Is type of practice setting associated with physician's cultural competency training? Analysis from the National Ambulatory Medical Care Survey.

This study examined whether type of physician practice settings was associated with cultural competency training for newly hired physicians. We used data from the 2016 National Ambulatory Medical Care Survey Supplement on Culturally and Linguistically Appropriate Services for Office-based Physician Survey. The survey contains a sample of 397 office-based physician responses completed during the period from August to December 2016 (weighted n = 293306). The outcome variable was whether cultural competency training was required for newly hired physicians. The primary predictor variable was type of physician practice settings. We used logistic regression to analyze the association between physician practice settings and cultural competency training for newly hired physicians adjusting for covariates. About 71% physicians belonged to solo or group practice settings. Among these, only 10.4% required cultural competency training for newly hired physicians. Among other practice settings, 34.8% required the training. Results from logistic regression showed that newly hired physicians in solo or group practices (adjusted odds ratio: 0.22; 95% confidence interval: 0.11-0.44) were less likely to have cultural competency training compared to those in other settings. Practice settings are associated with cultural competency training. Cultural competency training across all practice settings may contribute toward improving patient-physician communication, reducing health disparities, and increasing patient satisfaction.

Urgent Care Center and Emergency Department Utilization for Non-Emergent Health Conditions: Analysis of Managed Care Beneficiaries.

The objective was to identify predictors of utilization for urgent care centers (UCCs), emergency departments (EDs), or for both services for non-emergent health conditions among beneficiaries from a managed care organization (MCO) who resided within a 10-mile radius of UCCs. A cross-sectional design was used to analyze 2016 administrative claims data from an MCO that contracted with a UCC with 12 locations (n = 20,107). Outcome variables were number of visits to UCC, ED, or both. The MCO used the New York University ED algorithm to identify non-emergent health conditions. The Behavioral Model of Health Care Utilization was used as a conceptual framework to identify predictors in the model; age, sex, race/ethnicity, distance to UCC from residence, type of insurance, primary care physician visits, inpatient admissions, chronic conditions, morbid obesity, and smoking behavior. Generalized linear models were used to analyze the association between outcomes and predictors. About 22.7% were UCC users, 66.8% were ED users, and 10.5% used both. African Americans (incident rate ratio [IRR] = 0.95; 95% confidence interval [CI]: 0.91-0.98] were less likely to use UCCs and more likely to use the ED (IRR = 1.10; 95% CI: 1.07-1.13). Beneficiaries with multiple chronic conditions were more likely to use the ED than UCCs. Distance was not a predictor of UCC or ED usage. Utilization of UCC was low for non-emergent health conditions. African Americans and individuals with multiple chronic conditions preferred the ED to UCC for non-emergent health conditions. This study implies that MCO beneficiaries, especially the African American population, need to be informed about UCC locations and services provided.