The role of cultural distance between patient and provider in explaining racial/ethnic disparities in HIV care.
The role of cultural distance between patient and provider in explaining racial/ethnic disparities in HIV care.
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DOI：
10.1016/j.pec.2011.01.012
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发表时间：
2011-12
影响因子：
3.5
通讯作者：
Beach MC
中科院分区：
文献类型：
--
作者：
Saha S;Sanders DS;Korthuis PT;Cohn JA;Sharp VL;Haidet P;Moore RD;Beach MC
我们试图评估患者和提供者之间的文化距离是否与艾滋病毒/艾滋病患者的护理质量有关，以及文化距离是否有助于解释艾滋病毒护理中的种族/民族差异。我们对美国 4 家 HIV 诊所的 437 名患者和 45 名医疗服务提供者进行了调查。我们研究了患者与医疗服务提供者之间的感知文化距离与患者对医疗保健质量、对服务提供者的信任、接受抗逆转录病毒治疗、药物依从性和病毒抑制的评分之间的关系。我们还研究了艾滋病毒护理这些方面的种族/民族差异是否是由文化距离造成的。文化距离越大，患者对医疗质量的评价越低，对医疗服务提供者的信任度越低。与白人患者相比，非白人患者的信任度、依从性和病毒抑制水平明显较低。调整患者与提供者的文化距离并没有显着影响这些差异（调解的 p 值>.10）。患者与提供者的文化距离与感知的护理质量和信任呈负相关，但不能解释艾滋病毒护理中的种族/民族差异。弥合文化差异可能会改善患者与提供者的关系，但对减少种族/民族差异的影响可能有限，除非同时努力解决其他不平等护理来源的问题。
We sought to evaluate whether cultural distance between patients and providers was associated with quality of care for people living with HIV/AIDS, and whether cultural distance helped explain racial/ethnic disparities in HIV care. We surveyed 437 patients and 45 providers at 4 HIV clinics in the U.S. We examined the association of patients' perceived cultural distance from their providers with patient ratings of healthcare quality, trust in provider, receipt of antiretroviral therapy, medication adherence, and viral suppression. We also examined whether racial/ethnic disparities in these aspects of HIV care were mediated by cultural distance. Greater cultural distance was associated with lower patient ratings of healthcare quality and less trust in providers. Compared to white patients, nonwhites had significantly lower levels of trust, adherence, and viral suppression. Adjusting for patient-provider cultural distance did not significantly affect any of these disparities (p-values for mediation >.10). Patient-provider cultural distance was negatively associated with perceived quality of care and trust but did not explain racial/ethnic disparities in HIV care. Bridging cultural differences may improve patient–provider relationships but may have limited impact in reducing racial/ethnic disparities, unless coupled with efforts to address other sources of unequal care.
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