Racial Differences in Patient-Provider Communication and Medication Adherence.

描述（由申请人提供）：该职业发展奖的目标是发展患者与提供者沟通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，以改善患者与提供者的沟通，重点是其与慢性病患者的健康差异的关系。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，以进一步发展成为独立研究者所需的技能：1）与心血管疾病，健康差异研究，患者-提供者沟通和行为医学的多学科导师团队互动; 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门知识; 3）严格的实践培训，使用定性分析和客观的相互作用分析系统，以阐明患者如何-提供者的沟通与患者的治疗结果有关; 4）参加研讨会/讲习班，以获得制定干预措施所需的基本知识，从而改善患者与提供者的沟通。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护理，但其中许多研究都检查了护理过程，如患者满意度，而很少关注中间结果，如药物依从性。此外，研究种族差异的患者提供者的沟通没有充分捕捉的相互影响，患者和提供者可能在相互作用。因此，潜在的途径，通过患者-供应商的沟通有助于高血压相关的差异是不清楚的。这项建议的两阶段，混合方法的研究，提供了一个独特的机会，以解决这些差距，阐明患者的种族对患者提供者的沟通和药物依从性之间的影响，120名高血压黑人和白色患者在纽约市贝尔维尤门诊护理实践。具体而言，从定性分析的结果患者提供者的沟通（第1阶段）将告知一个概念模型，将用于定量评估患者的种族，患者提供者的沟通和药物依从性（第2阶段）之间的关系的发展。此外，将患者、提供者和临床水平的特征作为协变量进行评价，以检查患者-提供者沟通与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，沿着建立导师团队的支持，并获得一个资源充足的机构，将有助于启动候选人的学术研究轨迹成为一个独立的调查员，重点是行为医学和心血管健康的差异。从该奖项中获得的知识将为制定干预措施提供宝贵的信息，以降低高危人群中心血管疾病死亡率和发病率的差异。 公共卫生相关性：根据医学研究所的报告《不平等待遇》，病人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至关重要的作用。随着越来越多的证据表明，供应商的沟通行为是潜在的修改，并持久，它是至关重要的是要了解患者-供应商的沟通对中间患者的结果，如药物依从性的影响。确定潜在的途径，通过人际关系的过程中的病人与供应商的关系差异影响黑人患者的服药依从性相比，白人将提供所需的信息，制定有针对性的干预措施，以改善病人与供应商的沟通，从而减少心血管疾病的死亡率和发病率的种族差异。

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.