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Journal of General Internal Medicine

, Volume 25, Issue 7, pp 682–687 | Cite as

Differences in Patient–Provider Communication for Hispanic Compared to Non-Hispanic White Patients in HIV Care

  • Mary Catherine BeachEmail author
  • Somnath Saha
  • P. Todd Korthuis
  • Victoria Sharp
  • Jonathon Cohn
  • Ira Wilson
  • Susan Eggly
  • Lisa A. Cooper
  • Debra Roter
  • Andrea Sankar
  • Richard Moore
Original Article

Abstract

Background

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.

Objective

To explore differences in patient–provider communication for English-speaking, HIV-infected Hispanic and non-Hispanic white patients.

Design

Cross-sectional analysis.

Setting

Two HIV care sites in the United States (New York and Portland) participating in the Enhancing Communication and HIV Outcomes (ECHO) study.

Subjects

Nineteen HIV providers and 113 of their patients.

Measurements

Patient interviews, provider questionnaires, and audio-recorded, routine, patient–provider encounters coded with the Roter Interaction Analysis System (RIAS).

Results

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).

Conclusion

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 WORDS

HIV/AIDS patient–physician relations patient–physician communication health disparities 

Notes

Acknowledgement

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

None disclosed.

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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Mary Catherine Beach
    • 1
    • 6
    Email author
  • Somnath Saha
    • 2
  • P. Todd Korthuis
    • 2
  • Victoria Sharp
    • 3
  • Jonathon Cohn
    • 4
  • Ira Wilson
    • 5
  • Susan Eggly
    • 4
  • Lisa A. Cooper
    • 1
  • Debra Roter
    • 1
  • Andrea Sankar
    • 4
  • Richard Moore
    • 1
  1. 1.Johns Hopkins UniversityBaltimoreUSA
  2. 2.Oregon Health Science UniversityPortlandUSA
  3. 3.Saint-Lukes RooseveltNew YorkUSA
  4. 4.Wayne State UniversityDetroitUSA
  5. 5.Tufts-New England Medical CenterBostonUSA
  6. 6.Associate Professor of Medicine and Health, Behavior & SocietyJohns Hopkins UniversityBaltimoreUSA

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