Patient Perceptions of Provider Race Concordance and Quality of Chronic Illness Care.
Academic Article
Overview
abstract
BACKGROUND: Black people are more likely to have hypertension and report lower quality of care than White people. Patient-provider race concordance could improve perceived quality of care, potentially lessening disparities. OBJECTIVE: Investigate the association between patient-provider race concordance and patient-perceived quality of chronic disease care, as measured by the Patient Assessment of Chronic Illness Care (PACIC) scale. DESIGN: Cross-sectional analysis of baseline data from a randomized trial with Black patients with persistently uncontrolled hypertension. SETTING: Participants received care at one of 69 rural primary care practices in Alabama and North Carolina. PARTICIPANTS: Three hundred and ninety-one Black patients with persistently uncontrolled hypertension enrolled in the Southeastern Collaboration to Improve Blood Pressure Control (SEC) trial. MAIN MEASURE: PACIC overall scores and subscale scores (patient activation, delivery system, goal setting, problem solving, follow-up). RESULTS: Of 1592 patients enrolled in the SEC trial, 391 participants self-reported race concordance data and completed the PACIC. Most participants were age < 60 (52.4%), 65.2% identified as women, and 50.1% were beneficiaries of either Medicare or Medicaid. Those with patient-provider race concordance reported higher overall PACIC scores (58.8% vs 46.1%, p < 0.05), with higher sub-scores of goal setting (60.9% vs 46.8%, p < 0.05) and problem-solving (62.7% vs 48.0%, p < 0.05) compared to those without race concordance. Poisson regression models of participants age ≥ 60 years demonstrated that those with race concordance were more likely to have higher overall PACIC scores (RR 1.53, 95% CI 1.17-2.0, p = 0.002), goal-setting subscale scores (RR 1.63, 95% CI 1.24-2.15, p = 0.0005), and problem-solving subscale scores (RR 1.66, 95% CI 1.29-2.14, p < 0.0001). Those < 60 years of age had no significant findings comparing those with and without race concordance. CONCLUSIONS: Older Black patients perceived greater quality of care if their providers were also Black.
