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. 2007 Nov;99(11):1248–1254.

Exploring racial and sociodemographic trends in physician behavior, physician trust and their association with blood pressure control.

Mustafa M Rawaf 1, Nancy R Kressin 1
PMCID: PMC2574331  PMID: 18020100

Abstract

Racial disparities in several facets of healthcare have been widely documented, showing that African Americans face disproportionately high health risks when compared to whites. With respect to hypertension, 40% of the > or = 36 million African Americans are affected. We examined the correlation between the patient-physician relationship and the racial disparities in healthcare. We hypothesized that increased physician counseling would lead to higher patient trust and, thus, a greater likelihood of having controlled blood pressure. Four-hundred-sixty black and 333 white Veteran Affairs (VA) patients previously diagnosed with hypertension were included. Patients with a systolic reading > or = 140 mmHg and/or a diastolic reading > or = 90 mmHg at a recent doctor visit were considered to have uncontrolled blood pressure. By using patient exit interviews (PEIs), we quantified the number of counseling behaviors performed by physicians. Patient trust in physician was measured by validated questions answered on a 1-5 agreement scale. Results showed no racial disparity in blood pressure control. While blacks were found to receive more counseling, whites reported higher trust. Controlling for sociodemographic factors, we found that regardless of race, higher PEI scores were associated with higher trust; however, they were also associated with uncontrolled blood pressure. The association of physician behavior with blood pressure was not mediated by trust. We were unable to make direct cause-and-effect conclusions because the measures were recorded from a one-time questionnaire. Future research should focus on uncovering causal relationships, allowing physicians to work towards ending the established healthcare disparities.

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Selected References

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  1. Anderson L. A., Dedrick R. F. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990 Dec;67(3 Pt 2):1091–1100. doi: 10.2466/pr0.1990.67.3f.1091. [DOI] [PubMed] [Google Scholar]
  2. Blendon R. J., Aiken L. H., Freeman H. E., Corey C. R. Access to medical care for black and white Americans. A matter of continuing concern. JAMA. 1989 Jan 13;261(2):278–281. [PubMed] [Google Scholar]
  3. Brody H. Relationship-centered care: beyond the finishing school. J Am Board Fam Pract. 1995 Sep-Oct;8(5):416–418. [PubMed] [Google Scholar]
  4. Carlisle D. M., Leake B. D., Shapiro M. F. Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988. Am J Public Health. 1995 Mar;85(3):352–356. doi: 10.2105/ajph.85.3.352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cooper-Patrick L., Gallo J. J., Gonzales J. J., Vu H. T., Powe N. R., Nelson C., Ford D. E. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999 Aug 11;282(6):583–589. doi: 10.1001/jama.282.6.583. [DOI] [PubMed] [Google Scholar]
  6. Doescher M. P., Saver B. G., Franks P., Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000 Nov-Dec;9(10):1156–1163. doi: 10.1001/archfami.9.10.1156. [DOI] [PubMed] [Google Scholar]
  7. Fiscella Kevin, Meldrum Sean, Franks Peter, Shields Cleveland G., Duberstein Paul, McDaniel Susan H., Epstein Ronald M. Patient trust: is it related to patient-centered behavior of primary care physicians? Med Care. 2004 Nov;42(11):1049–1055. doi: 10.1097/00005650-200411000-00003. [DOI] [PubMed] [Google Scholar]
  8. Grumbach K., Selby J. V., Damberg C., Bindman A. B., Quesenberry C., Jr, Truman A., Uratsu C. Resolving the gatekeeper conundrum: what patients value in primary care and referrals to specialists. JAMA. 1999 Jul 21;282(3):261–266. doi: 10.1001/jama.282.3.261. [DOI] [PubMed] [Google Scholar]
  9. Hall Mark A., Zheng Beiyao, Dugan Elizabeth, Camacho Fabian, Kidd Kristin E., Mishra Aneil, Balkrishnan Rajesh. Measuring patients' trust in their primary care providers. Med Care Res Rev. 2002 Sep;59(3):293–318. doi: 10.1177/1077558702059003004. [DOI] [PubMed] [Google Scholar]
  10. Heisler Michele, Smith Dylan M., Hayward Rodney A., Krein Sarah L., Kerr Eve A. Racial disparities in diabetes care processes, outcomes, and treatment intensity. Med Care. 2003 Nov;41(11):1221–1232. doi: 10.1097/01.MLR.0000093421.64618.9C. [DOI] [PubMed] [Google Scholar]
  11. Jha Ashish K., Fisher Elliott S., Li Zhonghe, Orav E. John, Epstein Arnold M. Racial trends in the use of major procedures among the elderly. N Engl J Med. 2005 Aug 18;353(7):683–691. doi: 10.1056/NEJMsa050672. [DOI] [PubMed] [Google Scholar]
  12. Kao A. C., Green D. C., Zaslavsky A. M., Koplan J. P., Cleary P. D. The relationship between method of physician payment and patient trust. JAMA. 1998 Nov 18;280(19):1708–1714. doi: 10.1001/jama.280.19.1708. [DOI] [PubMed] [Google Scholar]
  13. Kjellstrand C. M. Age, sex, and race inequality in renal transplantation. Arch Intern Med. 1988 Jun;148(6):1305–1309. [PubMed] [Google Scholar]
  14. Leopold N., Cooper J., Clancy C. Sustained partnership in primary care. J Fam Pract. 1996 Feb;42(2):129–137. [PubMed] [Google Scholar]
  15. Levine R. S., Foster J. E., Fullilove R. E., Fullilove M. T., Briggs N. C., Hull P. C., Husaini B. A., Hennekens C. H. Black-white inequalities in mortality and life expectancy, 1933-1999: implications for healthy people 2010. Public Health Rep. 2001 Sep-Oct;116(5):474–483. doi: 10.1093/phr/116.5.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Mechanic D., Schlesinger M. The impact of managed care on patients' trust in medical care and their physicians. JAMA. 1996 Jun 5;275(21):1693–1697. [PubMed] [Google Scholar]
  17. Mostashari F., Riley E., Selwyn P. A., Altice F. L. Acceptance and adherence with antiretroviral therapy among HIV-infected women in a correctional facility. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Aug 1;18(4):341–348. doi: 10.1097/00042560-199808010-00005. [DOI] [PubMed] [Google Scholar]
  18. Murray-García J. L., Selby J. V., Schmittdiel J., Grumbach K., Quesenberry C. P., Jr Racial and ethnic differences in a patient survey: patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000 Mar;38(3):300–310. doi: 10.1097/00005650-200003000-00007. [DOI] [PubMed] [Google Scholar]
  19. Ockene I. S., Hebert J. R., Ockene J. K., Merriam P. A., Hurley T. G., Saperia G. M. Effect of training and a structured office practice on physician-delivered nutrition counseling: the Worcester-Area Trial for Counseling in Hyperlipidemia (WATCH). Am J Prev Med. 1996 Jul-Aug;12(4):252–258. [PubMed] [Google Scholar]
  20. Pappas G., Queen S., Hadden W., Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993 Jul 8;329(2):103–109. doi: 10.1056/NEJM199307083290207. [DOI] [PubMed] [Google Scholar]
  21. Pbert L., Adams A., Quirk M., Hebert J. R., Ockene J. K., Luippold R. S. The patient exit interview as an assessment of physician-delivered smoking intervention: a validation study. Health Psychol. 1999 Mar;18(2):183–188. doi: 10.1037//0278-6133.18.2.183. [DOI] [PubMed] [Google Scholar]
  22. Rehman Shakaib U., Hutchison Florence N., Hendrix Katharine, Okonofua Eni C., Egan Brent M. Ethnic differences in blood pressure control among men at Veterans Affairs clinics and other health care sites. Arch Intern Med. 2005 May 9;165(9):1041–1047. doi: 10.1001/archinte.165.9.1041. [DOI] [PubMed] [Google Scholar]
  23. Rep M. H., Schrijver H. M., van Lopik T., Hintzen R. Q., Roos M. T., Adèr H. J., Polman C. H., van Lier R. A. Interferon (IFN)-beta treatment enhances CD95 and interleukin 10 expression but reduces interferon-gamma producing T cells in MS patients. J Neuroimmunol. 1999 Apr 1;96(1):92–100. doi: 10.1016/s0165-5728(98)00271-9. [DOI] [PubMed] [Google Scholar]
  24. Safran D. G., Taira D. A., Rogers W. H., Kosinski M., Ware J. E., Tarlov A. R. Linking primary care performance to outcomes of care. J Fam Pract. 1998 Sep;47(3):213–220. [PubMed] [Google Scholar]
  25. Schoenbaum M., Waidmann T. Race, socioeconomic status, and health: accounting for race differences in health. J Gerontol B Psychol Sci Soc Sci. 1997 May;52(Spec No):61–73. doi: 10.1093/geronb/52b.special_issue.61. [DOI] [PubMed] [Google Scholar]
  26. Schwartz E., Kofie V. Y., Rivo M., Tuckson R. V. Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986. Int J Epidemiol. 1990 Sep;19(3):591–598. doi: 10.1093/ije/19.3.591. [DOI] [PubMed] [Google Scholar]
  27. Taira D. A., Safran D. G., Seto T. B., Rogers W. H., Inui T. S., Montgomery J., Tarlov A. R. Do patient assessments of primary care differ by patient ethnicity? Health Serv Res. 2001 Dec;36(6 Pt 1):1059–1071. [PMC free article] [PubMed] [Google Scholar]
  28. Thom D. H., Campbell B. Patient-physician trust: an exploratory study. J Fam Pract. 1997 Feb;44(2):169–176. [PubMed] [Google Scholar]
  29. Thom D. H., Ribisl K. M., Stewart A. L., Luke D. A. Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999 May;37(5):510–517. doi: 10.1097/00005650-199905000-00010. [DOI] [PubMed] [Google Scholar]
  30. Thom D. H., Stanford Trust Study Physicians Physician behaviors that predict patient trust. J Fam Pract. 2001 Apr;50(4):323–328. [PubMed] [Google Scholar]
  31. Weissman J. S., Stern R., Fielding S. L., Epstein A. M. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991 Feb 15;114(4):325–331. doi: 10.7326/0003-4819-114-4-325. [DOI] [PubMed] [Google Scholar]
  32. Wenneker M. B., Epstein A. M. Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. JAMA. 1989 Jan 13;261(2):253–257. [PubMed] [Google Scholar]
  33. Wong Mitchell D., Shapiro Martin F., Boscardin W. John, Ettner Susan L. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002 Nov 14;347(20):1585–1592. doi: 10.1056/NEJMsa012979. [DOI] [PubMed] [Google Scholar]
  34. Yergan J., Flood A. B., LoGerfo J. P., Diehr P. Relationship between patient race and the intensity of hospital services. Med Care. 1987 Jul;25(7):592–603. doi: 10.1097/00005650-198707000-00003. [DOI] [PubMed] [Google Scholar]

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