Race, physician -patient concordance, and social distance: Effects on communication and participation in medical visits.

摘要

Background. The existence of health disparities along racial and ethnic lines in the United States is well documented, but contention remains in explaining what causes race to be associated with disparate health and health care. The 2002 Institute of Medicine report, Unequal Treatment suggests the importance of the physician-patient relationship as a potential point of intervention in the effort to eliminate such disparities. Other research suggests that matching of physicians and patients (i.e. concordance) on a variety of characteristics including race may improve medical visit communication and patients' perceptions of care. This dissertation explores the relationship of individual and shared characteristics between physicians and patients to the communication processes and outcomes of medical visits. It seeks to: (1) describe the mechanisms through which individual characteristics affect medical visit communication and patients' perceptions of care, and (2) determine the strength with which shared characteristics of physicians and patients predict medical visit communication and patients' perceptions of care.;Methods. Data were derived from two cross-sectional studies conducted in 1998 and 2002. Primary care physicians (PCP's) were recruited from primary care offices in the Baltimore/Washington, DC/Virginia metropolitan area and served as PCP's for all 458 adult patients in the study (n = 256 African American, n = 202 white). Coded medical visit audiotapes with measures for communication content and tone, and patients ratings of care derived from questionnaire data were the main outcome measures. Statistical analyses included descriptive statistics and multiple linear and logistic regression modeling using generalized estimating equations.;Results. Sixty-seven percent of patients were female (mean age = 49 years) with an average of 12.4 years of education. African-American patients were significantly (p < 0.01) younger than white patients (mean age = 46.56y versus 53.03y respectively), more likely to see female physicians (68% versus 53%), and less likely to see a physician of their same race (48% versus 70%). After controlling for patient and physician demographic characteristics, physicians exhibited significantly less positive affect (p = 0.02) and more verbal dominance (p < 0.01) with African-American than with white patients. Physicians talked an average of 73% more than African-American patients versus 50% more than white patients.;Conclusions. Medical visit communication differs in content and tone for African Americans as compared to whites. (Abstract shortened by UMI.).