Racial Differences in Patient-Provider Communication and Medication Adherence.

描述(由申请者提供)：该职业发展奖的目标是发展患者-提供者沟通方面的理论和方法专业知识，以促进候选人发展成为研究的领导者，以改善患者-提供者沟通，重点是其与慢性病患者健康差距的关系。基于她在心血管行为医学和少数族裔健康方面的培训和经验，候选人确定了四个核心培训领域，以进一步发展成为独立调查员所需的技能：1)与心血管疾病、健康差距研究、患者与提供者沟通和行为医学的多学科指导团队互动；2)课程工作和教学培训，以发展少数群体和心血管健康研究的方法学和分析原则方面的专业知识；3)在定性分析和客观交互分析系统的使用方面进行严格的动手培训，以阐明患者-提供者沟通如何与患者结果相关；以及；4)参加研讨会/讲习班，以获得制定干预措施以改善患者与提供者沟通所需的基本知识。尽管越来越多的证据表明，患者-提供者沟通中的种族差异会影响患者的护理，但这些研究中的许多都检查了护理过程，如患者满意度，而很少关注中间结果，如服药依从性。此外，检查患者与提供者交流中的种族差异的研究还没有充分地捕捉到患者和提供者在互动过程中可能对彼此产生的相互影响。因此，患者-提供者沟通导致高血压相关差异的潜在途径尚不清楚。这项拟议的两阶段混合方法研究提供了一个独特的机会，通过阐明患者种族对在纽约市贝尔维尤门诊护理实践中心接受护理的120名高血压黑人和白人患者的患者-提供者沟通和服药依从性的影响，提供了解决这些差距的独特机会。具体地说，患者-提供者沟通的定性分析(第一阶段)的结果将为概念模型的开发提供信息，该概念模型将用于定量评估患者种族、患者-提供者沟通和药物依从性之间的关系(第二阶段)。此外，患者、提供者和临床层面的特征将作为协变量进行评估，以检查患者与提供者沟通和服药依从性之间关系的潜在混杂因素。拟议的职业发展计划和研究项目，加上现有导师团队的支持和进入资源充足的机构的机会，将有助于将候选人的学术研究轨迹转变为一名独立的调查者，专注于行为医学和心血管健康差异。从这一奖项中获得的知识将为制定干预措施提供宝贵的信息，以降低高危人群中不同的心血管死亡率和发病率。 公共卫生相关性：根据医学研究所的不平等待遇报告，患者与提供者的沟通可能在黑人和白人之间不同的健康结果中发挥关键作用。随着越来越多的证据表明提供者的沟通行为可能是可改变的和持久的，理解患者-提供者沟通对中间患者结果的影响是至关重要的，例如药物依从性。确定患者-提供者关系中的人际关系过程与白人相比对黑人患者的服药依从性产生不同影响的潜在途径，将为制定有针对性的干预措施提供必要的信息，以改善患者-提供者的沟通，从而减少心血管死亡率和发病率方面的种族差异。

DESCRIPTION (provided by applicant): The goal of this career development award is to develop theoretical and methodological expertise in patient-provider communication to facilitate the candidate's development into a leader in research to improve patient-provider communication with an emphasis on its relation to health disparities in patients with chronic disease. Building on her training and experience in cardiovascular behavioral medicine and minority health, the candidate has identified four core-training areas to further develop the skills needed to become an independent investigator: 1) interaction with a multidisciplinary mentorship team in cardiovascular disease, health disparities research, patient-provider communication, and behavioral medicine; 2) coursework and didactic training to develop expertise in methodological and analytical principles of minority and cardiovascular health research; 3) rigorous hands-on training in the use of qualitative analysis and an objective interaction analysis system to elucidate how patient-provider communication relates to patient outcomes, and; 4) participation in seminars/workshops to gain the fundamental knowledge needed to develop an intervention to improve patient-provider communication. Despite the mounting evidence that racial differences in patient- provider communication affects patient care, many of these studies have examined processes of care such as patient satisfaction with little attention to intermediate outcomes such as medication adherence. Further, studies examining racial differences in patient-provider communication have not adequately captured the mutual influence the patient and provider may have on one another during the interaction. Thus, the potential pathways through which patient-provider communication contribute to hypertension-related disparities is not clearly understood. This proposed two-phase, mixed-methods study, provides a unique opportunity to address these gaps by elucidating the effect of patient's race on patient-provider communication and medication adherence among 120 hypertensive black and white patients receiving care at the Bellevue Ambulatory Care Practice in New York City. Specifically, findings from a qualitative analysis of patient-provider communication (Phase 1) will inform the development of a conceptual model that will be used to quantitatively evaluate the relationship between patient's race, patient-provider communication and medication adherence (Phase 2). In addition, patient-, provider-, and clinic-level characteristics will be evaluated as covariates to examine potential confounders of the relationship between patient-provider communication and medication adherence. The proposed career development plan and research project, along with the support of an established mentorship team and access to a well-resourced institution, will be instrumental in launching the candidate's academic research trajectory into an independent investigator with a focus in behavioral medicine and cardiovascular health disparities. The knowledge gained from this award will provide invaluable information for developing interventions to reduce the disparate rates of cardiovascular mortality and morbidity in high-risk populations. PUBLIC HEALTH RELEVANCE: According to the Institute of Medicine report Unequal Treatment, patient-provider communication may play a vital role in disparate health outcomes between blacks and whites. With increasing evidence that provider communication behaviors are potentially modifiable, and enduring, it is critical to understand the effect of patient-provider communication on intermediate patient outcomes such as medication adherence. Identifying the potential pathways through which interpersonal processes in the patient-provider relationship differentially affect medication adherence in black patients compared to whites will provide needed information for developing targeted interventions to improve patient-provider communication, thus reducing the racial disparities in cardiovascular mortality and morbidity.