Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes
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Health professional organizations have advocated for increasing the “cultural competence” (CC) of healthcare providers, to reduce racial and ethnic disparities in patient care. It is unclear whether provider CC is associated with more equitable care.
To evaluate whether provider CC is associated with quality of care and outcomes for patients with HIV/AIDS.
DESIGN AND PARTICIPANTS
Survey of 45 providers and 437 patients at four urban HIV clinics in the U.S.
Providers’ self-rated CC was measured using a novel, 20-item instrument. Outcome measures included patients’ receipt of antiretroviral (ARV) therapy, self-efficacy in managing medication regimens, complete 3-day ARV adherence, and viral suppression.
Providers’ mean age was 44 years; 56 % were women, and 64 % were white. Patients’ mean age was 45; 67 % were men, and 77 % were nonwhite. Minority patients whose providers scored in the middle or highest third on self-rated CC were more likely than those with providers in the lowest third to be on ARVs, have high self-efficacy, and report complete ARV adherence. Racial disparities were observed in receipt of ARVs (adjusted OR, 95 % CI for white vs. nonwhite: 6.21, 1.50–25.7), self-efficacy (3.77, 1.24–11.4), and viral suppression (13.0, 3.43–49.0) among patients of low CC providers, but not among patients of moderate and high CC providers (receipt of ARVs: 0.71, 0.32–1.61; self-efficacy: 1.14, 0.59–2.22; viral suppression: 1.20, 0.60–2.42).
Provider CC was associated with the quality and equity of HIV care. These findings suggest that enhancing provider CC may reduce racial disparities in healthcare quality and outcomes.
KEY WORDSculture ethnic groups HIV
- 5.Institute of Medicine. Unequal Treatment: confronting Racial and Ethnic Disparities in Health Care. Washington: National Academies Press; 2002.Google Scholar
- 12.Centers for Disease Control and Prevention (CDC). Epidemiology of HIV/AIDS—United States, 1981–2005. MMWR Morb Mortal Wkly Rep. 2006;55:589–592.Google Scholar
- 26.American Medical Association. H-295.897. Enhancing the cultural competence of physicians. Health and ethics policies of the AMA House of Delegates. Available at http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf; accessed November 14, 2012.
- 27.American Academy of Nurse Practitioners. Position statement on nurse practitioner curriculum. Available at http://www.aanp.org/images/documents/publications/NPCurriculum.pdf; accessed November 14, 2012.
- 28.American Academy of Family Physicians. Culturally competent health care. Available at http://www.aafp.org/online/en/home/policy/policies/c/crosscult.html; accessed November 14, 2012.
- 36.DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington: U.S. Department of Health and Human Services; 2006.Google Scholar
- 38.Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12:255–266.PubMedCrossRefGoogle Scholar
- 43.Glaspy J, Bukowski R, Steinberg D, Taylor C, Tchekmedyian S, Vadhan-Raj S. Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. Procrit Study Group. J Clin Oncol. 1997;15:1218–34.PubMedGoogle Scholar
- 45.HCSUS Baseline Questionnaire. Module 9: Social support and coping. Available at http://www.rand.org/health/projects/hcsus/Base/index.html; accessed November 14, 2012.
- 48.Hall ET. Beyond culture. New York: Anchor Books; 1976.Google Scholar
- 49.Sanchez-Jones TR. Cross-cultural communication. In: Williams CL, Davis CM, eds. Therapeutic Interaction in Nursing. Sudbury: Jones & Bartlett Publishers; 2004.Google Scholar