title: National Use of Safety-Net Clinics for Primary Care among Adults with Non-Medicaid Insurance in the United States.
abstract: OBJECTIVE
  To describe the prevalence, characteristics, and predictors of safety-net use for primary care among non-Medicaid insured adults (i.e., those with private insurance or Medicare).
  
  
  METHODS
  Cross-sectional analysis using the 2006-2010 National Ambulatory Medical Care Surveys, annual probability samples of outpatient visits in the U.S. We estimated national prevalence of safety-net visits using weighted percentages to account for the complex survey design. We conducted bivariate and multivariate logistic regression analyses to examine characteristics associated with safety-net clinic use.
  
  
  RESULTS
  More than one-third (35.0%) of all primary care safety-net clinic visits were among adults with non-Medicaid primary insurance, representing 6,642,000 annual visits nationally. The strongest predictors of safety-net use among non-Medicaid insured adults were: being from a high-poverty neighborhood (AOR 9.53, 95% CI 4.65-19.53), being dually eligible for Medicare and Medicaid (AOR 2.13, 95% CI 1.38-3.30), and being black (AOR 1.97, 95% CI 1.06-3.66) or Hispanic (AOR 2.28, 95% CI 1.32-3.93). Compared to non-safety-net users, non-Medicaid insured adults who used safety-net clinics had a higher prevalence of diabetes (23.5% vs. 15.0%, p<0.001), hypertension (49.4% vs. 36.0%, p<0.001), multimorbidity (≥2 chronic conditions; 53.5% vs. 40.9%, p<0.001) and polypharmacy (≥4 medications; 48.8% vs. 34.0%, p<0.001). Nearly one-third (28.9%) of Medicare beneficiaries in the safety-net were dual eligibles, compared to only 6.8% of Medicare beneficiaries in non-safety-net clinics (p<0.001).
  
  
  CONCLUSIONS
  Safety net clinics are important primary care delivery sites for non-Medicaid insured minority and low-income populations with a high burden of chronic illness. The critical role of safety-net clinics in care delivery is likely to persist despite expanded insurance coverage under the Affordable Care Act.
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, United States of America.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America.
authors.forename: Oanh Kieu
authors.initials: OK
authors.lastname: Nguyen
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, United States of America.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America.
authors.forename: Anil N
authors.initials: AN
authors.lastname: Makam
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, United States of America.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008913:Minority Groups; D011203:Poverty; D011320:Primary Health Care; D064876:Safety-net Providers; D014481:United States