Adherence to Cardiovascular Disease Medications: Does Patient-Provider Race/Ethnicity and Language Concordance Matter?

Abstract

BackgroundPatient–physician race/ethnicity and language concordance may improve medication adherence and reduce disparities in cardiovascular disease (CVD) by fostering trust and improved patient–physician communication.ObjectiveTo examine the association of patient race/ethnicity and language and patient–physician race/ethnicity and language concordance on medication adherence rates for a large cohort of diabetes patients in an integrated delivery system.DesignWe studied 131,277 adult diabetes patients in Kaiser Permanente Northern California in 2005. Probit models assessed the effect of patient and physician race/ethnicity and language on adherence to CVD medications, after controlling for patient and physician characteristics.ResultsTen percent of African American, 11 % of Hispanic, 63% of Asian, and 47% of white patients had same race/ethnicity physicians. 24% of Spanish-speaking patients were linguistically concordant with their physicians. African American (46%), Hispanic (49%) and Asian (52%) patients were significantly less likely than white patients (58%) to be in good adherence to all of their CVD medications (p < 0.001). Spanish-speaking patients were less likely than English speaking patients to be in good adherence (51% versus 57%, p < 0.001). Race concordance for African American patients was associated with adherence to all their CVD medications (53% vs. 50%, p < 0.05). Language concordance was associated with medication adherence for Spanish-speaking patients (51% vs. 45%, p < 0.05).ConclusionIncreasing opportunities for patient–physician race/ethnicity and language concordance may improve medication adherence for African American and Spanish-speaking patients, though a similar effect was not observed for Asian patients or English-proficient Hispanic patients.

Language Concordance, Interpersonal Care, and Diabetes Self-Care in Rural Latino Patients

“…13,34 Studies also demonstrate that language concordance can have a positive impact on health. 11,19,35 A cross-sectional study of a diabetes population receiving care at a Kaiser HMO found that Latinos with language-concordant providers were less likely to have poorly controlled diabetes, defined as an A1C>9 %.…”

Adherence to Chronic Disease Medications among New York City Medicaid Participants

“…[15][16][17][18] blacks and Hispanics were observed to be less adherent as compared with whites, potentially contributing to related health outcomes disparities. This study also provided a unique opportunity to describe adherence amongst Asians, which was found to be similar to whites.…”

Racial Disparities in Adherence to Cardiovascular Medications among the Elderly in Medicare: Three Empirical Essays

“…150,151 The large magnitude of disparities towards the lower end of the adherence distributions suggests that these barriers may be particularly pronounced among poorly adherent minority patients. Two issues need to be addressed, however, before we can effectively eliminate these barriers.…”

“…A number of factors, however, can be hypothesized as potential remedies for this disparate effect. The quality of communication and compassion in the patient-provider relationship, especially when race-concordance is possible, 150,151 has been repeatedly cited as a versatile avenue for intervention on medication adherence among blacks. 142 Quality provider communication can address patients' beliefs and concerns about how medications work and their side effects, and can address issues such as early discontinuation of statins, and the complexity of multi-drug regimens which we found to be associated with disproportionately lower adherence among blacks.…”

“…142 Also, better provider communication, especially in race-concordant relationships, was reportedly associated with better adherence. 142,150,151 Other studies have also shown a link between poor adherence and inadequate health literacy. 145,146 The evidence on the degree to which social support and sociodemographic characteristics affected adherence among blacks remains inconclusive.…”