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.
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.