Differences in Patient–Provider Communication for Hispanic Compared to Non-Hispanic White Patients in HIV Care
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Hispanic Americans with HIV/AIDS experience lower quality care and worse outcomes than non-Hispanic whites. While deficits in patient–provider communication may contribute to these disparities, no studies to date have used audio recordings to examine the communication patterns of Hispanic vs. non-Hispanic white patients with their health care providers.
To explore differences in patient–provider communication for English-speaking, HIV-infected Hispanic and non-Hispanic white patients.
Two HIV care sites in the United States (New York and Portland) participating in the Enhancing Communication and HIV Outcomes (ECHO) study.
Nineteen HIV providers and 113 of their patients.
Patient interviews, provider questionnaires, and audio-recorded, routine, patient–provider encounters coded with the Roter Interaction Analysis System (RIAS).
Providers were mostly non-Hispanic white (68%) and female (63%). Patients were Hispanic (51%), and non-Hispanic white (49%); 20% were female. Visits with Hispanic patients were less patient-centered (0.75 vs. 0.90, p = 0.009), with less psychosocial talk (80 vs. 118 statements, p < 0.001). This pattern was consistent among Hispanics who spoke English very well and those with less English proficiency. There was no association between patient race/ethnicity and visit length, patients’ or providers’ emotional tone, or the total number of patient or provider statements categorized as socioemotional, question-asking, information-giving, or patient activating. Hispanic patients gave higher ratings than whites (AOR 3.05 Hispanic vs. white highest rating of providers’ interpersonal style, 95% CI 1.20-7.74).
In this exploratory study, we found less psychosocial talk in patient–provider encounters with Hispanic compared to white patients. The fact that Hispanic patients rated their visits more positively than whites raises the possibility that these differences in patient–provider interactions may reflect differences in patient preferences and communication style rather than “deficits” in communication. If these findings are replicated in future studies, efforts should be undertaken to understand the reasons underlying them and their impact on the quality and equity of care.
KEY WORDSHIV/AIDS patient–physician relations patient–physician communication health disparities
This research was supported by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012). In addition, Dr. Korthuis was supported by the National Institute of Drug Abuse (K23 DA019808). Dr. Beach was supported by the Agency for Healthcare Research and Quality (K08 HS013903-05) and both Drs. Beach and Saha were supported by Robert Wood Johnson Generalist Physician Faculty Scholars Awards. The views expressed in this article are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services is intended or should be inferred. The authors wish also to acknowledge the helpful comments and review of John Fleishman, PhD.
Conflicts of Interest
- 11.Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse communities, common concerns: assessing health care quality for minority Americans. New York: The Commonwealth Fund; 2002.Google Scholar
- 13.Beach M, Saha S, Korthuis P et al. Does patient–provider communication differ for black compared to white HIV-infected patients? AIDS Behav. in press.Google Scholar
- 17.Wissow LS, Roter D, Bauman LJ, et al. Patient–provider communication during the emergency department care of children with asthma. The National Cooperative Inner-City Asthma Study, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD. Med Care. 1998;36:1439–50.CrossRefPubMedGoogle Scholar
- 20.McLellan AT, Cacciola JS, Zanis D. Addiction Severity Index, Lite Version (ASI-Lite). http://www.who.int/substance_abuse/research_tools/addictionseverity/en/index.html . 1997. Center for the Studies of Addiction, University of Pennsylvania/Philadelphia VA Medical Center. 2-14-2007. Accessed February 2010.