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Impact of Patient Race on Patient Experiences of Access and Communication in HIV Care

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ABSTRACT

BACKGROUND

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

OBJECTIVE

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

DESIGN

This was a cross-sectional survey.

PARTICIPANTS

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

MEASUREMENTS

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.

RESULTS

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.

CONCLUSIONS

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.

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Acknowledgments

Preliminary results were presented as an oral abstract at the 30th Annual Society of General Internal Medicine meeting (April 2007, Toronto, Canada). This work was supported by the Agency for Healthcare Research and Quality (290–01–0012). Dr. Korthuis is supported by the National Institute on Drug Abuse (K23-DA019809). Dr. Saha is supported by an Advanced Research Career Development Award from the Department of Veterans Affairs Health Services Research & Development Service, and a Generalist Physician Faculty Scholar Award from the Robert Wood Johnson Foundation. Dr. Gebo received support from the Johns Hopkins Richard S. Ross Clinician Scientist Award. Dr. Beach is supported by the Agency for Healthcare Research and Quality (1-K08-HS13903). The views expressed in this paper are those of the authors. No official endorsement by DHHS, the National Institutes of Health, the Agency for Healthcare Research and Quality, the Robert Wood Johnson Foundation, or the Department of Veterans Affairs is intended or should be inferred.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, Oregon Health and Science University, Portland, OR, USA

    P. Todd Korthuis MD, MPH, Somnath Saha MD, MPH & Moriah McSharry McGrath MPH

  2. Section of General Internal Medicine, Portland VA Medical Center, Portland, OR, USA

    Somnath Saha MD, MPH

  3. Agency for Healthcare Research and Quality, Rockville, MD, USA

    John A. Fleishman PhD

  4. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Joshua S. Josephs BA, Richard D. Moore MD, MHS, Kelly A. Gebo MD, MPH & Mary Catherine Beach MD, MPH

  5. Community Medical Alliance, Boston, MA, USA

    James Hellinger MD

  6. Oregon Health and Science University, Portland, OR, USA

    P. Todd Korthuis MD, MPH

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  1. P. Todd Korthuis MD, MPH
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  2. Somnath Saha MD, MPH
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  6. Richard D. Moore MD, MHS
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  7. Kelly A. Gebo MD, MPH
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Correspondence to P. Todd Korthuis MD, MPH.

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Korthuis, P.T., Saha, S., Fleishman, J.A. et al. Impact of Patient Race on Patient Experiences of Access and Communication in HIV Care. J GEN INTERN MED 23, 2046–2052 (2008). https://doi.org/10.1007/s11606-008-0788-5

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  • DOI: https://doi.org/10.1007/s11606-008-0788-5

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