The content of a low-income, uninsured primary care population: including the patient agenda.
BACKGROUND
Poor and uninsured people have increased risk of medical and psychiatric illness, but they might be more reluctant to seek care than those with higher incomes. Little information exists about the biopsychosocial problems and concerns of this population in primary care.


METHODS
We surveyed 500 consecutive patients (aged 18 to 64 years) in a primary care clinic serving only uninsured, low-income patients. We used self-report questions about why patients were coming to the clinic, a chronic illness questionnaire, the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, and items from the Childhood Trauma Questionnaire. Providers completed a questionnaire naming problems elicited from patients.


RESULTS
Patients reported their most common chronic medical problems to be headaches, chronic back problems, and arthritis. The most common concerns patients wanted to discuss with providers and that providers elicited from patients were problems with mood. Compared with patients without current major mental illness, patients with a current major mental illness reported significantly (P <.001) more concerns, chronic illnesses, stressors, forms of maltreatment and physical symptoms.


CONCLUSIONS
The illness content of this uninsured, low-income population is dominated by emotional distress and physical pain. These needs place a serious burden on providers and can complicate management of chronic medical illnesses. Recommendations for specialized interview training and integrating mental health services are discussed.
Mauksch
Larry B
LB
Department of Family Medicine, University of Washington School of Medicine, Seattle 98105, USA.
Katon
Wayne J
WJ
Russo
Joan
J
Tucker
Suzanne M
SM
Walker
Edward
E
Cameron
Janet
J
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D005431:Florida; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D016017:Odds Ratio; D011203:Poverty; D011320:Primary Health Care; D012107:Research Design; D011795:Surveys and Questionnaires