact care in a population of poor urban residents.
  
  
  METHODS
  Information from a community health needs survey was used for the study. The sample included adult residents in five urban census tracts with a large proportion of Puerto Rican Hispanics. Potential predictors included social characteristics, source of health insurance, perceived health status, number of chronic diseases, use of alternatives to medical care, smoking status, and problems with alcohol use.
  
  
  RESULTS
  A total of 826 household interviews were completed for a participation rate of 78% among eligible households. Individuals with no health insurance were six times more likely to lack a source of first-contact care, compared with those who have traditional indemnity insurance. Those who only had Medicaid were four times more likely to lack a source of first-contact care. Respondents involved in Medicaid-managed care programs had similar access to first-contact care as those with commercial insurance. Individuals who reported problems with alcohol were three times more likely to lack a source of first-contact care.
  
  
  CONCLUSIONS
  Health insurance is an important predictor of access to first-contact care for poor urban residents. Those who identify problems with alcohol and African-Americans have additional difficulty with access to first-contact care.
authors.affiliation: School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Jaén
authors.forename: K S
authors.initials: KS
authors.lastname: Robillard
authors.forename: L
authors.initials: L
authors.lastname: Tumiel
authors.forename: C A
authors.initials: CA
authors.lastname: Alvarez
authors.forename: R
authors.initials: R
authors.lastname: O'Shea
authors.forename: C
authors.initials: C
authors.lastname: Patchel
mesh_terms: D000328:Adult; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D012923:Social Class; D014504:Urban Health