Vulnerability and the patient-practitioner relationship: the roles of gatekeeping and primary care performance

Am J Public Health. 2003 Jan;93(1):138-44. doi: 10.2105/ajph.93.1.138.


Objectives: We examined whether patients' perceptions of their relationships with primary care practitioners (PCPs) vary by vulnerability status and assessed the extent to which gatekeeping arrangements and primary care performance moderate potential disparities.

Methods: We used the nationally representative 1996-1997 Community Tracking Study Household Survey as our data source.

Results: Whites reported better patient-practitioner relationships than minorities. Requirements that patients select a PCP and obtain referral authorization neither reduced nor exacerbated racial disparities in the patient-practitioner relationship. On the other hand, access to and continuity with a PCP substantively reduced disparities, especially for the most vulnerable group.

Conclusions: Enhancing primary care performance may reduce some of the barriers to care experienced by vulnerable populations, thereby improving patients' relationships with their PCPs.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • African Americans / psychology
  • African Americans / statistics & numerical data
  • Continuity of Patient Care
  • European Continental Ancestry Group / psychology
  • European Continental Ancestry Group / statistics & numerical data
  • Family Characteristics
  • Gatekeeping / organization & administration*
  • Health Care Surveys
  • Health Services Accessibility
  • Hispanic Americans / psychology
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Income
  • Middle Aged
  • Patient Satisfaction / ethnology
  • Patient Satisfaction / statistics & numerical data*
  • Physician-Patient Relations*
  • Primary Health Care / organization & administration
  • Primary Health Care / standards*
  • Risk Factors
  • Self Efficacy
  • United States / epidemiology
  • Vulnerable Populations / classification
  • Vulnerable Populations / ethnology
  • Vulnerable Populations / statistics & numerical data*