title: How patients view primary care: differences by minority status after psychiatric emergency.
abstract: BACKGROUND
  Patients' race or ethnic background may affect their ability to access health care due to their socioeconomic status, hereditary predispositions to illnesses, or discrimination either perceived or actual by those providing health care. For patients with mental health disorders, additional barriers are created due to poor experiences with the health care system.
  
  
  METHODS
  This was a mixed methods randomized control study examining the effectiveness of care managers linking patients to primary care after psychiatric crisis. The aim reported in this paper was to analyze differences by minority status in patients' quantitative and qualitative responses before and after facilitation to primary care (N=85). Patients responded to a "patient enablement" and primary care index assessing their feelings of empowerment after a primary care visit; and to qualitative questions about their experiences and perceptions of care.
  
  
  RESULTS
  Following a primary care visit, responses by minority and non-minority individuals did not differ significantly on either the patient enablement or primary care index score. On qualitative inquiry, both non-minorities and minorities reported positive and negative views of their health, with corresponding positive and negative health experiences.
  
  
  CONCLUSIONS
  In sum, there were no differences in patient enablement between the minority and non-minority subgroups over the course of the study, nor were there any changes in patient's perception of their relationship with healthcare providers. However, this cohort found primary care services less satisfactory than a general population without mental illness. Patients with psychiatric disorders experience stigmatization in their attempts to access health care. This stigma may have a greater impact than race and ethnicity, thereby leading to a similarity in perception of health care between minorities and non-minorities with mental illness.
authors.affiliation: New York Presbyterian Hospital, Columbia University Medical Center, Family Medicine Residency, New York, New York, USA.
authors.forename: Jasmin S
authors.initials: JS
authors.lastname: Roman
authors.forename: Kim S
authors.initials: KS
authors.lastname: Griswold
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Smith
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Servoss
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001294:Attitude to Health / Q000208:ethnology*; D019090:Case Management; D018864:Cultural Diversity; D004630:Emergencies / Q000523:psychology; D004637:Emergency Services, Psychiatric / Q000458:organization & administration; D005163:Factor Analysis, Statistical; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology*; D008913:Minority Groups / Q000523:psychology*; D009518:New York; D015404:Nursing Methodology Research; D011287:Prejudice; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration*; D012959:Socioeconomic Factors; D013240:Stereotyping; D011795:Surveys and Questionnaires