Vulnerability and the patient-practitioner relationship: the roles of gatekeeping and primary care performance.
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.
Shi
Leiyu
L
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md 21205, USA. lshi@jhsph.edu
Forrest
Christopher B
CB
Von Schrader
Sarah
S
Ng
Judy
J
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