Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices.
Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices.
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DOI：
10.1136/bmj.b3450
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发表时间：
2009-09-16
期刊：
影响因子：
--
通讯作者：
Roland M
中科院分区：
文献类型：
--
作者：
Mead N;Roland M
目的探讨少数民族患者对初级卫生保健评价低于白色患者的原因。设计横断面分析收集的病人调查在一般的做法。 设置1098英国全科医生进行了常规调查的患者使用的全科医生评估问卷2005年4月至2006年3月。188572名受访者中，95.8%的人认为自己是“白色”、“黑人/黑人英国人”、“亚裔/亚裔英国人”或“中国人”。分析仅限于133441（71%）和147686（78%）之间的受访者与相关变量的完整数据。主要结果测量患者对全科医生预约等待时间的评估，在手术中等待咨询开始的时间，以及护理的连续性。结果三个少数民族群体的受访者对护理各个方面的评价均明显低于白色患者。等待会诊开始所花费的时间（亚洲患者评分最低）和护理连续性（中国患者评分最低）的有效性评价似乎反映了少数族裔群体报告的更差经历。白色和少数民族患者的预约等待时间的评级之间的实质性差异持续存在，但是，即使调整后的实际时间患者报告的等待。在调整了对接待人员和医生沟通技巧的评价后，这种影响在中国和黑人受访者中消失了，但亚洲患者的评分仍然大大低于白色受访者。结论不同民族对护理的评价存在显著差异。一些负面评价可能反映了沟通问题。在亚洲患者中，较低的预约等待时间也可能反映了对护理的不同期望。在比较医疗服务提供者时，调整调查结果的种族可能是合理的;然而，卫生服务也有责任满足患者的合理期望。
Objective To examine why patients from ethnic minorities give poorer evaluations of primary health care than white patients. Design Cross sectional analysis of patient surveys collected in general practice. Setting 1098 English general practices that undertook a routine survey of patients using the General Practice Assessment Questionnaire between April 2005 and March 2006. Participants 188 572 survey respondents, 95.8% of whom identified themselves as “white,” “black/black British,” “Asian/Asian British,” or “Chinese.” Analyses were restricted to between 133 441 (71%) and 147 686 (78%) respondents with complete data on relevant variables. Main outcome measures Patient evaluations of waiting times for general practitioner appointments, time spent waiting in surgeries for consultations to start, and continuity of care. Results All aspects of care were rated substantially lower by respondents from the three ethnic minority groups than by white patients. Poorer evaluations of time spent waiting for consultations to begin (rated lowest by Asian patients) and continuity of care (rated lowest by Chinese patients) appeared to reflect worse reported experiences by ethnic minority groups. Substantial differences between white and ethnic minority patients’ ratings of appointment waiting times persisted, however, even after adjusting for the actual time patients reported waiting. This effect disappeared for Chinese and black respondents after adjusting for evaluations of reception staff and doctors’ communication skills, but Asian patients’ ratings remained considerably lower than those of white respondents. Conclusions Important differences in assessments of care exist in different ethnic minority groups. Some negative evaluations may reflect communication issues. Among Asian patients, lower ratings of waiting times for appointments may also reflect different expectations of care. Adjusting survey results for ethnicity may be justified when comparing healthcare providers; however, health services also have a responsibility to meet legitimate patient expectations.
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