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



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


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


This was a cross-sectional survey.


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


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.


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.


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.


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


  1. 1.
    Shapiro MF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV Cost and Services Utilization Study. J Am Med Assoc. 1999;281(24):2305–15.CrossRefGoogle Scholar
  2. 2.
    Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.PubMedCrossRefGoogle Scholar
  3. 3.
    Gebo KA, et al. Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001. J Acquir Immune Defic Syndr. 2005;38(1):96–103.PubMedCrossRefGoogle Scholar
  4. 4.
    McNaghten AD, et al. Differences in prescription of antiretroviral therapy in a large cohort of HIV-infected patients. J Acquir Immune Defic Syndr. 2003;32(5):499–505.PubMedCrossRefGoogle Scholar
  5. 5.
    Moore RD, et al. Racial differences in the use of drug-therapy for HIV disease in an urban community. N Eng J Med. 1994;330(11):763–8.CrossRefGoogle Scholar
  6. 6.
    Asch SM, et al. Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States. J Acquir Immune Defic Syndr. 2001;28(4):340–4.PubMedGoogle Scholar
  7. 7.
    Schneider EC, Zaslavsky AM, Epstein AM. Racial disparities in the quality of care for enrollees in Medicare managed care. J Am Med Assoc. 2002;287(10):1288–94.CrossRefGoogle Scholar
  8. 8.
    Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: National Academy Press; 2002.Google Scholar
  9. 9.
    Bach PB, et al. Primary care physicians who treat blacks and whites. N Eng J Med. 2004;351(6):575–84.CrossRefGoogle Scholar
  10. 10.
    Baicker K, et al. Who you are and where you live: how race and geography affect the treatment of medicare beneficiaries. Health Affairs, 2004. Suppl Web Exclusives: p. VAR33–44.Google Scholar
  11. 11.
    Doescher MP, et al. Racial/ethnic inequities in continuity and site of care: location, location, location. Health Serv Res. 2001;36(6 Pt 2):78–89.PubMedGoogle Scholar
  12. 12.
    Probst JC, et al. Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey. BMC Health Serv Res. 2007;7(40).Google Scholar
  13. 13.
    Johnson RL, et al. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19(2):101–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Cooper-Patrick L, et al. Race, gender, and partnership in the patient-physician relationship. J Am Med Assoc. 1999;282(6):583–9.CrossRefGoogle Scholar
  15. 15.
    Johnson RL, et al. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Institute of Medicine, Crossing the quality chasm: a new health system for the 21st century, ed. C.o.Q.o.H.C.i. America. Washington, D.C.: National Academy Press; 2001:xx, 337.Google Scholar
  17. 17.
    Balint J. The possibilities of patient-centered medicine. J R Coll Gen Pract. 1969;17:269–76.PubMedGoogle Scholar
  18. 18.
    Lipkin M. Suggestion and healing. Perspect Biol Med. 1984;28(1):121–6.PubMedGoogle Scholar
  19. 19.
    Beach MC, Saha S, Cooper LA. The role and relationship of cultural competence and patient-centeredness in health care quality. Commonwealth Fund Report 2006. Available at 2006 [cited 2008 July 16].
  20. 20.
    Berry LL, Seiders K, Wilder SS. Innovations in access to care: a patient-centered approach. Ann Intern Med. 2003;139(7):568–74.PubMedGoogle Scholar
  21. 21.
    Beach MC, Duggan PS, Moore RD. Is patients’ preferred involvement in health decisions related to outcomes for patients with HIV? J Gen Intern Med. 2007;22(8):1119–24.PubMedCrossRefGoogle Scholar
  22. 22.
    Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med. 2006;21(6):661–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Fleishman JA, et al. Hospital and outpatient health services utilization among HIV-infected adults in care 2000–2002. Med Care. 2005;43(9 Suppl.):III-40-III-52.Google Scholar
  24. 24.
    Gebo KA, et al. Hospital and outpatient health services utilization among HIV-infected patients in care 2000–2001. J Am Med Assoc. 2004.Google Scholar
  25. 25.
    Chander G, et al. Alcohol use among HIV infected persons in care: Results of a multi-site survey. HIV Med. 2008;(In Press).Google Scholar
  26. 26.
    Josephs JS, et al. Use of complementary and alternative medicine among a multistate, multisite cohort of people living with HIV/AIDS. HIV Med. 2007;8(5):300–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Lawrence PB, et al. The impact of illicit drug use and substance abuse treatment on adherence to highly active antiretroviral therapy (HAART). AIDS Care. 2007;19(9):1134–40.CrossRefGoogle Scholar
  28. 28.
    Hargraves J, Hays R, Cleary P. Psychometric Properties of the Consumer Assessment of Health Plans Study (CAHPS(R)) 2.0 Adult core survey. Health Serv Res. 2003;38(6 Pt 1):1509–27.PubMedCrossRefGoogle Scholar
  29. 29.
    Localio AR, et al. Adjustments for center in multicenter studies: an overview. Ann Intern Med. 2001;135(2):112–23.PubMedGoogle Scholar
  30. 30.
    StataCorp, Stata Statistical Software: Release 9.0. 2005, StataCorp: College Station, TX.Google Scholar
  31. 31.
    Hasnain-Wynia R, Baker DW. Obtaining data on patient race, ethnicity, and primary language in health care organizations: Current challenges and proposed solutions. Health Serv Res. 2006;41(4):1501–18.PubMedGoogle Scholar
  32. 32.
    Baicker K, Chandra A, Skinner JS. Geographic variation in health care and the problem of measuring racial disparities. Perspect Biol Med. 2005;48(1):S42–S53.PubMedCrossRefGoogle Scholar
  33. 33.
    Blustein J. Who is accountable for racial equity in health care? JAMA. 2008;299(7):814–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Saha S, Arbelaez JJ, Cooper LA. Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health. 2003;93(10):1713–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Lurie N, et al. Variation in racial and ethnic differences in consumer assessments of health care. Am J Managed Care. 2003;9(7):502–9.Google Scholar
  36. 36.
    Cooper LA, et al. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15.PubMedGoogle Scholar
  37. 37.
    Saha S, et al. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159(9):997–1004.PubMedCrossRefGoogle Scholar
  38. 38.
    Bozzette SA, et al. The care of HIV-infected adults in the United States: HIV Cost and Services Utilization Study Consortium. N Engl J Med. 1997;339(26):1897–904.CrossRefGoogle Scholar

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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