School of Social Work, Universityof Illinois at Urbana–Champaign, Urbana, IL 61801, USA.
Psychiatr Serv. 2011 May;62(5):525-31. doi: 10.1176/ps.62.5.pss6205_0525.
Data are limited on how clinicians contribute to outcome differences between black patients and white patients. Because the clinician-patient relationship is the foundation of mental health services, understanding clinicians' role in outcome differences may help identify evidence-based interventions that decrease disparities and capitalize on positive differences. Symptoms and functioning in a sample of black and white adults receiving outpatient services were examined to determine the effects of their primary clinician on those patterns.
The study included 551 patients (25% black) with serious mental illness and 62 mental health professionals (21% black) identified as the patients' primary clinician. Treatment outcomes were measured at baseline and two follow-ups (two and four months) with the Behavior and Symptom Identification Scale, a measure of symptoms and functioning. Data were analyzed with hierarchical linear modeling. Clinicians' levels of multicultural competence, burnout, and education were analyzed.
Clinicians moderated the relationship between patient race and outcome differences. There was significant variability among clinicians: approximately 20% had black patients whose outcomes were worse than those of their white patients, and 40% had black patients with better outcomes than their white patients. The only clinician factor predicting these differences was clinician's general experiences and relationships with people from racial-ethnic and cultural groups other than their own.
The occurrence of outcome differences varied across clinicians, with some clinicians magnifying outcome differences between black and white patients and others minimizing them. Factors other than clinicians' race, multicultural competence, education, and burnout may contribute to outcome differences between black and white patients.
关于临床医生如何导致黑人和白人患者之间的结果差异的数据有限。由于医患关系是精神卫生服务的基础，了解临床医生在结果差异中的作用可能有助于确定基于证据的干预措施，从而减少差异并利用积极的差异。本研究旨在调查接受门诊服务的黑人和白人成年人样本中的症状和功能，以确定其主要临床医生对这些模式的影响。
该研究包括 551 名患有严重精神疾病的患者（25%为黑人）和 62 名被确定为患者主要临床医生的心理健康专业人员（21%为黑人）。使用行为和症状识别量表（一种衡量症状和功能的测量工具）在基线和两个随访（两个月和四个月）时测量治疗结果。使用分层线性模型对数据进行分析。分析了临床医生的多元文化能力、倦怠和教育水平。
临床医生调节了患者种族与结果差异之间的关系。临床医生之间存在显著差异：约 20%的黑人群体患者的治疗结果比白人患者差，而 40%的黑人群体患者的治疗结果比白人患者好。唯一预测这些差异的临床医生因素是临床医生与自己以外的种族和文化群体的人建立关系和经验。
结果差异的发生在临床医生之间存在差异，一些临床医生放大了黑人和白人患者之间的结果差异，而另一些则最小化了这些差异。除了临床医生的种族、多元文化能力、教育和倦怠之外，其他因素可能导致黑人和白人患者之间的结果差异。
