Racial Differences in Patient-Provider Communication and Medication Adherence.

患者与提供者沟通和药物依从性的种族差异。

• 批准号: 8136485
• 负责人: Antoinette M Schoenthaler
• 金额: $ 13.45万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8136485
• 关键词: Address; Adherence; Affect; Ambulatory Care; Antihypertensive Agents; Area; Attention; Audiotape; Award; Behavioral Medicine; Cardiovascular Diseases; Cardiovascular system; Caring; Characteristics; Chronic Disease; Client satisfaction; Clinic; Code; Communication; Development; Development Plans; Dimensions; Dose; Educational workshop; Event; Feeling; Goals; Health; Health Services Accessibility; Healthy People 2010; Hypertension; Institute of Medicine (U.S.); Institution; Intervention; K-Series Research Career Programs; Knowledge; Mediating; Medical; Mentorship; Methods; Minority; Modeling; Monitor; Morbidity - disease rate; New York City; Outcome; Pathway interactions; Patient Care; Patient Preferences; Patients; Pharmaceutical Preparations; Phase; Play; Population; Preventive; Process; Provider; Race; Reporting; Research; Research Personnel; Research Project Grants; Role; Sum; System; Systems Analysis; Training; career development; communication behavior; design; experience; health care quality; health disparity; high risk; improved; interest; low socioeconomic status; medication compliance; minority health; mortality; multidisciplinary; public health relevance; racial difference; research and development; research study; skills

DESCRIPTION (provided by applicant): The goal of this career development award is to develop theoretical and methodological expertise in patient-provider communication to facilitate the candidate's development into a leader in research to improve patient-provider communication with an emphasis on its relation to health disparities in patients with chronic disease. Building on her training and experience in cardiovascular behavioral medicine and minority health, the candidate has identified four core-training areas to further develop the skills needed to become an independent investigator: 1) interaction with a multidisciplinary mentorship team in cardiovascular disease, health disparities research, patient-provider communication, and behavioral medicine; 2) coursework and didactic training to develop expertise in methodological and analytical principles of minority and cardiovascular health research; 3) rigorous hands-on training in the use of qualitative analysis and an objective interaction analysis system to elucidate how patient-provider communication relates to patient outcomes, and; 4) participation in seminars/workshops to gain the fundamental knowledge needed to develop an intervention to improve patient-provider communication. Despite the mounting evidence that racial differences in patient- provider communication affects patient care, many of these studies have examined processes of care such as patient satisfaction with little attention to intermediate outcomes such as medication adherence. Further, studies examining racial differences in patient-provider communication have not adequately captured the mutual influence the patient and provider may have on one another during the interaction. Thus, the potential pathways through which patient-provider communication contribute to hypertension-related disparities is not clearly understood. This proposed two-phase, mixed-methods study, provides a unique opportunity to address these gaps by elucidating the effect of patient's race on patient-provider communication and medication adherence among 120 hypertensive black and white patients receiving care at the Bellevue Ambulatory Care Practice in New York City. Specifically, findings from a qualitative analysis of patient-provider communication (Phase 1) will inform the development of a conceptual model that will be used to quantitatively evaluate the relationship between patient's race, patient-provider communication and medication adherence (Phase 2). In addition, patient-, provider-, and clinic-level characteristics will be evaluated as covariates to examine potential confounders of the relationship between patient-provider communication and medication adherence. The proposed career development plan and research project, along with the support of an established mentorship team and access to a well-resourced institution, will be instrumental in launching the candidate's academic research trajectory into an independent investigator with a focus in behavioral medicine and cardiovascular health disparities. The knowledge gained from this award will provide invaluable information for developing interventions to reduce the disparate rates of cardiovascular mortality and morbidity in high-risk populations. PUBLIC HEALTH RELEVANCE: According to the Institute of Medicine report Unequal Treatment, patient-provider communication may play a vital role in disparate health outcomes between blacks and whites. With increasing evidence that provider communication behaviors are potentially modifiable, and enduring, it is critical to understand the effect of patient-provider communication on intermediate patient outcomes such as medication adherence. Identifying the potential pathways through which interpersonal processes in the patient-provider relationship differentially affect medication adherence in black patients compared to whites will provide needed information for developing targeted interventions to improve patient-provider communication, thus reducing the racial disparities in cardiovascular mortality and morbidity.

描述（由申请人提供）：该职业发展奖的目标是发展医患沟通方面的理论和方法专业知识，以促进候选人发展成为研究领域的领导者，以改善医患沟通，重点关注其与健康的关系慢性病患者的差异。基于她在心血管行为医学和少数民族健康方面的培训和经验，候选人确定了四个核心培训领域，以进一步发展成为独立研究者所需的技能：1）与心血管疾病、健康差异研究方面的多学科指导团队互动、医患沟通和行为医学； 2) 课程作业和教学培训，以培养少数民族和心血管健康研究的方法和分析原则方面的专业知识； 3) 使用定性分析和客观交互分析系统进行严格的实践培训，以阐明医患沟通与患者结果之间的关系； 4) 参加研讨会/讲习班，以获得制定改善医患沟通干预措施所需的基础知识。尽管越来越多的证据表明患者与提供者沟通中的种族差异会影响患者护理，但许多研究都考察了患者满意度等护理过程，而很少关注药物依从性等中间结果。此外，研究患者与提供者沟通中的种族差异并没有充分捕捉到患者和提供者在互动过程中可能对彼此产生的相互影响。因此，医患沟通导致高血压相关差异的潜在途径尚不清楚。这项拟议的两阶段混合方法研究通过阐明患者种族对医患沟通和服药依从性的影响，为解决这些差距提供了一个独特的机会，该研究对 120 名在贝尔维尤流动护理诊所接受护理的高血压黑人和白人患者进行了研究。纽约市。具体来说，对患者与提供者沟通的定性分析（第一阶段）的结果将为概念模型的开发提供信息，该模型将用于定量评估患者种族、患者与提供者沟通和药物依从性之间的关系（第二阶段）。此外，患者、提供者和诊所层面的特征将作为协变量进行评估，以检查患者与提供者沟通和药物依从性之间关系的潜在混杂因素。拟议的职业发展计划和研究项目，以及已建立的导师团队的支持和进入资源丰富的机构的机会，将有助于将候选人的学术研究轨迹推向以行为医学和心血管健康为重点的独立研究者差异。从该奖项中获得的知识将为制定干预措施提供宝贵的信息，以降低高危人群心血管死亡率和发病率的差异。 公共卫生相关性：根据医学研究所报告《不平等待遇》，医患沟通可能在黑人和白人之间不同的健康结果中发挥着至关重要的作用。随着越来越多的证据表明提供者沟通行为可能是可改变的且持久的，了解医患沟通对患者中间结果（例如药物依从性）的影响至关重要。与白人相比，确定医患关系中的人际过程对黑人患者的药物依从性产生不同影响的潜在途径，将为制定有针对性的干预措施以改善医患沟通提供所需的信息，从而减少心血管死亡率和发病率的种族差异。