The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication
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.
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.
Communication behaviors and visit length from coding of audiotapes.
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.
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.
KEY WORDSpatient-physician communication hypertension blood pressure control racial disparities double jeopardy
This paper was presented, in part, at the 30th Annual Meeting of the Society of General Internal Medicine, April 27, 2007, Toronto, Ontario. This work was supported by grants from the National Heart, Lung, and Blood Institute (R01HL069403, K24HL083113, and T32HL07180). The authors would like to thank David M. Levine, MD, MPH, ScD, Michael S. Barr, MD, MBA, and Lee R. Bone, MPH, RN for their contributions as co-investigators in the Patient-Physician Partnership to Improve High Blood Pressure Adherence Study and Drs. Levine and Barr for reviewing earlier versions of this manuscript. Dr. Cene also received salary support from the National Center for Research Resources (KL2RR025746). The content of the manuscript is solely the responsibility of the authors and does not necessarily reflect the views of the National Center for Research Resources or the National Heart, Lung, and Blood Institute.
Conflict of Interest
Dr. Debra Roter is the author of the Roter Interaction Analysis System (RIAS) and holds the copyright for the system. Johns Hopkins University also has rights to enhancements of the system. Neither Debra Roter nor Johns Hopkins collect royalties for use of the system in research conducted at the Johns Hopkins University and Medical Institutions. Debra Roter is owner of RIASWorks LLC, a company that provides RIAS coding services to clients outside of the Johns Hopkins University System. It may be possible that the company will benefit indirectly from dissemination of the current research. Dr. Lisa Cooper received a grant, and Ms. Kathryn Carson received salary support, from AMGEN, a human therapeutics company in the biotechnology industry.
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