title: Racial disparities in access to care for men in a public assistance program for prostate cancer.
abstract: California's IMPACT program provides all its enrollees with health insurance and social service resources. We hypothesized that racial/ethnic disparities in access to care might be attenuated among men served by this program. Our objective was to evaluate racial/ethnic differences in health services utilization and patient-reported health care outcomes among disadvantaged men in a prostate cancer public-assistance program, and to identify modifiable factors that might explain persistent disparities in this health care setting. We performed a retrospective cohort study of 357 low-income men enrolled in IMPACT from 2001 through 2005. We evaluated realized access to care with two health services utilization measures: (1) use of emergency department care without hospitalization and, (2) frequency of prostate-specific antigen testing. We also measured two patient-experience outcomes: (1) satisfaction with care received from IMPACT, and (2) confidence in IMPACT care providers. We observed significant bivariate associations between race/ethnicity and patient-experience outcomes (P<0.05), but not utilization measures. In multivariable models, Hispanic men were more likely than white men to report complete satisfaction with health care received in IMPACT (adjusted OR=5.15, 95% CI 1.17-22.6); however, the association between race/ethnicity and satisfaction was not statistically significant (P=0.11). Language preference and self-efficacy in patient-physician interactions are potentially-modifiable predictors of patient-experience outcomes. We observed no racial/ethnic disparities in health services utilization among disadvantaged men served by a disease-specific public assistance program. The greater satisfaction and confidence among Hispanic men are explained by modifiable variables that suggest avenues for improvement.
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Box 951738, Los Angeles, CA 90095-1738, USA. dcmiller@mednet.ucla.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.forename: Lillian
authors.initials: L
authors.lastname: Gelberg
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.forename: Sevan
authors.initials: S
authors.lastname: Stepanian
authors.forename: Arlene
authors.initials: A
authors.lastname: Fink
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Andersen
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000368:Aged; D002140:California; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms; D044469:Racial Groups; D012189:Retrospective Studies; D012946:Social Welfare; D011795:Surveys and Questionnaires; D014481:United States