Attitudes about Racism, Medical Mistrust, and Satisfaction with Care among African American and White Cardiac Patients
ABSTRACT The authors examine determinants of satisfaction with medical care among 1,784 (781 African American and 1,003 white) cardiac patients. Patient satisfaction was modeled as a function of predisposing factors (gender, age, medical mistrust, and perception of racism) and enabling factors (medical insurance). African Americans reported less satisfaction with care. Although both black and white patients tended not to endorse the existence of racism in the medical care system, African American patients were more likely to perceive racism. African American patients were significantly more likely to report mistrust. Multivariate analysis found that the perception of racism and mistrust of the medical care system led to less satisfaction with care. When perceived racism and medical mistrust were controlled, race was no longer a significant predictor of satisfaction.
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ABSTRACT: Background: Healthcare discrimination based on race/ethnicity is associated with decreased healthcare access and utilization among racial/ethnic minority patients. Discrimination based on criminal record may also negatively impact healthcare access and utilization among ex-prisoners. Methods: We conducted a secondary analysis of data from a cross-sectional survey of 172 men recently released from state prison. We examined the association between self-reported criminal record discrimination by healthcare workers and utilization of 1) emergency department (ED) and 2) primary care services. We created staged logistic regression models, adjusting for sociodemographic characteristics and self-reported racial/ethnic discrimination. Results: Among 172 male participants, 42% reported a history of criminal record discrimination by healthcare workers. Participants who reported discrimination were older (mean, 42 vs. 39 years; p = .01), more likely to be college educated (26% vs. 11%; p = .03), and had more extensive incarceration histories (median years incarcerated, 16 vs. 9; p = .002) compared to those who did not report discrimination. Self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization [odds ratio (OR) = 2.7, 95% confidence interval 24 (CI) 1.2-6.2] but not infrequent primary care utilization [OR = 1.6, 95% CI 0.7-3.8]. Conclusions: Recently released prisoners report criminal record discrimination by healthcare workers, and this experience may impact healthcare utilization. Future studies should seek to further characterize criminal record discrimination by healthcare workers and prospectively examine its impact on health outcomes. Background03/2014; 2(6):1-8. DOI:10.1186/2194-7899-2-6
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ABSTRACT: The objective of this study was to assess factors that affect breast cancer patients' recall of patient assistance services. We surveyed newly-diagnosed breast cancer patients and compared recall of receiving patient assistance services at 2 weeks and 6 months in a patient-assistance randomized controlled trial aimed to connect women to such programs. The intervention group received information about assistance programs targeted to their practical, psychosocial, and/or informational needs; the control group received a Department of Health pamphlet about breast cancer and its treatment, including a list of patient assistance services. Of 333 women, 210 (63%) reported informational, 183 (55%) psychosocial and 177 (53%) practical needs. At 2 weeks, 96% (202/210) of women with informational needs reported receiving informational material but at 6 months, recall dropped to 69% (140/210). All women whose informational needs were met recalled receiving information, compared to 31% whose needs were unmet (p < 0.0001). Of 109 intervention patients with psychosocial or practical needs, 77% (79) contacted a program specified in their action plan at 2 weeks. However, at 6 months, only 39% (31/79) recalled contacting a program. Women without recall were less likely to report having their needs met (6% vs. 58%; p < 0.001). Recall of patient assistance services is strongly related to having needs met. Use of patient surveys to evaluate utilization or impact of such programs should be used with caution due to poor patient recall. CLINICAL TRIALS # NCT00233077: http://www.clinicaltrials.gov/ct2/show/NCT00233077?term=Nina+Bickell&rank=2.SpringerPlus 10/2012; 1:24. DOI:10.1186/2193-1801-1-24
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ABSTRACT: Over the past decade, interest in exploring how health care system distrust is associated with individual health outcomes and behaviors has grown substantially, and the racial difference in distrust has been well documented, with African Americans demonstrating higher distrust than whites. However, relatively little is known about whether the individual-level determinants of distrust differ by various dimensions of distrust, and even less is understood regarding whether the race-distrust association could be moderated by the neighborhood social environment. This study used a dual-dimensional distrust scale (values and competence distrust), and applied social disorganization theory to address these gaps. We combined the 2008 Philadelphia Health Management Corporation's household survey (N = 3746 adult respondents, 51% of which are of African American race) with neighborhood-level data (N = 45 neighborhoods) maintained by the 2000 U.S. Census and the Philadelphia Police Department. Using multilevel modeling, we found that first, after controlling for individual- and neighborhood-level covariates, African American residents have greater values distrust than whites, but no racial difference was found in competence distrust; second, competence distrust is more likely to be determined by personal health status and access to health care services than is values distrust; and third, ceteris paribus, the association between race and values distrust was weakened by the increasing level of neighborhood stability. These results not only indicate that different aspects of distrust may be determined via different mechanisms, but also suggest that establishing a stable neighborhood may ameliorate the level of distrust in the health care system among African Americans. As distrust has been identified as a barrier to medical research, the insight provided by this study can be applied to develop a health care system that is trusted, which will, in turn, improve population health.Social Science [?] Medicine 02/2012; 74(9):1342-52. DOI:10.1016/j.socscimed.2012.01.012 · 2.56 Impact Factor