患者/照顾者对临床医生的信任与医疗保健歧视经历之间的关联。
Associations Between Patient/Caregiver Trust in Clinicians and Experiences of Healthcare-Based Discrimination.
机构信息
From the California University of Science and Medicine, Colton, CA (AK); Social Interventions Research and Evaluation Network, Center for Health and Community, University of California San Francisco, San Francisco, CA (LMG); Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA (LMG, EHDM); Children's HealthWatch, Boston, MA (SEDC); School of Public Health & Chobanian and Avedisian School of Medicine, Boston University, Boston, MA (SEDC); Department of Medicine, University of Massachusetts Chan Medical School, North Worcester, MA (EB); Division of Emergency Medicine, Boston Children's Hospital, Boston, MA (EWF); Department of Pediatrics, Harvard Medical School, Boston, MA (EWF); Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI (AJC); Department of Family Medicine, Warren Alpert Medical School of Brown University (AJC); Department of Health Services, Policy, and Practice, Brown University School of Public Health (AJC); Section of General Internal Medicine, University of Chicago, Chicago, IL (NJG); Center for Community Health and Health Equity, Brigham and Women's Hospital, Boston, MA (MJO); Department of Medicine, Brigham and Women's Hospital, Boston, MA (CRC).
出版信息
J Am Board Fam Med. 2024 Jul-Aug;37(4):607-636. doi: 10.3122/jabfm.2023.230182R1.
BACKGROUND
Higher trust in healthcare providers has been linked to better health outcomes and satisfaction. Lower trust has been associated with healthcare-based discrimination.
OBJECTIVE
Examine associations between experiences of healthcare discrimination and patients' and caregivers of pediatric patients' trust in providers, and identify factors associated with high trust, including prior experience of healthcare-based social screening.
METHODS
Secondary analysis of cross-sectional study using logistic regression modeling. Sample consisted of adult patients and caregivers of pediatric patients from 11 US primary care/emergency department sites.
RESULTS
Of 1,012 participants, low/medium trust was reported by 26% identifying as non-Hispanic Black, 23% Hispanic, 18% non-Hispanic multiple/other race, and 13% non-Hispanic White ( = .001). Experience of any healthcare-based discrimination was reported by 32% identifying as non-Hispanic Black, 23% Hispanic, 39% non-Hispanic multiple/other race, and 26% non-Hispanic White ( = .012). Participants reporting low/medium trust had a mean discrimination score of 1.65/7 versus 0.57/7 for participants reporting high trust ( < .001). In our adjusted model, higher discrimination scores were associated with lower trust in providers (aOR 0.74, 95%CI = 0.64, 0.85). A significant interaction indicated that prior healthcare-based social screening was associated with reduced impact of discrimination on trust: as discrimination score increased, odds of high trust were greater among participants who had been screened (aOR = 1.28, 95%CI = 1.03, 1.58).
CONCLUSIONS
Patients and caregivers reporting more healthcare-based discrimination were less likely to report high provider trust. Interventions to strengthen trust need structural antiracist components. Increased rapport with patients may be a potential by-product of social screening. Further research is needed on screening and trust.
背景
更高的医疗服务提供者信任与更好的健康结果和满意度相关。较低的信任与医疗保健为基础的歧视有关。
目的
检查医疗保健歧视的经历与儿科患者的患者和照顾者对提供者的信任之间的关联，并确定与高信任相关的因素，包括之前的医疗保健为基础的社会筛选经历。
方法
使用逻辑回归建模对横断面研究进行二次分析。样本包括来自美国 11 个初级保健/急诊部门的成年患者和儿科患者的照顾者。
结果
在 1012 名参与者中，26%的非西班牙裔黑人、23%的西班牙裔、18%的非西班牙裔多种族/其他种族和 13%的非西班牙裔白人表示信任程度较低/中等（= 0.001）。32%的非西班牙裔黑人、23%的西班牙裔、39%的非西班牙裔多种族/其他种族和 26%的非西班牙裔白人报告了任何医疗保健为基础的歧视（= 0.012）。报告低/中等信任的参与者歧视评分平均为 1.65/7，而报告高信任的参与者歧视评分平均为 0.57/7（< 0.001）。在我们的调整模型中，较高的歧视评分与对提供者的信任度较低相关（优势比 0.74，95%置信区间 0.64，0.85）。一个显著的交互作用表明，之前的医疗保健为基础的社会筛选与减少歧视对信任的影响有关：随着歧视评分的增加，接受过筛选的参与者中高信任的可能性更大（优势比 1.28，95%置信区间 1.03，1.58）。
结论
报告更多医疗保健为基础的歧视的患者和照顾者不太可能报告对提供者的高度信任。加强信任的干预措施需要结构性的反种族主义组成部分。与患者建立更好的关系可能是社会筛选的潜在副产品。需要进一步研究筛选和信任。
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