Perceptions, preferences, and partnerships: A patient-centered approach to understanding racial and ethnic differences in mental healthcare.

摘要

Background. Racial and ethnic disparities are a persistent challenge to health and healthcare quality. The advancement of the policy agenda in this area requires studies that move beyond description to explain how disparities occur and what strategies are effective in eliminating them. Patient-centeredness is a shared pillar in both healthcare improvement and disparities elimination strategies.Objective. To identify individual-level and system-level opportunities to reduce racial and ethnic differences in mental health and healthcare outcomes.Design. The study entailed the cross-sectional analysis of secondary data from the Collaborative Psychiatric Epidemiology Studies (CPES), including the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL), and the National Latino and Asian American Study (NLAAS) as well as enrollment data from the "Patient-Centered Care for African-Americans with Depression Study" using regression methodology.Findings. The importance of social context manifests from the patient's point of understanding of their own mental health status, through choices regarding care-seeking, and, finally, in interactions with clinicians during the care encounter. Social factors, such as educational attainment and insurance status may influence the way that individuals perceive their own mental health status and, subsequently, their needs for care. Sectors of preference among racial and ethnic minority groups may be a powerful leveraging tool in mental healthcare delivery to vulnerable populations. The spiritual sector in particular, having deeply-seated cultural and social significance for some minority populations, may play a significant role in promoting Asian, black, and Latino initiation of and retention in care for mental conditions. Finally, partnership in communication must navigate delicate social nuances in order to be effective and may not be fully represented by current shared decision-making schema. More investigation is needed to understand social underpinnings of conversations between African-American patients with depression and their physicians and opportunities for optimizing care.Conclusions. In accordance with IOM recommendations, patients' perceptions (values and beliefs), preferences, and engagement of patients as partners in care should be acknowledged in the treatment of mental conditions. More research is needed to understand how patients' perspectives may be appropriately activated and optimized in efforts towards improvements in healthcare quality and outcomes.