Dataset Information

"Are you accepting new patients?" A pilot field experiment on telephone-based gatekeeping and Black patients' access to pediatric care.

ABSTRACT: STUDY OBJECTIVES:To determine whether name and accent cues that the caller is Black shape physician offices' responses to telephone-based requests for well-child visits. METHOD AND DATA:In this pilot study, we employed a quasi-experimental audit design and examined a stratified national sample of pediatric and family practice offices. Our final data include information from 205 audits (410 completed phone calls). Qualitative data were blind-coded into binary variables. Our case-control comparisons using McNemar's tests focused on acceptance of patients, withholding information, shaping conversations, and misattributions. FINDINGS:Compared to the control group, "Black" auditors were less likely to be told an office was accepting new patients and were more likely to experience both withholding behaviors and misattributions about public insurance. The strength of associations varied according to whether the cue was based on name or accent. Additionally, the likelihood and ways office personnel communicated that they were not accepting patients varied by region. CONCLUSIONS:Linguistic profiling over the telephone is an aspect of structural racism that should be further studied and perhaps integrated into efforts to promote equitable access to care. Future research should look reactions to both name and accent, taking practice characteristics and regional differences into consideration.

SUBMITTER: Leech TGJ

PROVIDER: S-EPMC6341201 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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"Are you accepting new patients?" A pilot field experiment on telephone-based gatekeeping and Black patients' access to pediatric care.

Leech Tamara G J TGJ Irby-Shasanmi Amy A Mitchell Anne L AL

Health services research 20181203

<h4>Study objectives</h4>To determine whether name and accent cues that the caller is Black shape physician offices' responses to telephone-based requests for well-child visits.<h4>Method and data</h4>In this pilot study, we employed a quasi-experimental audit design and examined a stratified national sample of pediatric and family practice offices. Our final data include information from 205 audits (410 completed phone calls). Qualitative data were blind-coded into binary variables. Our case-co ...[more]

PMID: 30506767

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Project description:ImportanceEfforts to transform primary care through the medical home model may have limited effectiveness if they do not incorporate families' preferences for different primary care services.ObjectiveTo assess parents' relative preferences for different categories of enhanced access services in primary care.Design, setting, and participantsInternet-based survey that took place with a national online panel from December 8, 2011, to December 22, 2011. Participants included 820 parents of children aged 0 to 17 years. Hispanic and black non-Hispanic parents were each oversampled to 20% of the sample. The survey included a discrete choice experiment with questions that asked parents to choose between hypothetical primary care practices with different levels of enhanced access and other primary care services.Main outcomes and measuresWe estimated parents' relative preferences for different enhanced access services using travel time to the practice as a trade-off and parents' marginal willingness to travel in minutes for practices with different levels of services.ResultsThe response rate of parents who participated in the study was 41.2%. Parents were most likely to choose primary care offices that guaranteed same-day sick visits (coefficient, 0.57 [SE, 0.05]; P < .001) followed by those with higher professional continuity (coefficient, 0.36 [SE, 0.03]; P < .001). Parents were also significantly more likely to choose practices with 24-hour telephone advice plus nonurgent email advice (0.08 [0.04]; P < .05), evening hours 4 or more times a week (0.14 [0.04]; P < .001), and at least some hours on weekends. Parents were significantly less likely to choose practices that were closed during some weekday daytime hours or had wait times longer than 4 weeks for preventive care visits. There was very little variation in preferences among parents with different sociodemographic characteristics. Parents' marginal willingness to travel was 14 minutes (95% CI, 11-16 minutes) for guaranteed same-day sick visits and 44 minutes (95% CI, 37-51 minutes) for an office with idealized levels of all services.Conclusions and relevanceAs primary care practices for children implement aspects of the medical home model, those that emphasize same-day sick care and professional continuity are more likely to meet parents' preferences for enhanced access. Practices should seek to engage families in prioritizing changes in practice services as part of medical home implementation.

Dataset Information

"Are you accepting new patients?" A pilot field experiment on telephone-based gatekeeping and Black patients' access to pediatric care.

Publications

"Are you accepting new patients?" A pilot field experiment on telephone-based gatekeeping and Black patients' access to pediatric care.

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