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The effect of patient race and blood pressure control on patient-physician communication
Crystal W Cené1, Debra Roter, Kathryn A Carson
1Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Insights
Black patients with uncontrolled high blood pressure (hypertension) experience poorer communication with physicians. Race, not just blood pressure control, significantly impacts patient-physician communication quality.
Area of Science:
- Health Services Research
- Health Disparities
- Cardiovascular Medicine
Background:
- Racial disparities in hypertension control lead to higher cardiovascular mortality in Black populations.
- Quality of patient-physician communication is linked to better health outcomes, including blood pressure control.
- Both race and blood pressure control can negatively influence communication.
Purpose of the Study:
- To investigate if being Black and having uncontrolled blood pressure (BP) create a
- double jeopardy
- situation, worsening patient-physician communication beyond either factor alone.
- To assess the combined impact of race and BP control on communication dynamics.
- To understand the specific communication deficits experienced by Black patients with uncontrolled hypertension.
Main Methods:
- Cross-sectional study using data from a randomized controlled trial on hypertension adherence.
- Inclusion of 226 hypertensive patients and 39 physicians from 15 primary care practices.
- Analysis of audiotaped patient-physician interactions to measure communication behaviors and visit length.
Main Results:
- Black patients with uncontrolled BP had shorter visits and less biomedical, psychosocial, and rapport-building communication compared to white patients with controlled BP.
- Black patients with uncontrolled BP experienced "double jeopardy" in terms of patient positive affect, receiving lower ratings.
- Black patients with controlled BP also had shorter visits and less communication than white patients with controlled BP.
Conclusions:
- Patient race is a stronger determinant of patient-physician communication quality than blood pressure control.
- Interventions to enhance patient-physician communication are needed to address racial disparities in hypertension care.
- Improving communication quality may be a key strategy to reduce racial disparities in cardiovascular outcomes.
Background:
Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication.
Objective:
To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy."
Design, Settings, And Patients:
Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD.
Measurements:
Communication behaviors and visit length from coding of audiotapes.
Results:
After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B = -3.9 min, p < 0.01) with less biomedical (B = -24.0, p = 0.05), psychosocial (B = -19.4, p < 0.01), and rapport-building (B = -19.5, p = 0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP.
Conclusions:
This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.
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