Unequal interactions: Examining the role of patient-centered care in reducing inequitable diffusion of a medical innovation, the human papillomavirus (HPV) vaccine
Unequal interactions: Examining the role of patient-centered care in reducing inequitable diffusion of a medical innovation, the human papillomavirus (HPV) vaccine
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DOI：
10.1016/j.socscimed.2017.09.030
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发表时间：
2018-03-01
影响因子：
5.4
通讯作者：
Schuster, Mark A.
中科院分区：
文献类型：
--
作者：
Fenton, Anny T.;Elliott, Marc N.;Schuster, Mark A.
理论基础：关于医疗创新传播不平等的研究很少考虑以患者为中心的护理的作用。目的：我们利用获得许可后不久对人乳头瘤病毒(HPV)疫苗的吸收来探索以患者为中心的护理的作用。方法：使用对美国父母和青少年的纵向多点调查，我们评估了以患者为中心的护理评级是否会在HPV疫苗接种过程的两个决策点上形成种族/民族和社会经济差距：(1)医疗提供者是否推荐疫苗，(2)父母是否决定接种。结果：我们没有发现证据表明，以患者为中心与接种疫苗的联系因父母教育而异。相比之下，父母对提供者以患者为中心的评级与父母报告从提供者那里收到HPV疫苗推荐的种族/民族差异显著相关：在认为以病人为中心的护理较低的父母中，白人父母获得此类建议的几率是黑人父母的2.6倍，但当父母报告高度以病人为中心时，种族/民族差距几乎消失。温和的调解分析表明，以患者为中心是导致接种接种差异的主要原因：在报告较低以患者为中心的父母中，白人父母为他们的孩子接种疫苗的几率是黑人父母的8.1倍，而当以患者为中心的比例较高时，两组人接种疫苗的可能性相同。结论：结果表明，以患者为中心的护理是医疗创新不平等扩散的一个相对较少被研究的因素，值得更多关注。提高HPV疫苗接种率的努力应该探索为什么某些患者群体可能不太可能收到建议，并应该支持提供者一致地向所有患者群体通报疫苗接种情况。(C)2017爱思唯尔有限公司。保留所有权利。
Rationale: Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care.Objective: We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore the role of patient-centered care.Methods: Using a longitudinal multi-site survey of US parents and adolescents, we assessed whether patient-centered care ratings might shape racial/ethnic and socioeconomic gaps at two decision points in the HPV vaccination process: (1) Whether a medical provider recommends the vaccine and (2) whether a parent decides to vaccinate.Results: We did not find evidence that the association of patient-centeredness with vaccination varies by parent education. In contrast, parent ratings of providers' patient-centeredness were significantly associated with racial/ethnic disparities in parents' reports of receiving a HPV vaccine recommendation from a provider: Among parents who rate patient-centered care as low, white parents' odds of receiving such a recommendation are 2.6 times higher than black parents' odds, but the racial/ethnic gap nearly disappears when parents report high patient-centeredness. Moderated mediation analyses suggest that patient-centeredness is a major contributor underlying vaccination uptake disparities: Among parents who report low patient-centeredness, white parents' odds of vaccinating their child are 8.1 times higher than black parents' odds, while both groups are equally likely to vaccinate when patient-centeredness is high.Conclusion: The results indicate that patient-centered care, which has been a relatively understudied factor in the unequal diffusion of medical innovations, deserves more attention. Efforts to raise HPV vaccination rates should explore why certain patient groups may be less likely to receive recommendations and should support providers to consistently inform all patient groups about vaccination. (C) 2017 Elsevier Ltd. All rights reserved.