Racial Disparities in Access to Care for Men in a Public Assistance Program for Prostate Cancer

Published In: Journal of Community Health, v. 33, no. 5, Oct. 2008, p. 318-335

Posted on RAND.org on December 31, 2007

by David C. Miller, Lillian Gelberg, Lorna Kwan, Sevan Stepanian, Arlene Fink, Ronald Andersen, Mark Litwin

California's IMPACT program provides all its enrollees with health insurance and social service resources. The authors hypothesized that racial/ethnic disparities in access to care might be attenuated among men served by this program. Their 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. The authors performed a retrospective cohort study of 357 low-income men enrolled in IMPACT from 2001 through 2005. The authors 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. They also measured two patient-experience outcomes: (1) satisfaction with care received from IMPACT, and (2) confidence in IMPACT care providers. The authors 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. They 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.

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