Racial differences in patient perception of interactions with providers are associated with health outcomes in type II diabetes.
Hadley W Reid, Olivia M Lin, Rebecca L Fabbro and 6 others
PMID 33579569WHAT IT FOUND
HbA1c and medication adherence did not differ between non-Hispanic Black and non-Hispanic White diabetes patients, but clearer explanations and less hurried care were linked to lower estimated HbA1c in non-Hispanic Black patients; disrespect and discrimination were linked to poorer adherence and missed visits.
Key findings
01Non-Hispanic Black and non-Hispanic White patients did not differ significantly in average HbA1c or medication adherence, and missed appointments also did not differ significantly.
02Non-Hispanic Black patients who reported that their provider always explained results and medications had a mean estimated HbA1c 0.59 percentage points lower than non-Hispanic Black patients who reported this happened sometimes.
03Patients who reported that office staff were never disrespectful had an estimated mean medication adherence score 0.67 points lower than those reporting sometimes disrespectful staff, meaning better adherence, and non-Hispanic Black patients reporting never experiencing discrimination had an estimated missed-appointment probability of 0.42 compared with 0.86 for those reporting sometimes experiencing discrimination.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an exploratory cross-sectional study, so it can show associations but cannot show that better communication caused better diabetes control. Only 221 patients were included, and the response rate was 23.6%, so findings may not apply to all patients with diabetes. Patients who agreed to take the survey may have had better relationships with providers than patients who did not, and responses on the interaction survey had low variability. The authors did not adjust for multiple comparisons, so some reported associations could be chance findings. Medication adherence and perceptions of discrimination or disrespect were self-reported, and missed appointments included cancelled, not rescheduled, and no-showed appointments.
Declared interests
The authors declared no competing interests. The paper lists NIH extramural research support.
The easy way to misread this
Do not conclude that clearer explanation or respectful staff care will lower HbA1c or improve adherence. This was an observational survey, and the study did not test a communication intervention.