African-American patients who have experienced racism or classism in health care settings have less positive doctor-patient communication during future visits with other health care providers, according to a study led by the University of Pittsburgh School of Medicine. The study also showed that past experiences with discrimination do not have the same impact on subsequent doctor-patient communication for white patients. The study appears in the July issue of the journal Medical Care.

Leslie Hausmann, Ph.D., assistant professor of internal medicine, Pitt School of Medicine, and research health scientist, Veterans Affairs Pittsburgh Healthcare System Center for Health Equity Research and Promotion, said the study is important because it shows that the effects of discrimination on patient disengagement with the health care system can be seen at the level of doctor-patient interactions, and it offers an avenue towards intervention.

Dr. Hausmann surveyed 100 African-American and 253 white patients being treated for osteoarthritis at two Veterans Affairs clinics. Patients were surveyed about past experiences with racism and classism in healthcare settings before their visit to the VA clinics. Their clinic appointments were then audiotaped and coded by the researchers for informational content and emotional tone. After going to the clinics, patients also evaluated the visits, including whether they felt informed during the visit, whether the provider was warm and respectful, and whether it was easy to communicate with the provider.

The study found that 70 percent of African-Americans perceived that they had experienced racism in a health care setting in the past, compared with just 26 percent of whites. Also, African-American patients who had experienced racism or classism in the past displayed less positive emotion during the visit and reported that they felt their health care providers were less warm and respectful and more difficult to communicate with. The information exchanged between patients and providers during visits was not affected by patients' past experiences with discrimination. For white patients, neither the informational content nor emotional tone of visits was affected by past experiences of discrimination.

Past studies have shown that patients who feel discriminated against in health care settings tend to miss more appointments and are less likely to take medication as prescribed, among other things that can negatively affect their health.

"There may be a cycle where patients experience discrimination, the effects of which carry over and make future health care encounters less positive, which further reduces patient satisfaction, and so on. Over time, this cycle may lead to patients disengaging from the health care system all together. It is important to find a way to break that cycle," Dr. Hausmann said. "This study suggests that focusing on doctor-patient interactions may be useful in that regard. Educating providers about how their patients' past experiences may affect how patients communicate, and training providers on how to maintain positive emotional tone while communicating with patients are good ways to start."

Collaborators on the study were Michael J. Hannon, M.A.; Barbara A. Hanusa, Ph.D.; and C. Kent Kwoh, M.D., all of the University of Pittsburgh School of Medicine and the VA Pittsburgh Healthcare System; Said A. Ibrahim, M.D., M.P.H., University of Pennsylvania School of Medicine and Philadelphia VA Medical System; and Denise M. Kresevic, R.N., Ph.D., Louis Stokes Department of Veterans Affairs Medical Center.

The study was funded by the Veterans Health Administration and the National Institutes of Musculoskeletal and Skin Disorders.

Source:
University of Pittsburgh School of Medicine