title: Vulnerability and the patient-practitioner relationship: the roles of gatekeeping and primary care performance.
abstract: OBJECTIVE
  We examined whether patients' perceptions of their relationships with primary care practitioners (PCPs) vary by vulnerability status and assessed the extent to which gatekeeping arrangements and primary care performance moderate potential disparities.
  
  
  METHODS
  We used the nationally representative 1996-1997 Community Tracking Study Household Survey as our data source.
  
  
  RESULTS
  Whites reported better patient-practitioner relationships than minorities. Requirements that patients select a PCP and obtain referral authorization neither reduced nor exacerbated racial disparities in the patient-practitioner relationship. On the other hand, access to and continuity with a PCP substantively reduced disparities, especially for the most vulnerable group.
  
  
  CONCLUSIONS
  Enhancing primary care performance may reduce some of the barriers to care experienced by vulnerable populations, thereby improving patients' relationships with their PCPs.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md 21205, USA. lshi@jhsph.edu
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Forrest
authors.forename: Sarah
authors.initials: S
authors.lastname: Von Schrader
authors.forename: Judy
authors.initials: J
authors.lastname: Ng
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D005191:Family Characteristics; D020793:Gatekeeping / Q000458:organization & administration*; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D008875:Middle Aged; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D012307:Risk Factors; D020377:Self Efficacy; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations / Q000145:classification / Q000208:ethnology / Q000706:statistics & numerical data*; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data