Race, gender, and partnership in the patient-physician relationship
Race, gender, and partnership in the patient-physician relationship
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DOI：
10.1001/jama.282.6.583
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发表时间：
1999-08-11
影响因子：
120.7
通讯作者：
Ford, DE
中科院分区：
文献类型：
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作者：
Cooper-Patrick, L;Gallo, JJ;Ford, DE
背景许多研究都记录了种族和性别差异的医疗保健接受的病人。然而，很少有研究有相关的差异，在人际关系的质量，病人和医生的种族和gender.Objective描述种族/民族和性别的病人和医生是如何与医生的参与式决策（PDM）的风格。1996年11月至1998年6月对1816名18至65岁的成年人进行了电话调查（平均年龄41岁），最近参加了与城市环境中的大型混合模式管理式护理组织相关的32个初级保健实践中的一个。接受调查的患者中，66%为女性，43%为白色，45%为非洲裔美国人。医生样本（n = 64）为63%男性，56%白色，25%非裔美国人。主要结果测量患者对其医生PDM风格的评分，100分量表。结果非裔美国人患者在调整患者年龄，性别，教育，婚姻状况，健康状况，和医患关系的长度（平均[SE] PDM评分，58.0 [1.2] vs 60.6 [3.3]; P= 0.03）。少数民族和白色医生的PDM类型评分没有差异（非裔美国人的调整后平均[SE] PDM评分为59.2 [1.7] vs whiles，61.7 [3.1]; P = 0.13）。与他们的医生有着种族一致关系的患者比种族不一致关系的患者对他们的就诊的参与性评价更高（差异[SEI，2.6 [1.1]; P=.02），女性医生的患者有更多的参与性就诊（女性的调整后平均[SE] PDM评分为62.4 [1.3]，男性为59.5 [3.1]; P=.03），但医生和患者之间的性别一致性与PDM评分无显著相关性（未校正的平均值[SEI PDM评分，一致性为76.0 [1.0]，不一致性为74.5 [0.9]; P = 0.12）。患者满意度与PDM评分在所有种族/ethnicationgroups.Conclusions我们的数据表明，非洲裔美国人的患者率与医生的参与比白人少。然而，看医生的病人认为他们自己种族的医生的决策风格更具参与性。改善初级保健医生和患者之间的跨文化沟通，并为患者提供接触不同医生群体的机会，可能会导致更多的患者参与护理，更高水平的患者满意度和更好的健康结果。
Context Many studies have documented race and gender differences in health care received by patients. However, few studies have related differences in the quality of interpersonal care to patient and physician race and gender.Objective To describe how the race/ethnicity and gender of patients and physicians are associated with physicians' participatory decision-making (PDM) styles.Design, Setting, and Participants Telephone survey conducted between November 1996 and June 1998 of 1816 adults aged 18 to 65 years (mean age, 41 years) who had recently attended 1 of 32 primary care practices associated with a large mixed-model managed care organization in an urban setting. Sixty-six percent of patients surveyed were female, 43% were white, and 45% were African American. The physician sample (n = 64) was 63% male, with 56% white, and 25% African American.Main Outcome Measure Patients' ratings of their physicians' PDM style on a 100-point scale.Results African American patients rated their visits as significantly less participatory than whites in models adjusting for patient age, gender, education, marital status, health status, and length of the patient-physician relationship (mean [SE] PDM score, 58.0 [1.2] vs 60.6 [3.3]; P=.03). Ratings of minority and white physicians did not differ with respect to PDM style (adjusted mean [SE] PDM score for African Americans, 59.2 [1.7] vs whiles, 61.7 [3.1]; P =.13). Patients in race-concordant relationships with their physicians rated their visits as significantly more participatory than patients in race-discordant relationships (difference [SEI, 2.6 [1.1]; P=.02), Patients of female physicians had more participatory visits (adjusted mean [SE] PDM score for female, 62.4 [1.3] vs male, 59.5 [3.1]; P=.03), but gender concordance between physicians and patients was not significantly related to PDM score (unadjusted mean [SEI PDM score, 76.0 [1.0] for concordant vs 74.5 [0.9] for discordant; P =.12). Patient satisfaction was highly associated with PDM score within all race/ethnicity groups.Conclusions Our data suggest that African American patients rate their visits with physicians as less participatory than whites. However, patients seeing physicians of their own race rate their physicians' decision-making styles as more participatory. Improving crosscultural communication between primary care physicians and patients and providing patients with access to a diverse group of physicians may lead to more patient involvement in care, higher levels of patient satisfaction, and better health outcomes.