患者-提供者沟通、患者自我效能方面的种族差异，及其与系统性红斑狼疮相关损害的关联：一项横断面调查。
Racial Differences in Patient-provider Communication, Patient Self-efficacy, and Their Associations With Systemic Lupus Erythematosus-related Damage: A Cross-sectional Survey.
机构信息
K. Sun, MD, MS, Assistant Professor, A.E. Eudy, PhD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Associate Professor, R.E. Sadun, MD, PhD, Assistant Professor, J.L. Rogers, MD, Assistant Professor, J. Doss, MD, MPH, Assistant Professor, M.E. Clowse, Associate Professor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine;
K. Sun, MD, MS, Assistant Professor, A.E. Eudy, PhD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Associate Professor, R.E. Sadun, MD, PhD, Assistant Professor, J.L. Rogers, MD, Assistant Professor, J. Doss, MD, MPH, Assistant Professor, M.E. Clowse, Associate Professor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine.
出版信息
J Rheumatol. 2021 Jul;48(7):1022-1028. doi: 10.3899/jrheum.200682. Epub 2020 Sep 1.
OBJECTIVE
Despite significant racial disparities in systemic lupus erythematosus (SLE) outcomes, few studies have examined how disparities may be perpetuated in clinical encounters. We aimed to explore associations between areas of clinical encounters - patient-provider communication and patient self-efficacy - with SLE-related damage, in order to identify potential areas for intervention to reduce SLE outcome disparities.
METHODS
We collected cross-sectional data from a tertiary SLE clinic including patient-provider communication, general self-efficacy, self-efficacy for managing medications and treatments, patient-reported health status, and clinical information. We compared racial groups and used logistic regression to assess race-stratified association of patient-provider communication and patient self-efficacy with having SLE-related damage.
RESULTS
Among 121 patients (37% White, 63% African American), African Americans were younger, more likely to be on Medicaid, and less likely to be college educated, married, or living with a partner or spouse. African Americans reported less fatigue and better social function, took more complex SLE medication regimens, had lower fibromyalgia (FM) scores, and had higher SLE disease activity and SLE-related damage scores. African Americans reported similar self-efficacy compared to White patients, but they reported more hurried communication with providers, which was reflected in their perception that providers used words that were difficult to understand. Perceiving providers use difficult words and lower general self-efficacy were associated with having SLE-related damage among African American but not White patients.
CONCLUSION
African Americans had more severe SLE and perceived more hurried communication with providers. Both worse communication and lower self-efficacy were associated with having SLE-related damage among African American but not White patients, suggesting that these factors should be investigated as potential interventions to reduce SLE racial disparities.
目的
尽管红斑狼疮（SLE）的系统结局存在显著的种族差异，但很少有研究探讨这些差异是如何在临床接触中持续存在的。我们旨在探讨临床接触的各个方面——医患沟通和患者自我效能——与 SLE 相关损害之间的关联，以确定潜在的干预领域，以减少 SLE 结局的种族差异。
方法
我们从一家三级 SLE 诊所收集了横断面数据，包括医患沟通、一般自我效能、管理药物和治疗的自我效能、患者报告的健康状况和临床信息。我们比较了不同种族群体，并使用逻辑回归评估了医患沟通和患者自我效能与 SLE 相关损害的种族分层关联。
结果
在 121 名患者（37%为白人，63%为非裔美国人）中，非裔美国人更年轻，更有可能享受医疗补助，更不可能接受过大学教育、已婚或与伴侣或配偶同住。非裔美国人报告的疲劳和社会功能更好，服用的 SLE 药物治疗方案更复杂，纤维肌痛（FM）评分更低，SLE 疾病活动度和 SLE 相关损害评分更高。非裔美国患者的自我效能与白人患者相似，但他们报告与提供者的沟通更匆忙，这反映在他们认为提供者使用了难以理解的词汇。感知到提供者使用难以理解的词汇和较低的一般自我效能与非裔美国患者而非白人患者的 SLE 相关损害有关。
结论
非裔美国人的 SLE 更为严重，并且与提供者的沟通更为匆忙。沟通较差和自我效能较低与非裔美国患者而非白人患者的 SLE 相关损害有关，这表明这些因素应作为潜在的干预措施进行调查，以减少 SLE 的种族差异。
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