Primary care provider cultural competence and racial disparities in HIV care and outcomes

Somnath (Som) Saha, Philip (Todd) Korthuis, Jonathan A. Cohn, Victoria L. Sharp, Richard D. Moore, Mary Catherine Beach

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: 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. Objective: 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. Main Measures: 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. Key Results: 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)622-629
Number of pages8
JournalJournal of General Internal Medicine
Volume28
Issue number5
DOIs
StatePublished - May 2013

Fingerprint

Cultural Competency
Primary Health Care
HIV
Self Efficacy
Quality of Health Care
Healthcare Disparities
Health Personnel
Self Report
Patient Care
Acquired Immunodeficiency Syndrome
Outcome Assessment (Health Care)

Keywords

  • Culture
  • Ethnic groups
  • HIV

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Primary care provider cultural competence and racial disparities in HIV care and outcomes. / Saha, Somnath (Som); Korthuis, Philip (Todd); Cohn, Jonathan A.; Sharp, Victoria L.; Moore, Richard D.; Beach, Mary Catherine.

In: Journal of General Internal Medicine, Vol. 28, No. 5, 05.2013, p. 622-629.

Research output: Contribution to journalArticle

Saha, Somnath (Som) ; Korthuis, Philip (Todd) ; Cohn, Jonathan A. ; Sharp, Victoria L. ; Moore, Richard D. ; Beach, Mary Catherine. / Primary care provider cultural competence and racial disparities in HIV care and outcomes. In: Journal of General Internal Medicine. 2013 ; Vol. 28, No. 5. pp. 622-629.
@article{e9cbe856ed184653b645c4c12e89da29,
title = "Primary care provider cultural competence and racial disparities in HIV care and outcomes",
abstract = "Background: 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. Objective: 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. Main Measures: 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. Key Results: 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). Conclusions: 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.",
keywords = "Culture, Ethnic groups, HIV",
author = "Saha, {Somnath (Som)} and Korthuis, {Philip (Todd)} and Cohn, {Jonathan A.} and Sharp, {Victoria L.} and Moore, {Richard D.} and Beach, {Mary Catherine}",
year = "2013",
month = "5",
doi = "10.1007/s11606-012-2298-8",
language = "English (US)",
volume = "28",
pages = "622--629",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "5",

}

TY - JOUR

T1 - Primary care provider cultural competence and racial disparities in HIV care and outcomes

AU - Saha, Somnath (Som)

AU - Korthuis, Philip (Todd)

AU - Cohn, Jonathan A.

AU - Sharp, Victoria L.

AU - Moore, Richard D.

AU - Beach, Mary Catherine

PY - 2013/5

Y1 - 2013/5

N2 - Background: 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. Objective: 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. Main Measures: 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. Key Results: 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). Conclusions: 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.

AB - Background: 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. Objective: 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. Main Measures: 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. Key Results: 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). Conclusions: 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.

KW - Culture

KW - Ethnic groups

KW - HIV

UR - http://www.scopus.com/inward/record.url?scp=84891380562&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84891380562&partnerID=8YFLogxK

U2 - 10.1007/s11606-012-2298-8

DO - 10.1007/s11606-012-2298-8

M3 - Article

C2 - 23307396

AN - SCOPUS:84891380562

VL - 28

SP - 622

EP - 629

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 5

ER -