title: Adults' lack of a usual source of care: a matter of preference?
abstract: OBJECTIVE
  We wanted to identify characteristics of adults who do not have a usual source of care and then stratify the analysis by those who prefer vs those who do not prefer to have a usual source of care.
  
  
  METHODS
  We analyzed data from a nationally representative sample of 9,011 adults to identify characteristics of those more likely to not have a usual source of care. Based on stated reasons for lacking a usual source of care, we created 2 subpopulations of adults without a usual source of care: those who had no preference and those who did. We identified and compared characteristics of each subpopulation.
  
  
  RESULTS
  In the year 2000, 20% of adults did not have a usual source of care. Among all adults, lack of insurance (odds ratio [OR] = 3.2; 95% confidence interval [CI], 2.6-3.9) was independently associated with lacking a usual source of care, as were male sex (OR = 2.1; 95% CI, 1.7-2.4), excellent reported health (OR = 2.0; 95% CI, 1.2-3.2), younger age (for ages 18-29 years, OR = 4.1; 95% CI, 3.1-5.4) and Hispanic ethnicity (OR = 1.5; 95% CI,1.2-1.9). Of those without a usual source of care, 72% cited reasons indicating no preference to have one. Associations among such respondents were similar to those found among adults as a whole. Among respondents who preferred to have a usual source of care, however, the sex of the respondent became less significant, lack of insurance became more significant, and reported health status became nonsignificant.
  
  
  CONCLUSIONS
  Most adults who lack a usual source of care do so for reasons of preference, evidently placing little value on having a usual source of care. Helping these persons have a usual source of care will likely require different interventions than needed to help those who want a usual source of care but cannot get one.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. anthony_viera@med.unc.edu
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Viera
authors.forename: Donald E
authors.initials: DE
authors.lastname: Pathman
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Garrett
mesh_terms: D000293:Adolescent; D000328:Adult; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D014481:United States