The Effects of Patient Characteristics on Clinician’s Adherence to Preventive Practice Guidelines

ABSTRACT BACKGROUND: The existence of health disparities confirms that not all patients, regardless of differences in patient demographics, are provided quality healthcare (Agency of Health Care Research and Quality, 2003). Moreover, research suggests that health disparities may be present due to the inadequate delivery of medical services (S. Haist, J. Wilson, M. Lineberry, & C. Griffith, 2007; Van Ryn, Burgess, Malat, & Griffin, 2006). The differences in the delivery of care and services to ethnic minorities and those of low socioeconomic status warrant examining the role healthcare providers play in the causation of these health disparities (Smedley, Stith, & Nelson, 2003). OBJECTIVE: The purpose of the study is to identify differences in routine screening practices of Physician Assistants and determine if such differences are associated with patients’ race and socioeconomic status. DESIGN: One hundred and twelve (N = 112) practicing Physician Assistants (N = 142) in Kentucky were surveyed and randomly assigned to receive one of four clinical vignettes. The likelihood of offering different routine screening recommendations was examined based on patient race and socioeconomic status. MAIN MEASURES: We investigated the mean differences of selected preventative care recommendation options for vignette patients as a function of patient race and socioeconomic status. KEY RESULTS: A multivariate analysis revealed that the race of a patient had a statistically significant multivariate effect on differences in screening recommendation, (p =.017) for hypertension (HTN), p=.017, immunization, p=.002. Univariate analysis showed statistically significant differences, with the African American patient were significantly less likely to receive screening for hypertension (HTN), (M = 3.42), 95% CI [3.24, 3.59], or immunizations (M = 2.45), 95% CI [2.21, 2.69] when compared to Caucasian women (M = 3.71, 2.98), 95% CIs [3.55, 3.88], [2.76, 3.23], respectively. CONCULSION: The findings suggest that the race of the patient in the vignette influenced the likelihood of receiving screening recommendations. The findings show that care delivered by Physician Assistants (PAs), are a possible source of healthcare disparities between patients from racial/ethnic minority backgrounds and their Caucasian counterparts. Keywords: disparities, health education, race & ethnicity, socioeconomic, preventive car