Racial differences in patient perception of interactions with providers are associated with health outcomes in type II diabetes.

OBJECTIVES: Examine the association of patient perceptions of care with hemoglobin A1c (HbA1c), medication adherence, and missed appointments in non-Hispanic Black (NHB) and White (NHW) patients with type 2 diabetes (T2DM). METHODS: We used linear and logistic regression models to analyze the association of the Interpersonal Processes of Care survey (IPC) with HbA1c, medication adherence, and missed appointments. We then examined how these associations differed by race. RESULTS: There was no overall association between IPC subdomains and HbA1c in our sample (N = 221). NHB patients perceiving their provider always explained results and medications had a HbA1c on average 0.59 (-1.13, -0.04; p = 0.04) points lower than those perceiving their provider sometimes explained results and medications. No effect was observed in NHWs. Never perceiving disrespect from office staff was associated with an average 0.67 (-1.1, -0.24; p = 0.002) point improvement in medication adherence for all patients. Never perceiving discrimination from providers was associated with a 0.44 (-0.63, -0.25; p < 0.0001) decrease in the probability of missing an appointment for NHB patients. CONCLUSIONS: These results demonstrate that particular aspects of communication in the patient-provider interaction may contribute to racial disparities in T2DM. PRACTICE IMPLICATIONS: Communication training for both providers and staff may reduce disparities in T2DM.

Duke Scholars

Author Maren Karine Olsen Biostatistics & Bioinformatics, Division of Biostatistics

Author Kimberly Sherell Johnson Medicine, Geriatrics and Palliative Care

Author Laura Pat Svetkey Medicine, Nephrology

Author Roland Albert Matsouaka Biostatistics & Bioinformatics, Division of Biostatistics

Author Bryan Courtney Batch Medicine, Endocrinology, Metabolism, and Nutrition