Exploring racial and sociodemographic trends in physician behavior, physician trust and their association with blood pressure control.

Racial disparities in several facets of healthcare have been widely documented, showing that African Americans face disproportionately high health risks when compared to whites. With respect to hypertension, 40% of the > or = 36 million African Americans are affected. We examined the correlation between the patient-physician relationship and the racial disparities in healthcare. We hypothesized that increased physician counseling would lead to higher patient trust and, thus, a greater likelihood of having controlled blood pressure. Four-hundred-sixty black and 333 white Veteran Affairs (VA) patients previously diagnosed with hypertension were included. Patients with a systolic reading > or = 140 mmHg and/or a diastolic reading > or = 90 mmHg at a recent doctor visit were considered to have uncontrolled blood pressure. By using patient exit interviews (PEIs), we quantified the number of counseling behaviors performed by physicians. Patient trust in physician was measured by validated questions answered on a 1-5 agreement scale. Results showed no racial disparity in blood pressure control. While blacks were found to receive more counseling, whites reported higher trust. Controlling for sociodemographic factors, we found that regardless of race, higher PEI scores were associated with higher trust; however, they were also associated with uncontrolled blood pressure. The association of physician behavior with blood pressure was not mediated by trust. We were unable to make direct cause-and-effect conclusions because the measures were recorded from a one-time questionnaire. Future research should focus on uncovering causal relationships, allowing physicians to work towards ending the established healthcare disparities.