Health promotion referrals in an urban clinic: Removing financial barriers influences physician but not patient behavior

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.