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Access to Hypertensive Care: Effects of Income, Insurance, and Source of Care

Access to Hypertensive Care: Effects of Income, Insurance, and Source of Care Abstract Background: This study examines the relationship between income, health insurance, and usual source of care characteristics and screening and management of hypertension. Methods: This is a secondary analysis of data from the 1987 National Medical Expenditure Survey. Adult survey respondents constitute a sample representative of the total adult noninstitutionalized US population. Screening, follow-up care, and pharmacologic treatment for hypertension were examined among low income individuals, the uninsured, those without a usual source of care place, and those without a particular usual source of care physician. Results: The uninsured, individuals without a usual source of care place, and those without a particular usual source of care physician received less screening, follow-up care, and pharmacologic treatment for hypertension. Income did not affect receipt of hypertensive care. Conclusions: Lack of health insurance and lack of a usual source of care are barriers to hypertensive care. Policies that increase access to health insurance or to usual source of care physicians may enable more individuals to attain control of hypertension.(Arch Intern Med. 1995;155:1497-1502) References 1. The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med . 1993;153:154-183.Crossref 2. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease, 1: prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet . 1990;335: 765-774.Crossref 3. Whelton PK, Klag MJ. Epidemiological considerations in the treatment of hypertension. Drugs . 1986;31( (suppl 4) ):8-22.Crossref 4. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease, 2: short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet . 1990:335:827-838.Crossref 5. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA . 1991; 265:3255-3264.Crossref 6. Kittner SJ, White LR, Losonczy KG, Wolf PA, Hebel JR. Black-white differences in stroke incidence in a national sample: the contribution of hypertension and diabetes mellitus. JAMA . 1990;264:1267-1270.Crossref 7. Rostand SG, Kirk KA, Rutsky EA, et al. Racial difference in the incidence of treatment for end-stage renal disease. N Engl J Med . 1982;302:1276-1279.Crossref 8. Ferguson R, Grim CE, Opgenorth TJ. The epidemiology of end-state renal disease: the 6-year south-central Los Angeles experience, 1980-85. Am J Public Health . 1987;77:864-865.Crossref 9. McClellan W, Tuttle E, Issa A. Racial differences in the incidence of hypertensive end-stage renal disease (ESRD) are not entirely explained by differences in the prevalence of hypertension. Am J Kidney Dis . 1988;12:285-290.Crossref 10. US Renal Data System. USRDS 1993 Annual Data Report . Bethesda, Md: National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1993. 11. Perneger TV, Klag MJ, Feldman HI, Whelton PK. Projections of hypertension-related renal disease in middle-aged residents of the United States. JAMA . 1993; 269:1272-1277.Crossref 12. Jones CA, Agodoa L. Kidney disease and hypertension in blacks: scope of the problem. Am J Kidney Dis . 1993;21( (suppl 1) ):6-9.Crossref 13. Haywood LJ. Hypertension in minority populations: access to care. Am J Med . 1990;88( (suppl 3B) ):17S-20S.Crossref 14. Gillum RF. Cardiovascular disease in the United States: an epidemiologic overview. In: Saunders E, ed. Cardiovascular Diseases in Blacks . Philadelphia, Pa: FA Davis Co Publishers; 1991:3-16. 15. Hypertension Detection and Follow-up Program Cooperative Group. Educational level and 5-year all-cause mortality in the Hypertension Detection and Follow-up Program. Hypertension . 1987;9:641-646.Crossref 16. Tyroler HA. Socioeconomic status in the epidemiology and treatment of hypertension. Hypertension . 1989;13( (suppl 1) ):94-97.Crossref 17. McClellan WM, Hall D, Brogan D, Miles C, Wilber JA. Continuity of care in hypertension: an important correlate of blood pressure control among aware hypertensives. Arch Intern Med . 1988;148:525-528.Crossref 18. Aday LA, Andersen R. A framework for the study of access to medical care. Health Services Res . 1974:209-220. 19. Hypertension Prevalence and the Status of Awareness, Treatment, and Control in the United States: Final Report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee. Hypertension . 1985;7:457-468. 20. Freeman DH, Ostfeld AM, Hellenbrand K, Richards VA, Tracy R. Changes in the prevalence distribution of hypertension: Connecticut adults 1978-79 to 1982. J Chronic Dis . 1985;38:157-164.Crossref 21. Cornoni-Huntley J, LaCroix AZ, Havlik RJ. Race and sex differentials in the impact of hypertension in the United States: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Intern Med . 1989; 149:780-788.Crossref 22. Havlik RJ, LaCroix AZ, Kleinman JC, Ingram DD, Harris T, Cornoni-Huntley J. Antihypertensive drug therapy and survival by treatment status in a national survey. Hypertension . 1989;13( (suppl 1) ):28-32.Crossref 23. Roccella EJ, Lenfant C. Regional and racial differences among stroke victims in the United States. Clin Cardiol . 1989;12:IV18-IV22. 24. Caralis PV. Hypertension in the Hispanic-American population. Am J Med . 1990; 88( (suppl 3B) ):9S-16S.Crossref 25. Caralis PV. Coronary artery disease in Hispanic Americans: how does ethnic background affect risk factors and mortality rates? Postgrad Med . 1992;91: 179-193. 26. James SA, Wagner EH, Strogatz DA, et al. The Edgecombe County (NC) High Blood Pressure Control Program, II: barriers to the use of medical care among hypertensives. Am J Public Health . 1984;74:468-472.Crossref 27. Shulman NB, Martinez B, Brogan D, Carr AA, Miles CG. Financial cost as an obstacle to hypertension therapy. Am J Public Health . 1986;76:1105-1108.Crossref 28. Weir MR, Saunders E. Pharmacologic management of systemic hypertension in blacks. Am J Cardiol . 1988;61:46H-52H.Crossref 29. Francis CK. Hypertension, cardiac disease, and compliance in minority patients. Am J Med . 1991;91( (suppl 1A) ):29S-36S.Crossref 30. American Heart Association. Report of the task force on the availability of cardiovascular drugs to the medically indigent. Circulation . 1992;85:849-860.Crossref 31. Keeler EB, Brook RH, Goldberg GA, Kamberg CJ, Newhouse JP. How free care reduced hypertension in the health insurance experiment. JAMA . 1985;254: 1926-1931.Crossref 32. Plasencia A, Ostfled AM, Gruber SB. Effects of sex on differences in awareness, treatment, and control of high blood pressure. Am J Prev Med . 1988; 4:315-326. 33. Shea S, Misra D, Ehrlich MH, Field L, Francis CK. Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med . 1992;327:776-781.Crossref 34. Franks P, Clancy CM. Physician gender bias in clinical decision making: screening for cancer in primary care. Med Care . 1993;31:213-218.Crossref 35. Hahn B. Marital status and women's health: the effect of economic marital acquisitions. J Marriage Fam . 1993;55:495-504.Crossref 36. Cunningham P, Altman B. The use of ambulatory health care services by American Indians with disabilities. Med Care . 1993;31:600-616.Crossref 37. Cornelius LJ. Barriers to medical care for white, black, and Hispanic American children. J Natl Med Assoc . 1993;85:281-288. 38. Cornelius LJ. Ethnic minorities and access to medical care: where do they stand? J Assoc Acad Minor Phys . 1993;4:16-25. 39. Broussard BA, Johnson A, Himes JH, et al. Prevalence of obesity in American Indians and Alaska natives. Am J Clin Nutr . 1991;53( (suppl 6) ):1535S-1542S. 40. Stoddard JJ, St Peter RF, Newacheck PW. Health insurance status and ambulatory care for children. N Engl J Med . 1994;330:1421-1425.Crossref 41. Hahn B. Health care utilization: the effect of extending insurance to adults on Medicaid or uninsured. Med Care . 1994;32:227-239.Crossref 42. Franks P, Clancy CM, Gold MR, Nutting PA. Health insurance and subjective health status: data from the 1987 National Medical Expenditure Survey. Am J Public Health . 1993;83:1295-1299.Crossref 43. Cohen JW. Medicaid physician fees and use of physician and hospital services. Inquiry . 1993;30:281-292. 44. Short PF, Lefkowitz DC. Encouraging preventive services for low-income children: the effect of expanding Medicaid. Med Care . 1992;30:766-780.Crossref 45. Cornelius LJ. Health habits of school-age children. J Health Care Poor Under-served . 1991;2:374-395.Crossref 46. Wilcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA . 1994;272:292-296.Crossref 47. Smyer MA, Shea DG, Streit A. The provision and use of mental health services in nursing homes: results from the National Medical Expenditure Survey. Am J Public Health . 1994;84:284-287.Crossref 48. Rubin RJ, Altman WM, Mendelson DN. Health care expenditures for people with diabetes mellitus. J Clin Endocrinol Metab . 1994;78:809A-809F.Crossref 49. Altman BM, Cunningham PJ. Dynamic process of movement in residential settings. Am J Ment Retard . 1993;98:304-316. 50. Cunningham PJ, Mueller CD. Individuals with mental retardation in residential facilities: findings from the 1987 National Medical Expenditure Survey. Am J Ment Retard . 1991;96:109-117. 51. Edwards WS, Berlin M. Questionnaires and Data Collection Methods for the Household Survey and the Survey of American Indians and Alaska Natives . Rockville, Md: Public Health Service; 1989. Dept of Health and Human Services publication (PHS) 89-3450. 52. Cohen S, DiGaetano R, Waksberg J. Sample Design of the 1987 Household Survey . Rockville, Md: Public Health Service; 1991. Publication 91-0037. 53. Agency for Health Care Policy and Research. Health Status Questionnaires and Access to Care Supplement Data File Documentation . Rockville, Md: Agency for Health Care Policy and Research; 1991. 54. Palmer RH, Clark LE, Lawthers AG, et al. DEMPAQ: A Project to Develop and Evaluate Methods to Promote Ambulatory Care Quality Final Report . Glen Burnie, Md: Delmarva Foundation for Medical Care Inc; 1994. 55. Research Triangle Institute. SUDAAN: Survey Data Analysis Software Version 6.34 . Research Triangle Park, NC: Research Triangle Institute; 1993. 56. Hayward RSA, Steinberg EP, Ford DE, Roizen MF, Roach KW. Preventive care guidelines: 1991. In: Eddy DM, ed. Common Screening Tests . Philadelphia, Pa: American College of Physicians; 1991:326-393. 57. Perloff JD, Morris NM. Asking about the usual source of care: an appraisal of health care survey alternatives. Med Care . 1992;30:950-957.Crossref 58. Quam L, Ellis LBM, Venus P, Clouse J, Taylor CG, Leatherman S. Using claims data for epidemiologic research: the concordance of claims-based criteria with the Medical Record and Patient Survey for Identifying a Hypertensive Population. Med Care . 1993;131:498-507.Crossref 59. Harlow SD, Linet MS. Agreement between questionnaire data and medical records: the evidence for accuracy of recall. Am J Epidemiol . 1989;129:233-248. 60. Brook RH, Kamberg CJ, Lohr K, Goldberg BA, Keeler EB, Newhouse JP. Quality of ambulatory care: epidemiology and comparison by insurance status and income. Med Care . 1990;28:392-433.Crossref 61. Paganini-Hill A, Ross RK. Reliability of recall of drug usage and other health-related information. Am J Epidemiol . 1982;116:114-122. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Access to Hypertensive Care: Effects of Income, Insurance, and Source of Care

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American Medical Association
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Copyright © 1995 American Medical Association. All Rights Reserved.
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0003-9926
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1538-3679
DOI
10.1001/archinte.1995.00430140063005
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Abstract

Abstract Background: This study examines the relationship between income, health insurance, and usual source of care characteristics and screening and management of hypertension. Methods: This is a secondary analysis of data from the 1987 National Medical Expenditure Survey. Adult survey respondents constitute a sample representative of the total adult noninstitutionalized US population. Screening, follow-up care, and pharmacologic treatment for hypertension were examined among low income individuals, the uninsured, those without a usual source of care place, and those without a particular usual source of care physician. Results: The uninsured, individuals without a usual source of care place, and those without a particular usual source of care physician received less screening, follow-up care, and pharmacologic treatment for hypertension. Income did not affect receipt of hypertensive care. Conclusions: Lack of health insurance and lack of a usual source of care are barriers to hypertensive care. Policies that increase access to health insurance or to usual source of care physicians may enable more individuals to attain control of hypertension.(Arch Intern Med. 1995;155:1497-1502) References 1. The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med . 1993;153:154-183.Crossref 2. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease, 1: prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet . 1990;335: 765-774.Crossref 3. Whelton PK, Klag MJ. Epidemiological considerations in the treatment of hypertension. Drugs . 1986;31( (suppl 4) ):8-22.Crossref 4. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease, 2: short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet . 1990:335:827-838.Crossref 5. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA . 1991; 265:3255-3264.Crossref 6. Kittner SJ, White LR, Losonczy KG, Wolf PA, Hebel JR. Black-white differences in stroke incidence in a national sample: the contribution of hypertension and diabetes mellitus. JAMA . 1990;264:1267-1270.Crossref 7. Rostand SG, Kirk KA, Rutsky EA, et al. Racial difference in the incidence of treatment for end-stage renal disease. N Engl J Med . 1982;302:1276-1279.Crossref 8. Ferguson R, Grim CE, Opgenorth TJ. The epidemiology of end-state renal disease: the 6-year south-central Los Angeles experience, 1980-85. Am J Public Health . 1987;77:864-865.Crossref 9. McClellan W, Tuttle E, Issa A. Racial differences in the incidence of hypertensive end-stage renal disease (ESRD) are not entirely explained by differences in the prevalence of hypertension. Am J Kidney Dis . 1988;12:285-290.Crossref 10. US Renal Data System. USRDS 1993 Annual Data Report . Bethesda, Md: National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1993. 11. Perneger TV, Klag MJ, Feldman HI, Whelton PK. Projections of hypertension-related renal disease in middle-aged residents of the United States. JAMA . 1993; 269:1272-1277.Crossref 12. Jones CA, Agodoa L. Kidney disease and hypertension in blacks: scope of the problem. Am J Kidney Dis . 1993;21( (suppl 1) ):6-9.Crossref 13. Haywood LJ. Hypertension in minority populations: access to care. Am J Med . 1990;88( (suppl 3B) ):17S-20S.Crossref 14. Gillum RF. Cardiovascular disease in the United States: an epidemiologic overview. In: Saunders E, ed. Cardiovascular Diseases in Blacks . Philadelphia, Pa: FA Davis Co Publishers; 1991:3-16. 15. Hypertension Detection and Follow-up Program Cooperative Group. Educational level and 5-year all-cause mortality in the Hypertension Detection and Follow-up Program. Hypertension . 1987;9:641-646.Crossref 16. Tyroler HA. Socioeconomic status in the epidemiology and treatment of hypertension. Hypertension . 1989;13( (suppl 1) ):94-97.Crossref 17. McClellan WM, Hall D, Brogan D, Miles C, Wilber JA. Continuity of care in hypertension: an important correlate of blood pressure control among aware hypertensives. Arch Intern Med . 1988;148:525-528.Crossref 18. Aday LA, Andersen R. A framework for the study of access to medical care. Health Services Res . 1974:209-220. 19. Hypertension Prevalence and the Status of Awareness, Treatment, and Control in the United States: Final Report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee. Hypertension . 1985;7:457-468. 20. Freeman DH, Ostfeld AM, Hellenbrand K, Richards VA, Tracy R. Changes in the prevalence distribution of hypertension: Connecticut adults 1978-79 to 1982. J Chronic Dis . 1985;38:157-164.Crossref 21. Cornoni-Huntley J, LaCroix AZ, Havlik RJ. Race and sex differentials in the impact of hypertension in the United States: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Intern Med . 1989; 149:780-788.Crossref 22. Havlik RJ, LaCroix AZ, Kleinman JC, Ingram DD, Harris T, Cornoni-Huntley J. Antihypertensive drug therapy and survival by treatment status in a national survey. Hypertension . 1989;13( (suppl 1) ):28-32.Crossref 23. Roccella EJ, Lenfant C. Regional and racial differences among stroke victims in the United States. Clin Cardiol . 1989;12:IV18-IV22. 24. Caralis PV. Hypertension in the Hispanic-American population. Am J Med . 1990; 88( (suppl 3B) ):9S-16S.Crossref 25. Caralis PV. Coronary artery disease in Hispanic Americans: how does ethnic background affect risk factors and mortality rates? Postgrad Med . 1992;91: 179-193. 26. James SA, Wagner EH, Strogatz DA, et al. The Edgecombe County (NC) High Blood Pressure Control Program, II: barriers to the use of medical care among hypertensives. Am J Public Health . 1984;74:468-472.Crossref 27. Shulman NB, Martinez B, Brogan D, Carr AA, Miles CG. Financial cost as an obstacle to hypertension therapy. Am J Public Health . 1986;76:1105-1108.Crossref 28. Weir MR, Saunders E. Pharmacologic management of systemic hypertension in blacks. Am J Cardiol . 1988;61:46H-52H.Crossref 29. Francis CK. Hypertension, cardiac disease, and compliance in minority patients. Am J Med . 1991;91( (suppl 1A) ):29S-36S.Crossref 30. American Heart Association. Report of the task force on the availability of cardiovascular drugs to the medically indigent. Circulation . 1992;85:849-860.Crossref 31. Keeler EB, Brook RH, Goldberg GA, Kamberg CJ, Newhouse JP. How free care reduced hypertension in the health insurance experiment. JAMA . 1985;254: 1926-1931.Crossref 32. Plasencia A, Ostfled AM, Gruber SB. Effects of sex on differences in awareness, treatment, and control of high blood pressure. Am J Prev Med . 1988; 4:315-326. 33. Shea S, Misra D, Ehrlich MH, Field L, Francis CK. Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med . 1992;327:776-781.Crossref 34. Franks P, Clancy CM. Physician gender bias in clinical decision making: screening for cancer in primary care. Med Care . 1993;31:213-218.Crossref 35. Hahn B. Marital status and women's health: the effect of economic marital acquisitions. J Marriage Fam . 1993;55:495-504.Crossref 36. Cunningham P, Altman B. The use of ambulatory health care services by American Indians with disabilities. Med Care . 1993;31:600-616.Crossref 37. Cornelius LJ. Barriers to medical care for white, black, and Hispanic American children. J Natl Med Assoc . 1993;85:281-288. 38. Cornelius LJ. Ethnic minorities and access to medical care: where do they stand? J Assoc Acad Minor Phys . 1993;4:16-25. 39. Broussard BA, Johnson A, Himes JH, et al. Prevalence of obesity in American Indians and Alaska natives. Am J Clin Nutr . 1991;53( (suppl 6) ):1535S-1542S. 40. Stoddard JJ, St Peter RF, Newacheck PW. Health insurance status and ambulatory care for children. N Engl J Med . 1994;330:1421-1425.Crossref 41. Hahn B. Health care utilization: the effect of extending insurance to adults on Medicaid or uninsured. Med Care . 1994;32:227-239.Crossref 42. Franks P, Clancy CM, Gold MR, Nutting PA. Health insurance and subjective health status: data from the 1987 National Medical Expenditure Survey. Am J Public Health . 1993;83:1295-1299.Crossref 43. Cohen JW. Medicaid physician fees and use of physician and hospital services. Inquiry . 1993;30:281-292. 44. Short PF, Lefkowitz DC. Encouraging preventive services for low-income children: the effect of expanding Medicaid. Med Care . 1992;30:766-780.Crossref 45. Cornelius LJ. Health habits of school-age children. J Health Care Poor Under-served . 1991;2:374-395.Crossref 46. Wilcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA . 1994;272:292-296.Crossref 47. Smyer MA, Shea DG, Streit A. The provision and use of mental health services in nursing homes: results from the National Medical Expenditure Survey. Am J Public Health . 1994;84:284-287.Crossref 48. Rubin RJ, Altman WM, Mendelson DN. Health care expenditures for people with diabetes mellitus. J Clin Endocrinol Metab . 1994;78:809A-809F.Crossref 49. Altman BM, Cunningham PJ. Dynamic process of movement in residential settings. Am J Ment Retard . 1993;98:304-316. 50. Cunningham PJ, Mueller CD. Individuals with mental retardation in residential facilities: findings from the 1987 National Medical Expenditure Survey. Am J Ment Retard . 1991;96:109-117. 51. Edwards WS, Berlin M. Questionnaires and Data Collection Methods for the Household Survey and the Survey of American Indians and Alaska Natives . Rockville, Md: Public Health Service; 1989. Dept of Health and Human Services publication (PHS) 89-3450. 52. Cohen S, DiGaetano R, Waksberg J. Sample Design of the 1987 Household Survey . Rockville, Md: Public Health Service; 1991. Publication 91-0037. 53. Agency for Health Care Policy and Research. Health Status Questionnaires and Access to Care Supplement Data File Documentation . Rockville, Md: Agency for Health Care Policy and Research; 1991. 54. Palmer RH, Clark LE, Lawthers AG, et al. DEMPAQ: A Project to Develop and Evaluate Methods to Promote Ambulatory Care Quality Final Report . Glen Burnie, Md: Delmarva Foundation for Medical Care Inc; 1994. 55. Research Triangle Institute. SUDAAN: Survey Data Analysis Software Version 6.34 . Research Triangle Park, NC: Research Triangle Institute; 1993. 56. Hayward RSA, Steinberg EP, Ford DE, Roizen MF, Roach KW. Preventive care guidelines: 1991. In: Eddy DM, ed. Common Screening Tests . Philadelphia, Pa: American College of Physicians; 1991:326-393. 57. Perloff JD, Morris NM. Asking about the usual source of care: an appraisal of health care survey alternatives. Med Care . 1992;30:950-957.Crossref 58. Quam L, Ellis LBM, Venus P, Clouse J, Taylor CG, Leatherman S. Using claims data for epidemiologic research: the concordance of claims-based criteria with the Medical Record and Patient Survey for Identifying a Hypertensive Population. Med Care . 1993;131:498-507.Crossref 59. Harlow SD, Linet MS. Agreement between questionnaire data and medical records: the evidence for accuracy of recall. Am J Epidemiol . 1989;129:233-248. 60. Brook RH, Kamberg CJ, Lohr K, Goldberg BA, Keeler EB, Newhouse JP. Quality of ambulatory care: epidemiology and comparison by insurance status and income. Med Care . 1990;28:392-433.Crossref 61. Paganini-Hill A, Ross RK. Reliability of recall of drug usage and other health-related information. Am J Epidemiol . 1982;116:114-122.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 24, 1995

References