Racial Differences in Patient-Provider Communication and Medication Adherence.

描述（由申请人提供）：该职业发展奖项的目标是发展医患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改善医患沟通的领导者，重点研究医患沟通与慢性疾病患者健康差异的关系。基于她在心血管行为医学和少数民族健康方面的培训和经验，候选人确定了四个核心培训领域，以进一步发展成为一名独立研究者所需的技能：1)在心血管疾病、健康差异研究、患者与提供者沟通和行为医学方面与多学科指导团队进行互动；2)课程和教学培训，以发展少数民族和心血管健康研究的方法和分析原则方面的专业知识；3)在使用定性分析和客观互动分析系统方面进行严格的实践培训，以阐明医患沟通与患者预后的关系；4)参加研讨会/工作坊，以获得制定干预措施以改善医患沟通所需的基本知识。尽管越来越多的证据表明，医患沟通中的种族差异会影响患者护理，但许多研究都只考察了患者满意度等护理过程，而很少关注药物依从性等中间结果。此外，研究患者-提供者沟通中的种族差异并没有充分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，医患沟通导致高血压相关差异的潜在途径尚不清楚。这项两阶段、混合方法的研究，通过阐明患者种族对在纽约市贝尔维尤门诊诊所接受治疗的120名黑人和白人高血压患者的医患沟通和药物依从性的影响，为解决这些差距提供了一个独特的机会。具体来说，对患者-提供者沟通的定性分析（第一阶段）的发现将为概念模型的发展提供信息，该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、提供者和临床水平的特征将作为协变量进行评估，以检查患者-提供者沟通和药物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，以及已建立的指导团队的支持和进入资源丰富的机构的机会，将有助于启动候选人的学术研究轨迹，使其成为一名专注于行为医学和心血管健康差异的独立研究者。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，以降低高危人群心血管死亡率和发病率的差异。

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.