Physician–Patient Racial Concordance, Continuity of Care, and Patterns of Care for Hypertension

Konrad, Thomas R.; Howard, Daniel; Edwards, Lloyd J.; Ivanova, Anastasia; Carey, Timothy S.

doi:10.2105/ajph.2004.046177

Cited by 30 publications

(23 citation statements)

References 26 publications

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“…Of the 27 studies, the majority ( n = 15) were retrospective or employed a secondary analyses. Studies that used secondary analyses included data ranging from 1987 (Konrad et al 2005) to 2001 (Blanchard et al 2007). Four studies were qualitative (Garcia et al 2003, Zayas et al 2005, Gordon et al 2006, Brown et al 2007), three used cross-sectional surveys (Cooper-Patrick et al 1999, Stevens et al 2003, Lasser et al 2005) and one collected data from actual patient–provider interactions (Tai-Seale et al 2005).…”

Section: Resultsmentioning

confidence: 99%

“…Of note, about half the studies in both ‘provision’ (Malat 2001, Stevens et al 2003, Stevens et al 2005) and ‘utilization’ (Saha et al 1999, LaVeist et al 2003, Saha et al 2003, Konrad et al 2005) domains were based on patients’ (or parents in case of children) self-reports and did not include an objective measure of healthcare provision or utilization.…”

Section: Resultsmentioning

confidence: 99%

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Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes?

et al. 2009

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Objective To understand if patient–provider race-concordance is associated with improved health outcomes for minorities. Design A comprehensive review of published research literature (1980–2008) using MEDLINE, HealthSTAR, and CINAHL databases were conducted. Studies were included if they had at least one research question examining the effect of patient–provider race-concordance on minority patients’ health outcomes and pertained to minorities in the USA. The database search and data analysis were each independently conducted by two authors. The review was limited to data analysis in tabular and text format. A meta-analysis was not possible due to the discrepancy in methods and outcomes across studies. Results Twenty-seven studies met the inclusion criteria. Combined, the studies were based on data from 56,276 patients and only 1756 providers. Whites/Caucasians (37.6%) and Blacks/African Americans (31.5%), followed by Hispanics/Latinos (13.3%), and Asians/Pacific Islanders (4.3%) comprised the majority of the patient sample. The median sample of providers was only 16 for African Americans, 10 for Asians and two for Hispanics. The review presented mixed results. Of the 27 studies, patient–provider race-concordance was associated with positive health outcomes for minorities in only nine studies (33%), while eight studies (30%) found no association of race-concordance with the outcomes studied and 10 (37%) presented mixed findings. Analysis suggested that having a provider of same race did not improve ‘receipt of services’ for minorities. No clear pattern of findings emerged in the domains of healthcare utilization, patient–provider communication, preference, satisfaction, or perception of respect. Conclusions There is inconclusive evidence to support that patient–provider race-concordance is associated with positive health outcomes for minorities. Studies were limited to four racial/ethnic groups and generally employed small samples of minorities. Further research is needed to understand what health outcomes may be more sensitive to cultural proximity between patients and providers, and what patient, provider and setting-level variables may moderate or mediate these outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes?

et al. 2009

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“…On the other hand, because adverse work conditions were strongly associated with intent to leave the practice, care could eventually suffer from interruptions brought on by the departure of physicians. Because turnover could not be measured within the observation period, it was impossible to assess its impact on continuity or quality in this sample, although there is other evidence that discontinuous care does in fact adversely affect patient outcomes over time (Konrad, Howard, Edwards, Ivanova, & Carey, 2005). The investigators also concluded that their findings may explain difficulties in recruiting and retaining generalists but leave open the question of whether adverse work conditions influence health care quality and safety.…”

Section: Figure 1 the Memo Study Logic Modelmentioning

confidence: 98%

Measures, Methods, and Models of Doctor Satisfaction: Future Research Challenges

Konrad

2015

P&P

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This paper outlines the way in which various concepts measuring doctor reactions to their jobs and careers (e.g., satisfaction, burnout, etc.) have been developed. The variety of measures, methods, and models reflect differing disciplinary and theoretical approaches and research traditions. In order to identify productive ways to advance the field, this paper presents a proposal for how multidisciplinary, cross-national comparative research might be conducted to resolve some of the issues linking medical care organization, physicians' experiences, and patient outcomes. In seeking buy-in from stakeholders, researchers need to be cognizant that various ideologies and agendas shape the nature of the concerns that these interest groups (e.g., professional associations, clinical managers, payers, patient advocates, etc.) have about physician satisfaction, its precursors, and its consequences.Keywords: Physician satisfaction, burnout, measurement, methodology, medical autonomy Various concepts measuring doctor discontent (e.g., satisfaction, burnout, etc.) have been employed and measured. The measures, methods, and models used by academic researchers represent a wide variety of theoretical formulations and disciplinary approaches. I discuss the notion that variables operating at different levels of analysis have been posited as underlying factors accounting variation in physicians' attitudes. These include health system organization and workplace variables, as well as different individual level life experiences and personalities. Patients' clinical outcomes and satisfaction have been posited as being affected by doctor's satisfaction. In order to identify productive ways to advance the field, this paper provides an example of how research has been conducted in the US and suggests how cross-national research might be conducted in response to the concerns that physicians, their employers, and their patients experience in the process of providing, overseeing, and receiving medical care.

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“…Health care studies have shown that one determinant of choice is associated with client-physician racial concordance, i.e., individuals are more likely to seek treatment from a particular provider when there is racial concordance between client and physician [11][12][13][14][15][16][17][18][19][20][21][22]. This factor may not be as relevant in the public mental health setting where the clinicians in the CMHC program are assigned to a patient based on their case load.…”

Section: Introductionmentioning

confidence: 99%

Communities of color? Client-to-client racial concordance in the selection of mental health programs for Caucasians and African Americans

Koizumi

Rothbard

Smith

et al. 2011

Health Care Manag Sci

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A discrete-choice logit model was applied to study the determinants of mental health provider choice using data from a large urban county in the Northeast US. The study subjects were 9,544 adult Medicaid recipients who received outpatient treatment from the 20 Community Mental Health Center (CMHC) programs in 2001. In addition to a conventional set of variables representing client and provider characteristics, the regression model included several interaction terms to examine whether racial concordance level among patients influences the choice of an outpatient program. The results revealed that racial concordance among the clients seems to be a factor in choosing a program. In particular, Caucasian clients are much more likely to select a program with a higher percentage of Caucasian clients, even though they have to travel further. More generally, our results suggest that program choice may be driven more by the racial composition of the clients served than by spatial proximity to the program.

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Physician–Patient Racial Concordance, Continuity of Care, and Patterns of Care for Hypertension

Cited by 30 publications

References 26 publications

Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes?

Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes?

Measures, Methods, and Models of Doctor Satisfaction: Future Research Challenges

Communities of color? Client-to-client racial concordance in the selection of mental health programs for Caucasians and African Americans

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