Influence of patients' socioeconomic status on clinical management decisions: a qualitative study.
OBJECTIVE
Little is known about how patients' socioeconomic status (SES) influences physicians' clinical management decisions, although this information may have important implications for understanding inequities in health care quality. We investigated physician perspectives on how patients' SES influences care.


METHODS
The study consisted of in-depth semistructured interviews with primary care physicians in Connecticut. Investigators coded interviews line by line and refined the coding structure and interview guide based on successive interviews. Recurrent themes emerged through iterative analysis of codes and tagged quotations.


RESULTS
We interviewed 18 physicians from varied practice settings, 6 female, 9 from minority racial backgrounds, and 3 of Hispanic ethnicity. Four themes emerged from our interviews: (1) physicians held conflicting views about the effect of patient SES on clinical management, (2) physicians believed that changes in clinical management based on the patient's SES were made in the patient's interest, (3) physicians varied in the degree to which they thought changes in clinical management influenced patient outcomes, and (4) physicians faced personal and financial strains when caring for patients of low SES.


CONCLUSIONS
Physicians indicated that patient SES did affect their clinical management decisions. As a result, physicians commonly undertook changes to their management plan in an effort to enhance patient outcomes, but they experienced numerous strains when trying to balance what they believed was feasible for the patient with what they perceived as established standards of care.
Bernheim
Susannah M
SM
Department of Internal Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 208088, USA. susannah.bernheim@yale.edu
Ross
Joseph S
JS
Krumholz
Harlan M
HM
Bradley
Elizabeth H
EH
D000328:Adult; D001291:Attitude of Health Personnel; D003237:Connecticut; D003657:Decision Making; D005260:Female; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D010346:Patient Care Management / Q000191:economics* / Q000592:standards; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D036301:Qualitative Research; D011787:Quality of Health Care / Q000191:economics; D012923:Social Class