Health Promotion Referrals in an Urban Clinic: Removing Financial Barriers Influences Physician but Not Patient Behavior

Abstract

Purpose.This study describes the prevalence and characteristics of physician health promotion referrals and patient adherence to referrals in a community-based primary care clinic and associated wellness facility. The role of reimbursement for attendance to the wellness facility was specifically examined.Design.Retrospective cohort study.Setting.The Church Health Center of Memphis, Tennessee: a low-income urban clinic and its affiliated wellness center.Subjects.Patients were primarily African-American, lower-income, urban residents of Shelby County, Tennessee.Measures.All study data came from existing medical clinic and wellness facility records of utilization, patient history, and diagnoses.Results.Of 6321 clinic patients, 16.7% (n = 1069) received a provider health promotion referral. Logistic regression analyses identified that physician referral was related to patient factors of access to free wellness-facility membership, employment status, receiving a behavior-related diagnosis, and being African-American and female. Of patients receiving a referral, 17.2% (n = 184) adhered to this advice and visited the wellness facility. New patients were more likely to adhere to a referral than established patients.Conclusion.Demographic, financial, and patient characteristics influenced whether health behavior change referrals were made by primary care physicians in a community clinic. Removing financial barriers did not influence patient adherence, but new patients were more likely to follow the recommendation than those previously seen at the clinic.