Provider and clinic cultural competence in a primary care setting

Paez, Kathryn; Allen, Jerilyn K.; Carson, Kathryn A.; Cooper, Lisa A.

doi:10.1016/j.socscimed.2007.11.027

Cited by 76 publications

(80 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We did, however, develop our measure using qualitative methods to derive concepts described in the published literature, and our multidimensional instrument likely captures a more theoretically grounded and robust set of CC dimensions than prior studies that have used only two to three items or composites of items from multiple existing instruments. [50][51][52][53] In addition, our finding that CC scores were associated with better outcomes among minority but not white patients, and that racial disparities were less prominent among patients of higher CC providers, offers supportive evidence that our instrument measures a construct that predicts the major goals of CC, i.e., effectiveness in caring for minority patients and reducing racial and ethnic disparities in health care quality.…”

Section: Discussionmentioning

confidence: 82%

Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes

et al. 2013

View full text Add to dashboard Cite

BACKGROUND: Health professional organizations have advocated for increasing the "cultural competence" (CC) of healthcare providers, to reduce racial and ethnic disparities in patient care. It is unclear whether provider CC is associated with more equitable care. OBJECTIVE: To evaluate whether provider CC is associated with quality of care and outcomes for patients with HIV/AIDS. DESIGN AND PARTICIPANTS: Survey of 45 providers and 437 patients at four urban HIV clinics in the U.S. MAIN MEASURES: Providers' self-rated CC was measured using a novel, 20-item instrument. Outcome measures included patients' receipt of antiretroviral (ARV) therapy, self-efficacy in managing medication regimens, complete 3-day ARV adherence, and viral suppression. KEY RESULTS: Providers' mean age was 44 years; 56 % were women, and 64 % were white. Patients' mean age was 45; 67 % were men, and 77 % were nonwhite. Minority patients whose providers scored in the middle or highest third on self-rated CC were more likely than those with providers in the lowest third to be on ARVs, have high self-efficacy, and report complete ARV adherence. Racial disparities were observed in receipt of ARVs (adjusted OR, 95 % CI for white vs. nonwhite: 6.21, 1.50-25.7), self-efficacy (3.77, 1.24-11.4), and viral suppression (13.0, 3.43-49.0) among patients of low CC providers, but not among patients of moderate and high CC providers (receipt of ARVs: 0.71, 0.32-1.61; self-efficacy: 1.14, 0.59-2.22; viral suppression: 1.20, 0.60-2.42). CONCLUSIONS: Provider CC was associated with the quality and equity of HIV care. These findings suggest that enhancing provider CC may reduce racial disparities in healthcare quality and outcomes.

show abstract

Section: Discussionmentioning

confidence: 82%

Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes

et al. 2013

View full text Add to dashboard Cite

show abstract

“…12 Physicians selected their level of agreement on a 5-point Likert scale (strongly disagree to strongly agree) to two items assessing "motivation" to learn about cultures within their practice and society, and three items assessing "power and assimilation" attitudes reflecting awareness of white advantage and acceptance of a cultural group's choice to retain distinct customs and values. Physicians also reported the frequency, in 25% increments, of how much they performed four behaviors that are commonly identified as culturally competent: seeking information about a patient's culture; asking patients to tell about their own explanations of illness; receptivity to coworkers' feedback concerning cross-cultural patient-provider interactions; and adapting care to patients' preferences.…”

Section: Study Measuresmentioning

confidence: 99%

Physician Cultural Competence and Patient Ratings of the Patient-Physician Relationship

et al. 2009

Self Cite

View full text Add to dashboard Cite

OBJECTIVE: To determine the association of patients' ratings of the patient-physician relationship with physicians' self-reported cultural competence (CC). METHODS:Physicians completed a survey assessing their CC in three domains: motivation to learn about other cultures (motivation attitudes), awareness of white privilege and acceptance of a racial group's choice to retain distinct customs and values (power assimilation attitudes), and clinical behaviors reflective of CC. Their African-American and white patients completed interviews assessing satisfaction with the medical visit, trust in their physician, perceptions of their physician's respect for them and their participation in care. We conducted regression analyses to explore the associations between CC and patient ratings of the relationship. RESULTS:Patients of physicians reporting more motivation to learn about other cultures were more satisfied (OR=2.1, 95% CI=1.0-4.4), perceived their physicians were more facilitative (β=0.4, p=0.02) and reported seeking and sharing more information during the medical visit (β=0.2, p=0.03). Physicians' power assimilation attitudes were associated with patients' ratings of physician facilitation (β=0.4, p=0.02). Patients of physicians reporting more frequent CC behaviors were more satisfied (OR=3.1, 95% CI=1.4-6.9) and reported seeking and sharing more information (β=0.3, p=0.04). CONCLUSIONS:Attitudinal and behavioral components of CC are important to developing higher quality, participative relationships between patients and their physicians. Knowledge about the relationship between greater physician CC and improved patient-physician interpersonal outcomes is limited. The purpose of this study was to determine if patients' rate their involvement in their care and the quality of their relationship with their primary care physicians (PCPs) more favorably when their physicians are more culturally competent. We hypothesized that patients of physicians with more culturally competent attitudes and behaviors would perceive 495 that their physicians were more respectful toward them, would have more satisfaction with and trust toward their physicians and would report greater involvement in their care. METHODS Study DesignWe analyzed survey data from 26 PCPs located in 15 Baltimore practices serving low-income to middle-class communities and 123 of their patients. The data were collected as part of a clinical trial evaluating a patient coaching intervention and physician communication training to enhance patientcentered, but not culturally specific knowledge, attitudes or skills.11 PCPs were eligible to participate in the trial if they practiced at least 20 hours per week and planned to stay at the clinical site for at least 12 months. In order to be part of this analysis, physicians had to have at least one patient complete a 12-month interview, have one encounter or more with that patient within 9 months of the patient interview, and complete an Internet-based survey at the end of the study. Physicians' patients were eligible...

show abstract

“…Some strategies proposed for achieving this include embedding cultural competency in organisational policy, protocols and related key performance indicators [31]. Although there is some evidence that organisations that have integrated cultural competency standards into policies and practices influence health professionals to develop more culturally competent behaviours more rigorous research is needed in this area [32][33][34].…”

Section: Strengths and Limitations Of Interventionsmentioning

confidence: 99%

Cultural Competency Training and Education in the University-based Professional Training of Health Professionals: Characteristics, Quality and Outcomes of Evaluations

Clifford¹,

Calman²,

Jongen³

et al. 2017

Divers Equal Health Care

View full text Add to dashboard Cite

Provider and clinic cultural competence in a primary care setting

Cited by 76 publications

References 30 publications

Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes

Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes

Physician Cultural Competence and Patient Ratings of the Patient-Physician Relationship

Cultural Competency Training and Education in the University-based Professional Training of Health Professionals: Characteristics, Quality and Outcomes of Evaluations

Contact Info

Product

Resources

About