African American and Asian American patients are less likely than whites to turn to a medical specialist

African American and Asian American patients are less likely than whites to turn to a medical specialist for their initial care, suggesting a possible explanation for why racial differences in health care exist, according to a new UCLA study.

"Racial and Ethnic Differences in Patients' Preferences for Initial Care by Specialists" also found that patients who were older, had Medicaid insurance or had more confidence in the ability of their primary-care physician to diagnose or treat their illnesses, were also less likely to go to a specialist for their initial care. On the other hand, patients who had more certainty about which tests or treatments they needed, or had been to a specialist in the last year, were more likely to seek out a specialist.

The study, headed by Dr. Mitchell Wong, assistant professor of medicine at the David Geffen School of Medicine at UCLA, is published in the May 1 issue of The American Journal of Medicine.

"Researchers have struggled to understand why African Americans and other minorities receive worse health care and have worse health status," Wong said. "Obvious reasons, such as income and health insurance, only partly explain these disparities. We found that African Americans, as well as Asian Americans, are much less likely to prefer initial care from a specialist for their health problems. This may possibly explain why African Americans are less likely to receive certain treatments, such as cardiac bypass surgery or chemotherapy, that require care from a specialist."

The researchers studied 646 patients randomly selected from the waiting rooms at three academic-based internal medicine outpatient practices, two in Los Angeles and one in New York City. Of those, 48 percent were white, 29 percent African American, 9 percent Latino and 9 percent Asian American. Subjects generally had similar physical and mental health, though African Americans were likeliest to have multiple chronic conditions. The data was collected between November 1999 and February 2000.

Test subjects were asked their preferences for seeing a specialist for the actual health problem that brought them to their physician's office, as well as three hypothetical scenarios: two weeks of new-onset chest pain from exerting themselves, two months of knee pain and four weeks with a rash.

When the researchers adjusted for variables, they found that African Americans and Asian Americans were less likely than whites to prefer initial treatment from a specialist. Latinos also were less likely than whites to prefer specialists, though this difference was not statistically significant.

The reason for this disparity remains a mystery. Patients who did prefer initial care from a specialist were found to have less confidence and trust in their primary-care physician, had greater certainty about which tests or treatments they needed and had had prior experience with a specialist.

These factors, however, did not explain why African Americans and Asian Americans were less likely to prefer care from a specialist. The study authors suggest that other factors not examined may explain their findings. For instance, African Americans might have more negative attitudes about specialists, less understanding about specialists or different health beliefs.

Other researchers in addition to Wong were Dr. Steven M. Asch, associate professor in the division of general internal medicine at the Veterans' Administration Greater Los Angeles Healthcare System; Ronald M. Andersen, professor of public health in the UCLA School of Public Health; Ron D. Hays, UCLA professor of medicine; and Dr. Martin F. Shapiro, professor of medicine and chief of general internal medicine and health services research at UCLA.

The study was supported through grants from the Health Resources and Services Administration and the UCLA Department of Medicine Specialty Training and Advanced Research Program.