October's issue of the American Journal of Public Health focused on eliminating racial and ethnic disparities in access to and quality of care. Contributors addressed such topics as the Veterans Health Administration's efforts to promote health equity; HIV infection, cancer, and diabetes among minority patients; and collection of data on race and ethnicity. One Fund-supported article included in this issue examined how patient-physician relationships affect the quality of care for different racial and ethnic groups.
Quality: Patient-Physician Relationships
The root causes of disparities in the quality of care between minority Americans—including blacks, Hispanics, Asians, and Native Americans—and whites are not well understood, but a new study finds that patient-physician interactions contribute to the problem. Rather than view-ing cultural competency training as a mastery of "facts" about different groups, the findings suggest that—in order to improve the quality of care across racial and ethnic lines—physicians should use a patient-centered approach based on fundamental skills, such as listening and treating patients with respect.
"Patient-Physician Relationships and Racial Disparities in the Quality of Health Care," by Somnath Saha of the Portland Veterans Affairs Medical Center and Oregon Health and Science University and colleagues, examines the roles played by patient-physician interactions, physicians' cultural sensitivity, and patient-physician racial concordance in patients' perspectives of quality of care. The researchers used data from the Commonwealth Fund 2001 Health Care Quality Survey, for which phone interviews were conducted in six different languages with 1,037 black, 1,153 Hispanic, 621 Asian, and 3,488 white respondents.
Patient-Physician Care
The survey revealed that the quality of patient-physician interactions was generally lower among minorities, particularly Hispanics and Asians. Specifically, physician behaviors such as spending adequate time with patients and showing them respect were reported less often by ethnic minorities than by white respondents. Of note, the reported differences in the quality of patient-physician interactions between Asians and whites were greater, on average, than reported differences between the insured and the uninsured. Race discordance between patients and physicians did not seem to explain such differences. Instead, contributing factors included physicians' cultural sensitivity and patients' health literacy.
Satisfaction with Care
Non-white respondents expressed lower levels of satisfaction with their care than did whites. However, adjustment for demographic factors and patient-physician interactions improved patient satisfaction across different racial and ethnic groups.
Use of Services
Racial differences in the use of health services varied by type of service. In general, blacks received more appropriate services. Among patients with hypertension and heart disease, Hispanics received fewer services than whites, while among patients with diabetes, Asians received fewer services than whites. Accounting for differences in patient-physician interactions, physician cultural sensitivity, and patient-physician race concordance did not explain racial and ethnic disparities in use of health services.
Policy Implications
The authors conclude that efforts to improve cross-cultural patient-physician interactions should be aimed at increasing patients' health literacy as well as improving physicians' cultural sensitivity and interpersonal skills.
