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患者在与医疗保健提供者讨论处方药物方面的报告体验:在大型医疗服务系统中存在种族/民族差异的证据。

Patient-Reported Experiences in Discussing Prescribed Medications with a Health Care Provider: Evidence for Racial/Ethnic Disparities in a Large Health Care Delivery System.

机构信息

Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, California.

Janssen Scientific Affairs, LLC, Titusville, New Jersey.

出版信息

Popul Health Manag. 2020 Feb;23(1):78-84. doi: 10.1089/pop.2018.0206. Epub 2019 Apr 23.

DOI:10.1089/pop.2018.0206
PMID:31013464
Abstract

The objective was to understand patient-reported experiences in communicating with a health care provider about prescribed medications in a health care setting serving diverse racial/ethnic groups. Adult patients who completed a patient-experience survey and received a prescription for a hypertension, hyperlipidemia, or diabetes medication at the surveyed encounter were studied (N = 19,006). Data were collected in a large mixed-payer outpatient health care system in northern California between 2011 and 2014. Surveys were linked to the electronic health records of the office visit to which the survey refers, with detailed information on visit content, provider, and patient characteristics. The focus was on 2 survey questions asking about providers' efforts to include patients in treatment decisions and the information received about medications. Logistic regression was used to assess factors associated with survey responses, which were dichotomized as very good or not (ie, good, fair, poor, very poor). Chinese (OR: 0.59; 95% CI: 0.50-0.70), Asian Indians (0.68; 0.54-0.84), Japanese (0.74; 0.57-0.98), Koreans (0.46; 0.25-0.83), Vietnamese (0.51; 0.27-0.98), and African Americans (0.74; 0.55-0.99) vs. non-Hispanic whites (NHWs) reported poorer experiences of involvement in treatment decisions. Similarly, Chinese (0.59; 0.49-0.70), Asian Indians (0.67; 0.54-0.83), Koreans (0.38; 0.21-0.70), Vietnamese (0.46; 0.25-0.87), African Americans (0.65; 0.49-0.87), and Mexicans (0.77; 0.61-0.98) vs. NHWs reported poorer experiences for information received about medications. Almost all racial/ethnic groups report poorer experiences with involvement in treatment decisions and information received about medications than NHWs in the same clinical setting, which may contribute to poorer adherence and outcomes among racial/ethnic minority groups.

摘要

目的是了解在为不同种族/族裔群体服务的医疗保健环境中与医疗保健提供者就规定的药物进行沟通时患者的报告体验。研究对象为 2011 年至 2014 年间在加利福尼亚州北部一家大型混合支付门诊医疗保健系统中完成患者体验调查并在调查就诊时获得高血压、高血脂或糖尿病药物处方的成年患者(n=19006)。调查数据来自办公室就诊的电子健康记录,其中详细记录了就诊内容、提供方和患者特征。重点是 2 个调查问题,询问提供者在治疗决策中让患者参与的努力以及患者收到的关于药物的信息。使用逻辑回归评估与调查回答相关的因素,将其分为非常好或不好(即好、一般、差、很差)。与非西班牙裔白人(NHW)相比,中国人(OR:0.59;95%CI:0.50-0.70)、印度裔(0.68;0.54-0.84)、日裔(0.74;0.57-0.98)、韩裔(0.46;0.25-0.83)、越南裔(0.51;0.27-0.98)和非裔美国人(0.74;0.55-0.99)报告在治疗决策参与方面的体验较差。同样,中国人(0.59;0.49-0.70)、印度裔(0.67;0.54-0.83)、韩裔(0.38;0.21-0.70)、越南裔(0.46;0.25-0.87)、非裔美国人(0.65;0.49-0.87)和墨西哥裔(0.77;0.61-0.98)与 NHW 相比,报告在药物信息获取方面的体验较差。在相同的临床环境中,几乎所有种族/族裔群体在治疗决策参与和药物信息获取方面的体验都比 NHW 差,这可能导致少数族裔群体的治疗依从性和结果较差。

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