Impact of patient race on patient experiences of access and communication in HIV care

Philip (Todd) Korthuis, Somnath (Som) Saha, John A. Fleishman, Moriah McSharry McGrath, Joshua S. Josephs, Richard D. Moore, Kelly A. Gebo, James Hellinger, Mary Catherine Beach

Research output: Contribution to journalArticle

14 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2046-2052
Number of pages7
JournalJournal of General Internal Medicine
Volume23
Issue number12
DOIs
StatePublished - Dec 2008

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Communication
HIV
Patient-Centered Care
Hispanic Americans
Cross-Sectional Studies
Logistic Models

Keywords

  • Blacks
  • Communication
  • Health services accessibility
  • HIV research network
  • HIV/AIDS treatment
  • Physician-patient relations

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Impact of patient race on patient experiences of access and communication in HIV care. / Korthuis, Philip (Todd); Saha, Somnath (Som); Fleishman, John A.; McGrath, Moriah McSharry; Josephs, Joshua S.; Moore, Richard D.; Gebo, Kelly A.; Hellinger, James; Beach, Mary Catherine.

In: Journal of General Internal Medicine, Vol. 23, No. 12, 12.2008, p. 2046-2052.

Research output: Contribution to journalArticle

Korthuis, PT, Saha, SS, Fleishman, JA, McGrath, MM, Josephs, JS, Moore, RD, Gebo, KA, Hellinger, J & Beach, MC 2008, 'Impact of patient race on patient experiences of access and communication in HIV care', Journal of General Internal Medicine, vol. 23, no. 12, pp. 2046-2052. https://doi.org/10.1007/s11606-008-0788-5
Korthuis, Philip (Todd) ; Saha, Somnath (Som) ; Fleishman, John A. ; McGrath, Moriah McSharry ; Josephs, Joshua S. ; Moore, Richard D. ; Gebo, Kelly A. ; Hellinger, James ; Beach, Mary Catherine. / Impact of patient race on patient experiences of access and communication in HIV care. In: Journal of General Internal Medicine. 2008 ; Vol. 23, No. 12. pp. 2046-2052.
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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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AU - Saha, Somnath (Som)

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AU - McGrath, Moriah McSharry

AU - Josephs, Joshua S.

AU - Moore, Richard D.

AU - Gebo, Kelly A.

AU - Hellinger, James

AU - Beach, Mary Catherine

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N2 - 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.

AB - 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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