Racial disparities in the content of primary care office visits.
BACKGROUND
Little is known about racial disparities in primary care at the level of the office visit.


OBJECTIVE
To assess racial disparities in the receipt of commonly performed/recommended procedures during routine primary care office visits and examine trends in disparities over time.


METHODS
The sample included 88,303 visits by adults to 3,260 primary care physicians in office-based practices in the National Ambulatory Medical Care Surveys, 1985, 1989, 1990, 1991, 1992, and 1995 to 2001.


METHODS
Adjusted odds for receipt or recommendation of commonly performed office procedures.


RESULTS
During the years 1985 to 2001, African Americans, compared with whites, had lower odds of receiving a Pap test (odds ratio (OR) 0.81; 95% confidence interval (CI) 0.70 to 0.93), rectal exam (OR 0.67; 95% CI 0.56 to 0.80), smoking cessation counseling (OR 0.80; 95% CI 0.66 to 0.96), and mental health advice (OR 0.51; 95% CI 0.38 to 0.69), but had higher odds for visual screening (OR 1.38; 95% CI 1.08 to 1.77), weight advice counseling (OR 1.27; 95% CI 1.13 to 1.44) and receiving a follow-up appointment (OR 1.45; 95% CI 1.29 to 1.64). These findings were not appreciably altered by adjustment for physician practice characteristics including percent African American or Medicaid patients. Disparities disfavoring African Americans in cholesterol testing and smoking cessation observed during 1985 to 1992 were not observed in 1995 to 2001.


CONCLUSIONS
The findings suggest that race is associated with the type of primary care received by patients, at least for selected procedures, with evidence that some disparities have diminished over time.
Franks
Peter
P
Department of Family and Community Medicine, Center for Health Services Research in Primary Care, University of California, Davis, Sacramento, CA 95817, USA. pfranks@ucdavis.edu
Fiscella
Kevin
K
Meldrum
Sean
S
D001741:Black or African American / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D020379:Risk Adjustment; D044465:White People / Q000706:statistics & numerical data*