Racial and ethnic differences in patient perceptions of bias and cultural competence in health care
Racial and ethnic differences in patient perceptions of bias and cultural competence in health care
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DOI：
10.1111/j.1525-1497.2004.30262.x
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发表时间：
2004-02-01
影响因子：
5.7
通讯作者：
Cooper, LA
中科院分区：
文献类型：
--
作者：
Johnson, RL;Saha, S;Cooper, LA
目的：要确定：1）种族和民族差异是否存在于患者对初级保健提供者（PCP）和一般卫生保健系统相关的偏见和文化能力的看法中; 2）这些差异是否可以通过患者人口统计学、护理来源或患者-提供者沟通变量来解释。共有6，299白色，非洲裔美国人，西班牙裔，和亚洲adults.MEASUREMENTS和主要结果：采访进行了使用随机数字拨号，过抽样受访者从社区高种族/少数民族浓度，并产生54.3%的响应率。主要结果解决受访者的看法，他们的PCP和医疗保健系统相关的偏见和文化能力，调整后的概率（Pr）报告每个种族群体。大多数种族/民族差异的PCP偏见和文化能力的看法解释了人口统计学，护理来源，和病人-医生沟通变量。相比之下，即使在控制混杂因素后，患者对医疗保健系统范围内的偏见和文化能力的看法仍存在种族/民族差异：非洲裔美国人，西班牙裔和亚洲人仍然比白人更有可能（P <0.001）认为：1）如果他们属于不同的种族/族裔群体，他们会得到更好的医疗照顾（分别为Pr 0.13、Pr 0.08、Pr 0.08和Pr 0.01）; 2）医务人员基于种族/民族对他们进行不公平的判断或不尊重他们（分别为Pr 0.06、Pr 0.04、Pr 0.06和Pr 0.01）以及他们的英语水平（分别为Pr 0.09、Pr 0.06、Pr 0.06和Pr 0.03）。虽然人口统计学、护理来源和医患沟通解释了患者对PCP文化能力看法的大多数种族和民族差异，这些因素不能完全解释对整个卫生保健系统偏见和文化能力的看法的差异。未来的研究应该包括对美国医疗系统中文化偏见来源的更深入的研究。
OBJECTIVES: To determine: 1) whether racial and ethnic differences exist in patients' perceptions of primary care provider (PCP) and general health care system-related bias and cultural competence; and 2) whether these differences are explained by patient demographics, source of care, or patient-provider communication variables.DESIGN: Cross-sectional telephone survey.SETTING: The Commonwealth Fund 2001 Health Care Quality Survey.SUBJECTS: A total of 6,299 white, African-American, Hispanic, and Asian adults.MEASUREMENTS AND MAIN RESULTS: Interviews were conducted using random-digit dialing; oversampling respondents from communities with high racial/ethnic minority concentrations; and yielding a 54.3% response rate. Main outcomes address respondents' perceptions of their PCPs' and health care system-related bias and cultural competence; adjusted probabilities (Pr) are reported for each ethnic group. Most racial/ethnic differences in perceptions of PCP bias and cultural competence were explained by demographics, source of care, and patient-physician communication variables. In contrast, racial/ethnic differences in patient perceptions of health care system-wide bias and cultural competence persisted even after controlling for confounders: African Americans, Hispanics, and Asians remained more likely than whites (P < .001) to perceive that: 1) they would have received better medical care if they belonged to a different race/ethnic group (Pr 0.13, Pr 0.08, Pr 0.08, and Pr 0.01, respectively); and 2) medical staff judged them unfairly or treated them with disrespect based on race/ethnicity (Pr 0.06, Pr 0.04, Pr 0.06, and Pr 0.01, respectively) and how well they speak English (Pr 0.09, Pr 0.06, Pr 0.06, and Pr 0.03, respectively).CONCLUSION: While demographics, source of care, and patient-physician communication explain most racial and ethnic differences in patient perceptions of PCP cultural competence, differences in perceptions of health care system-wide bias and cultural competence are not fully explained by such factors. Future research should include closer examination of the sources of cultural bias in the US medical system.