title: Patient perceptions of access to care and referrals to specialists: a comparison of African-American and white older patients with knee and hip osteoarthritis.
abstract: BACKGROUND
  There is a marked racial difference in the use of knee and hip replacement for osteoarthritis (OA). The reasons for this disparity remain unclear. We examined how African-American and white patients with symptomatic OA of the knee and/or hip compare with respect to their perceptions of care for knee and hip OA.
  
  
  METHODS
  Survey of 596 male patients with OA of the knee and/or hip in primary care clinics at Cleveland VAMC.
  
  
  RESULTS
  African-American (44%) and white (56%) study participants were comparable with respect to age and clinical factors. African Americans were more likely to have VA insurance only [OR=1.93 (1.13-3.28)]. African Americans were less likely to report difficulty getting medical care when needed [OR=0.54 (0.34-0.88)]. Differences in the two groups regarding satisfaction with and confidence in the primary physician were not significant. The proportions of participants who received specialty care referrals were similar.
  
  
  CONCLUSIONS
  African-American patients reported having only VA insurance more often than white patients. Other aspects of perceived system and provider-based factors were similar between groups.
authors.affiliation: St. Peters Hospital, Emergency Department, New Brunswick, NJ, USA.
authors.forename: John P F
authors.initials: JP
authors.lastname: Lopez
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Burant
authors.forename: Laura A
authors.initials: LA
authors.lastname: Siminoff
authors.forename: C Kent
authors.initials: CK
authors.lastname: Kwoh
authors.forename: Said A
authors.initials: SA
authors.lastname: Ibrahim
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health / Q000208:ethnology*; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006622:Hip Prosthesis / Q000706:statistics & numerical data; D006801:Humans; D007720:Knee Prosthesis / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D044465:White People / Q000706:statistics & numerical data*