Annals of family medicine
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Annals of family medicine · Nov 2007
Comparative StudyInsurance + access not equal to health care: typology of barriers to health care access for low-income families.
Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. ⋯ Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.
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Annals of family medicine · Nov 2007
Comparative StudyThe inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland.
The inverse care law states that the availability of good medical care tends to vary inversely with the need for it in the population served, but there is little research on how the inverse care law actually operates. ⋯ The increased burden of ill health and multimorbidity in poor communities results in high demands on clinical encounters in primary care. Poorer access, less time, higher GP stress, and lower patient enablement are some of the ways that the inverse care law continues to operate within the NHS and confounds attempts to narrow health inequalities.
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In the past, researchers have inadvertently caused stigmatization of various populations, first by not involving community members and then through publishing negative findings. In contrast, participatory research, which is based on a partnership between researchers and those affected by the issue being studied, promotes the voice of those being researched. This essay highlights key principles, processes, complexities, and challenges of participatory research and outlines when participatory research is not appropriate. ⋯ Family physicians have established clinical partnerships with their patients and sometimes entire communities, are trained in patient-centered care-a good basis for community centered research-and are accustomed to working with uncertainty. In addition, they are frequently pragmatic, interested in questions arising from their patients and communities, and likely to respond well to community requests. The main challenges to participatory research are lack of funding, expertise, and time, which may improve as more funding agencies and universities support this approach to research.
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Annals of family medicine · Nov 2007
Pursuing equity: contact with primary care and specialist clinicians by demographics, insurance, and health status.
Long-term shifts in specialty choice and health workforce policy have raised concern about the future of primary care in the United States. The objective of this study was to examine current use of primary and specialty care across the US population for policy-relevant subgroups, such as disadvantaged populations and persons with chronic illness. ⋯ Primary care clinicians, especially family physicians, deliver a disproportionate share of ambulatory care to disadvantaged populations. A diminished primary care workforce will leave considerable gaps in US health care equity. Health care workforce policy should reflect this important population-level function of primary care.