Patient-reported Communication Quality and Perceived Discrimination in Maternity Care
Patient-reported Communication Quality and Perceived Discrimination in Maternity Care
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DOI：
10.1097/mlr.0000000000000411
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发表时间：
2015-10-01
期刊：
影响因子：
3
通讯作者：
Kozhimannil, Katy B.
中科院分区：
文献类型：
--
作者：
Attanasio, Laura;Kozhimannil, Katy B.
背景：高质量的沟通和积极的医患关系是以患者为中心的护理的两个方面，也是质量的重要组成部分。我们评估了患者报告的沟通问题中的种族/民族差异，以及全国妇女在产科护理中感受到的歧视，并测量了这些结果相关性中的种族/民族差异。 方法：本次分析的数据来自“倾听母亲 III”调查，该调查是对 2011-2012 年在美国一家医院生下单胎婴儿的妇女进行的全国样本调查。使用多项式和逻辑回归进行评估，结果是不愿提出问题和在产前护理中公开讨论存在障碍，以及在分娩住院期间感受到歧视。我们还估计了按种族/民族分层的模型。结果：超过 40% 的女性报告在产前护理中存在沟通问题，24% 的女性在住院分娩期间感到受到歧视。患有高血压或糖尿病与更不愿意提出问题以及报告每种类型的歧视的可能性相关。黑人和西班牙裔（与白人相比）女性因种族/民族而受到歧视的可能性更高。高等教育仅与黑人女性中更多报道的沟通问题有关。尽管患有糖尿病与所有女性的歧视观念有关，但黑人女性的这种关联更为强烈。结论：种族/族裔与感知到的种族歧视有关，但糖尿病和高血压是沟通问题和歧视观念的一致预测因素。努力改善沟通和减少感知歧视是改善产科服务中以患者为中心的护理的一个重要重点领域。
Background:High-quality communication and a positive patient-provider relationship are aspects of patient-centered care, a crucial component of quality. We assessed racial/ethnic disparities in patient-reported communication problems and perceived discrimination in maternity care among women nationally and measured racial/ethnic variation in the correlates of these outcomes.Methods:Data for this analysis came from the Listening to Mothers III survey, a national sample of women who gave birth to a singleton baby in a US hospital in 2011-2012. Outcomes were reluctance to ask questions and barriers to open discussion in prenatal care, and perceived discrimination during the birth hospitalization, assessed using multinomial and logistic regression. We also estimated models stratified by race/ethnicity.Results:Over 40% of women reported communication problems in prenatal care, and 24% perceived discrimination during their hospitalization for birth. Having hypertension or diabetes was associated with higher levels of reluctance to ask questions and higher odds of reporting each type of perceived discrimination. Black and Hispanic (vs. white) women had higher odds of perceived discrimination due to race/ethnicity. Higher education was associated with more reported communication problems among black women only. Although having diabetes was associated with perceptions of discrimination among all women, associations were stronger for black women.Conclusions:Race/ethnicity was associated with perceived racial discrimination, but diabetes and hypertension were consistent predictors of communication problems and perceptions of discrimination. Efforts to improve communication and reduce perceived discrimination are an important area of focus for improving patient-centered care in maternity services.