Does provision of health counseling differ by patient race?

Empirical data on health counseling provided to patients of different racial groups in primary care settings are limited, and existing studies have yielded inconsistent findings. This study's purpose was to use a national medical care survey to examine whether the visit-based rates of health counseling/education differed between black and white patients in primary care practice settings.

We performed secondary data analysis of visits to primary care providers made by black and white adult patients in the National Ambulatory Medical Care Survey (NAMCS).

From 1997 to 2000, visits by adult patients to their own primary care providers accounted for 41% of all ambulatory care visits. White patients made approximately 961 million of these visits, and black patients made about 120 million visits. Black patients were more likely to get health counseling for diet (odds ratio [OR]=1.2, 95% confidence interval [CI]=1.1-1.4), exercise (OR=1.3, 95% CI=1.1-1.5), and human immune deficiency virus/sexually transmitted disease (HIV/STD) (OR=3, 95% CI=1.7-5.1) but less likely to get mental health counseling (OR=0.6, 95% CI=0.4-.09) as compared with white patients. Stratifying by visit type, blacks had lower rates of receiving exercise counseling during non-illness care visits (18.9% versus 14.8%). There were no statistically significant differences in dietary or exercise counseling between black and white patients with diabetes or hypertension.

Black patients received similar or higher rates of certain types of health counseling than whites during the clinical encounters with their primary care providers. However, there was a significantly lower rate of mental health counseling provided to black patients. Reasons for this disparity require further investigation.