Association of Provider Perspectives on Race and Racial Health Care Disparities with Patient Perceptions of Care and Health Outcomes

Abstract

Purpose: Research suggests that providers contribute to racial disparities in health outcomes. Identifying modifiable provider perspectives that are associated with decreased racial disparities will help in the design of effective educational interventions for providers. Methods: This cross-sectional study investigated the association between primary care provider (PCP) perspectives on race and racial disparities with patient outcomes. Results: Study participants included 40 PCPs (70% White, 30% racial minority) caring for 55 patients (45% White, 55% Black) with type 2 diabetes mellitus. Associations of provider perspectives on race and racial disparities with patient variables (Interpersonal Processes of Care [IPC] Survey, which measures patient's ratings of their provider's interpersonal skills; medication adherence; glycemic control) were measured using Spearman correlation coefficients. Results suggest that Black patients of providers who reported greater skill in caring for Black patients had more positive perceptions of care in three of four IPC subdomains (Spearman correlation coefficients of -0.43, 0.44, 0.46, all with p<0.05); however, Black patients of providers who believe that racial disparities are highly prevalent had more negative perceptions of care in three of four IPC subdomains (Spearman correlation coefficients of 0.38, -0.53, -0.51, all with p<0.05). These same provider characteristics had no correlation with outcomes of medication adherence and hemoglobin A1c (HbA1c) or among White patients. Conclusion: Findings suggest that Black patients of providers who felt better equipped to take care of Black patients had a better experience. Therefore, educational interventions for providers may be most effective if they focus on skill development rather than increasing awareness about racial disparities alone.

Keywords: diabetes; health disparities; patient–provider interaction; provider communication; racial bias; shared decision-making.

FIG. 1.

Patient recruitment. This figure describes how the patient study population was recruited and enrolled.

FIG. 2.

Provider recruitment. This figure describes how the provider study population was recruited and enrolled.

FIG. 3.

Spearman correlation coefficients of PPRR versus IPC by patient race. This figure compares Black and White confidence intervals for Spearman correlation coefficients of the three PPRR subdomains (Provider Belief, Awareness, and Self-Efficacy) versus four IPC Subdomains (IPC 1–4) by patient race. For IPC 1, a positive correlation coefficient indicates that higher provider Awareness, Belief, or Self-Efficacy is correlated with more negative patient perceptions of care. For IPC 2–4, a positive correlation coefficient indicates that higher provider Awareness, Belief, or Self-Efficacy is correlated with more positive patient perceptions of care. A table of correlation coefficients and p-values can be found in Supplementary Table S4. IPC, Interpersonal Processes of Care; PPRR, Provider Perspectives on Race and Racial Disparities.