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Research ArticleOriginal Research

Influence of Patients’ Socioeconomic Status on Clinical Management Decisions: A Qualitative Study

Susannah M. Bernheim, Joseph S. Ross, Harlan M. Krumholz and Elizabeth H. Bradley
The Annals of Family Medicine January 2008, 6 (1) 53-59; DOI: https://doi.org/10.1370/afm.749
Susannah M. Bernheim
MD, MHS
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Joseph S. Ross
MD, MHS
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Harlan M. Krumholz
MD, SM
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Elizabeth H. Bradley
PhD
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Article Figures & Data

Tables

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    Table 1.

    Characteristics of the Physician Sample (N=18)

    CharacteristicValue
    Male, No. (%)12 (67)
    Age range, years31–54
    Race, No. (%)
        White9 (50)
        Asian6 (33)
        African American/black2 (11)
        Other1 (6)
    Ethnicity, Hispanic, No. (%)3 (17)
    Patient practice, years5–23
    Patient composition, No. (%)
        Uninsured0–50
        Medicaid2–70
    Veterans Affairs physicians, No. (%)2 (11)
    Practice setting, No. (%)
        Urban13 (72)
        Suburban4 (22)
        Rural1 (6)
    Specialty, No. (%)
        Internists16 (88)
        Family physicians2 (11)
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    Table 2.

    Physician Descriptions of Patients of Low Socioeconomic Status

    AttributesExamples of Descriptors Used by Physicians
    EconomicUninsured
    Unemployed
    On welfare
    SocioculturalMinority race or ethnicity
    Low educational achievement
    Poor social networks
    Personality traitsStoic
    Guarded or distrustful
    Appreciative
    Life circumstancesChaotic lives
    Involvement with substance abuse
    Difficulty with transportation
    Attitude and knowledge about medicinePoor health literacy
    Noncompliant
    Poor health behaviors
    Sicker or more acute visits
    Interested in health
    Unable to characterize as a groupEveryone is different
    No general statement about them

Additional Files

  • Tables
  • The Article in Brief

    Influence of Patients' Socioeconomic Status on Clinical Management Decisions: A Qualitative Study

    Susannah M. Bernheim, MD, MHS , and colleagues

    Background Patients' socioeconomic status (SES) has been shown to influence their health and the quality of their health care. This study looks at doctors' perspectives on how patients' SES influences the care they provide.

    What This Study Found Doctors change their management plans to make care more affordable, feasible, or comprehensible for patients with low socioeconomic status. Although these changes are intended for the patient's best interest, doctors have concerns about maintaining a standard of consistent care for all patients.

    Implications

    • Patients� socioeconomic status affects doctors� day-to-day clinical management decisions.
    • Helping patients accommodate their financial needs by altering care may contribute to differences in health care based on socioeconomic status.
    • Recognizing the role of socioeconomic factors in clinical decision making may be an important contribution in developing standards to ensure high-quality care and a physician workforce willing to care for vulnerable populations.
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The Annals of Family Medicine: 6 (1)
The Annals of Family Medicine: 6 (1)
Vol. 6, Issue 1
1 Jan 2008
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Influence of Patients’ Socioeconomic Status on Clinical Management Decisions: A Qualitative Study
Susannah M. Bernheim, Joseph S. Ross, Harlan M. Krumholz, Elizabeth H. Bradley
The Annals of Family Medicine Jan 2008, 6 (1) 53-59; DOI: 10.1370/afm.749

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Influence of Patients’ Socioeconomic Status on Clinical Management Decisions: A Qualitative Study
Susannah M. Bernheim, Joseph S. Ross, Harlan M. Krumholz, Elizabeth H. Bradley
The Annals of Family Medicine Jan 2008, 6 (1) 53-59; DOI: 10.1370/afm.749
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