Black, Hispanic patients wait longer for PCP appointments

Black and Hispanic patients experience barriers to timely access of primary care from the moment they call to schedule an appointment, according to a study published in JAMA Network Open.

“In this study, black and Hispanic callers seeking medical appointments were treated differently than white callers,” wrote Janna M. Wisniewski, PhD, assistant professor in the Department of Health Policy and Management in the School of Public Health and Tropical Medicine at Tulane University, and Brigham Walker, a graduate student in department of economics at Tulane University.

For the cross-sectional study, seven different women used pseudonyms they thought represented their gender, race and ethnicity to call a random sample of primary care offices in Texas. Among the callers, three self-identified as white, two identified as black, and two identified as Hispanic.

Callers began by introducing themselves as a new patient with their pseudonyms and asking for the next available appointment. They did not offer additional information unless specifically asked by the scheduler. All callers said that they were not insured and would pay for the visit themselves if they were asked about their insurance.

A total of 1,081 calls were made, 804 of which were answered by schedulers from 1,888 offices. Among the calls, 37.2% were made by simulated white callers, 26.7% from simulated black callers, and 36.1% from simulated Hispanic callers.

Before adjustment, appointments were more likely to be offered to black callers (32.2 percentage points more likely; 95% CI, 25.1-39.3) and Hispanic callers (21.1 percentage points more likely; 95% CI, 13.7-28.5) than white callers. After adjusting for whether callers were asked about their insurance status, these were no longer significant.

Compared with white callers, researchers found that black callers (44 percentage points more likely; 95%CI, 36.2-51.8) and Hispanic callers (25.3 percentage points more likely; 95% CI, 17.1-33.5) were more likely to be asked about their insurance status.

The mean wait time for an appointment was 10.8 calendar days (SE = 0.6 days; 95% CI, 9.6-12 days). Minority callers were given appointments that were further away than appointments for white patients, with a marginal effect estimate of 3.65 for black callers (95% CI, 0.579-6.721) and 2.644 for Hispanic callers (95% CI, 0.496 to 5.784).

“The results of this study suggest that black and Hispanic patients experienced barriers to timely access to primary care when faced with a human gatekeeper to schedule an appointment,” Wisniewski and Walker wrote.

The authors explained that technological solutions like using an automated scheduling system or online portal to schedule appointments in PCP offices could help combat these disparities.

“Additionally, the routine collection and use of data related to disparities in access at both the system and the individual practice level may motivate behavioral and operational change within health care organizations,” they wrote. – by Erin Michael

Disclosures: Walker reports being employed by McKesson Corporation, where he coordinates and conducts retrospective cancer care research using electronic medical records data and receiving grants from Blue Cross Blue Shield of Louisiana outside the submitted work. Wisniewski reports no relevant financial disclosures.