Impact of Patient Race on Patient Experiences of Access and Communication in HIV Care

  • P. Todd Korthuis
  • Somnath Saha
  • John A. Fleishman
  • Moriah McSharry McGrath
  • Joshua S. Josephs
  • Richard D. Moore
  • Kelly A. Gebo
  • James Hellinger
  • Mary Catherine Beach
  • for the HIV Research Network
Original Article

ABSTRACT

BACKGROUND

Patient-centered care—including the domains of access and communication—is an important determinant of positive clinical outcomes.

OBJECTIVE

To explore associations between race and HIV-infected patients’ experiences of access and communication.

DESIGN

This was a cross-sectional survey.

PARTICIPANTS

Nine hundred and fifteen HIV-infected adults receiving care at 14 U.S. HIV clinics.

MEASUREMENTS

Dependent variables included patients’ reports of travel time to their HIV care site and waiting time to see their HIV provider (access) and ratings of their HIV providers on always listening, explaining, showing respect, and spending enough time with them (communication). We used multivariate logistic regression to estimate associations between patient race and dependent variables, and random effects models to estimate site-level contributions.

RESULTS

Patients traveled a median 30 minutes (range 1–180) and waited a median 20 minutes (range 0–210) to see their provider. On average, blacks and Hispanics reported longer travel and wait times compared with whites. Adjusting for HIV care site attenuated this association. HIV care sites that provide services to a greater proportion of blacks and Hispanics may be more difficult to access for all patients. The majority of patients rated provider communication favorably. Compared to whites, blacks reported more positive experiences with provider communication.

CONCLUSIONS

We observed racial disparities in patients’ experience of access to care but not in patient–provider communication. Disparities were explained by poor access at minority-serving clinics. Efforts to make care more patient-centered for minority HIV-infected patients should focus more on improving access to HIV care in minority communities than on improving cross-cultural patient–provider interactions.

KEY WORDS

physician–patient relations communication HIV/AIDS treatment health services accessibility blacks HIV Research Network 

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • P. Todd Korthuis
    • 1
    • 6
  • Somnath Saha
    • 1
    • 2
  • John A. Fleishman
    • 3
  • Moriah McSharry McGrath
    • 1
  • Joshua S. Josephs
    • 4
  • Richard D. Moore
    • 4
  • Kelly A. Gebo
    • 4
  • James Hellinger
    • 5
  • Mary Catherine Beach
    • 4
  • for the HIV Research Network
  1. 1.Department of MedicineOregon Health and Science UniversityPortlandUSA
  2. 2.Section of General Internal MedicinePortland VA Medical CenterPortlandUSA
  3. 3.Agency for Healthcare Research and QualityRockvilleUSA
  4. 4.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Community Medical AllianceBostonUSA
  6. 6.Oregon Health and Science UniversityPortlandUSA

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