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Assari S. Psychosocial Determinants of Communication Satisfaction in Racially Concordant and Discordant Patient-Physician Interactions. JOURNAL OF MEDICAL RESEARCH AND INNOVATION 2019; 3:e000165. [PMID: 34734151 PMCID: PMC8562862 DOI: 10.32892/jmri.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/07/2019] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Although socioeconomic and race-related factors both influence the quality of medical encounters, it is not known how these effects differ between racially concordant and discordant medical visits. The current study investigated psychosocial determinants of physician visit satisfaction of Black adults based on a racial concordance of the medical encounter. MATERIALS AND METHODS Data came from the Detroit Area Study, a community survey of adults in Michigan, United States. The current analysis included 336 Black individuals who had visited a White (n = 191) or a Black (n = 145) physician in the last year. The outcome was satisfaction with the quality of communication with the doctor. Demographics (age and gender), socioeconomic status (education and income), psychosocial factors (control beliefs and social support), race-related factors (having a close White friend, negative attitudes about Blacks, discrimination), and health status (chronic disease count, self-rated health, and distress) of the patient as well as race of the doctor were measured. We used multi-group structural equation modeling for data analysis, where the two groups were racially concordant (those who met a Black physician) and racially discordant (those who met a White physician) visits. RESULTS Satisfaction with physician visit was lower in racially discordant than racially concordant encounters. In racially concordant visits, high education was associated with higher satisfaction; however, racial discrimination was associated with lower satisfaction. In racially discordant visits ((i.e., with a White doctor), having a White friend as well as high sense of control were associated with higher satisfaction, while negative attitudes about Blacks was associated with a lower level of satisfaction. CONCLUSIONS Racially concordant and discordant visits have different satisfaction levels. Racially concordant and discordant visits also have different predictors of communication satisfaction among Black patients. Socioeconomic status as well as racial attitudes and experiences impact the quality of communication of the Black patients with their doctors; however, these effects depend on the race of the doctor.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, USA
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Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Manag 2019; 9:317-334. [PMID: 31140916 PMCID: PMC6587104 DOI: 10.2217/pmt-2018-0030] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022] Open
Abstract
The burden of pain is unequal across racial and ethnic groups. In addition to racial and ethnic differences in the experience of pain, there are racial and ethnic disparities in the assessment and treatment of pain. In this article, we provide a nonexhaustive review of the biopsychosocial mechanistic factors contributing to racial and ethnic differences in both the experience and treatment of pain. Using a modified version of the Socioecological Model, we focus on patient-, provider- and system-level factors including coping, perceived bias and discrimination, patient preferences, expectations, patient/provider communication, treatment outcomes and healthcare access. In conclusion, we provide psychosocial factors influencing racial and ethnic differences in pain and highlight future research targets and possible solutions to reduce these disparities.
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Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alejandro Cortes
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Calia A Morais
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
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Chang TE, Weiss AP, Marques L, Baer L, Vogeli C, Trinh HT, Clain AJ, Blais MA, Fava M, Yeung AS. Race/ethnicity and other social determinants of psychological well-being and functioning in mental health clinics. J Health Care Poor Underserved 2016; 25:1418-31. [PMID: 25130249 DOI: 10.1353/hpu.2014.0138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Significant racial and ethnic differences exist in the receipt of psychiatric care and help-seeking. We examined the relationship between race/ethnicity and psychological well-being and functioning in psychiatric outpatients. We analyzed intake data for 8,697 adult patients in psychiatry clinics in New England between 2008 and 2010. Patients rated psychological wellbeing using the Schwartz Outcome Scale (SOS-10); clinicians rated the Global Assessment of Functioning (GAF). In an analysis of variance with covariates, race/ethnicity exhibited a small but statistically significant association with GAF (F(4,8481)=17.902, p<.001) and SOS-10 scores (F(4,8165)=7.271, p<.001). However, after adjustment for physical health and socioeconomic variables, these differences became insignificant or were reversed. Our findings suggest that the relationship between race/ethnicity and mental health may be confounded by other socioeconomic or health differences and may be small compared with the effect of those variables. Future studies on race and psychological well-being should take social determinants of health into consideration.
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Nassery N, Segal JB, Chang E, Bridges JFP. Systematic overuse of healthcare services: a conceptual model. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:1-6. [PMID: 25193241 PMCID: PMC5511697 DOI: 10.1007/s40258-014-0126-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A perfect storm of factors influences the overuse of healthcare services in the USA. Considerable attention has been placed on geographic variation in utilization; however, empiric data has shown that geographic variation in utilization is not associated with overuse. While there has been renewed interest in overuse in recent years, much of the focus has been on the overuse of individual procedures. In this paper we argue that overuse should be thought of as a widespread and pervasive phenomenon that we coin as systematic overuse. While not directly observable (i.e., a latent phenomenon), we suggest that systematic overuse could be identified by tracking a portfolio of overused procedures. Such a portfolio would reflect systematic overuse if it is associated with higher healthcare costs and no health benefit (including worse health outcomes) across a healthcare system. In this report we define and conceptualize systematic overuse and illustrate how it can be identified and validated via a simple empirical example using several Choosing Wisely indicators. The concept of systematic overuse requires further development and empirical verification, and this paper provides an important first step, a conceptual framework, to that end.
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Affiliation(s)
- Najlla Nassery
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Building Center Tower, Suite 2300, Baltimore, MD, 21224, USA,
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Hanmer J, Lu X, Rosenthal GE, Cram P. Insurance status and the transfer of hospitalized patients: an observational study. Ann Intern Med 2014; 160:81-90. [PMID: 24592493 PMCID: PMC4157678 DOI: 10.7326/m12-1977] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is little objective evidence to support concerns that patients are transferred between hospitals based on insurance status. OBJECTIVE To examine the relationship between patients' insurance coverage and interhospital transfer. DESIGN Data analyzed from the 2010 Nationwide Inpatient Sample. PATIENTS All patients aged 18 to 64 years discharged alive from U.S. acute care hospitals with 1 of 5 common diagnoses (biliary tract disease, chest pain, pneumonia, septicemia, and skin or subcutaneous infection). MEASUREMENTS For each diagnosis, the proportion of hospitalized patients who were transferred to another acute care hospital based on insurance coverage (private, Medicare, Medicaid, or uninsured) was compared. Logistic regression was used to estimate the odds of transfer for uninsured patients (reference category, privately insured) while patient- and hospital-level factors were adjusted for. All analyses incorporated sampling and poststratification weights. RESULTS Among 315 748 patients discharged from 1051 hospitals with any of the 5 diagnoses, the percentage of patients transferred to another acute care hospital varied from 1.3% (skin infection) to 5.1% (septicemia). In unadjusted analyses, uninsured patients were significantly less likely to be transferred for 3 diagnoses (P 0.05). In adjusted analyses, uninsured patients were significantly less likely to be transferred than privately insured patients for 4 diagnoses: biliary tract disease (odds ratio, 0.73 [95% CI, 0.55 to 0.96]), chest pain (odds ratio, 0.63 [CI, 0.44 to 0.89]), septicemia (odds ratio, 0.76 [CI, 0.64 to 0.91]), and skin infections (odds ratio, 0.64 [CI, 0.46 to 0.89]). Women were significantly less likely to be transferred than men for all diagnoses. LIMITATION This analysis relied on administrative data and lacked clinical detail. CONCLUSION Uninsured patients (and women) were significantly less likely to undergo interhospital transfer. Differences in transfer rates may contribute to health care disparities. PRIMARY FUNDING SOURCE National Institutes of Health.
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Evaluation of Patient Satisfaction: Radiation Therapy Services for Chinese Patients at the British Columbia Cancer Agency – Vancouver Centre. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013. [DOI: 10.1017/s1460396912000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground: Patient satisfaction surveys conducted in English exclude respondents who are not proficient in the English language. This makes it difficult to assess whether health care services provided are culturally appropriate. This study aims to evaluate the level of satisfaction for Chinese speaking patients who received radiation treatments at the British Columbia Cancer Agency, Vancouver Centre in Canada.Patients and Methods: Chinese patients were given a translated patient satisfaction survey on a voluntary basis to complete at the end of treatment. Contingency table analysis using the Pearson chi-square test or Fisher’s exact test was performed at 5% significance level for all analyses. Logistic regression analysis was conducted to investigate whether complete satisfaction with an aspect of care influenced overall satisfaction with services provided by the RT team.Results: The level of satisfaction in Chinese speaking patients was lower compared to English speaking patients. The results from the Chinese survey also identified the importance of treatment patients with courtesy and providing them with a pleasant wait area.Conclusions: Despite a language barrier, Chinese speaking patients still contributed to improvement initiatives at the Vancouver Centre. Efforts to ensure a culturally appropriate environment and provision of services include recruitment of staff members who reflect the cultural diversity of the community serviced, use of interpreter services or bilingual health providers for clients, use of linguistically appropriately education materials, and health care settings that is pleasant and respects the cultural diversity of the population serviced. This assessment provided a better understanding of whether services at the Vancouver Centre were culture appropriate.
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Stirbu I, Kunst AE, Mielck A, Mackenbach JP. Inequalities in utilisation of general practitioner and specialist services in 9 European countries. BMC Health Serv Res 2011; 11:288. [PMID: 22040155 PMCID: PMC3221557 DOI: 10.1186/1472-6963-11-288] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 10/31/2011] [Indexed: 11/14/2022] Open
Abstract
Background The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions. Methods Data on the use of GP and specialist services were derived from national health surveys of Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, the Netherlands and Norway. For each country and education level we calculated the absolute prevalence and relative inequalities in utilisation of GP and specialist services. In order to account for the need for care, the results were adjusted by the measure of self-assessed health. Results People with lower education used GP services equally often in most countries (except Belgium and Germany) compared with those with a higher level of education. At the same time people with a higher education used specialist care services significantly more often in all countries, except in the Netherlands. The general pattern of educational inequalities in utilisation of specialist care was similar for both men and women. Inequalities in utilisation of specialist care were equally large in Eastern European and in Western European countries, except for Latvia where the inequalities were somewhat larger. Similarly, large inequalities were found in the utilisation of specialist care among patients with chronic diseases, diabetes, and hypertension. Conclusions We found large inequalities in the utilisation of specialist care. These inequalities were not compensated by utilisation of GP services. Of particular concern is the presence of inequalities among patients with a high need for specialist care, such as those with chronic diseases.
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Affiliation(s)
- Irina Stirbu
- Department of Public Health, Erasmus Medical Centre Rotterdam, Erasmus University, The Netherlands.
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Shea M, McDonald DD. Factors associated with increased pain communication by older adults. West J Nurs Res 2010; 33:196-206. [PMID: 20702682 DOI: 10.1177/0193945910372775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this secondary analysis study was to identify factors associated with increased pain communication by older adults. Data were obtained from 312 older adults with osteoarthritis pain. Content analysis was conducted using criteria from the American Pain Society's "Guidelines for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis" to identify important pain management information described by the older adults in response to general questions about their pain. Gender was the only factor associated with increased pain communication from the predictor variables of age, education, gender, ethnicity, race, marital status, pain intensity, functional pain interference, treatment from a practitioner for arthritis and for pain, and pain relief. The lack of association between pain communication and factors such as pain intensity suggests that practitioners should routinely elicit specific pain information from older adults who have a history of chronic painful conditions such as osteoarthritis.
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Affiliation(s)
- Maura Shea
- University of Connecticut School of Nursing, 231 Glenbrook Road, Unit 2026, Storrs, CT 06269-2026, USA
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Spinal tuberculosis: the association between pedicle involvement and anterior column damage and kyphotic deformity. Spine (Phila Pa 1976) 2009; 34:713-7. [PMID: 19333105 DOI: 10.1097/brs.0b013e31819b2159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Pedicle involvement in spinal tuberculosis (TB), the prevertebral abscess formation, severity of vertebral body, and disc collapse were evaluated from magnetic resonance imaging (MRI) of the patients. OBJECTIVE To study the pedicle involvement in spine TB in relation to the degree of vertebral body and disc collapse, prevertebral abscess collection, and degree of kyphosis; and to correlate the occurrence of pedicle involvement and the degree of spinal deformity. SUMMARY OF BACKGROUND DATA There are a few reports describing the posterior element involvement in spinal TB. Typically, the infection resides in the anterior part of the vertebral body endplates and rarely involved the pedicles. METHODS There were 31 patients, who had been diagnosed and treated for spinal TB from 2003 to 2007 at our center. Critical evaluation of each patient's MRI was carried out for the pedicle involvement, prevertebral abscess formation, severity of vertebral body, and disc collapse. RESULTS Spinal TB mostly involved the thoracic level (48.4%). Pedicle involvement was noted in 64.5% of patients, and the highest involvement was at thoracic level. The mean vertebral body, disc collapse, prevertebral abscess, and kyphosis were more severe in pedicle involved group. CONCLUSION The posterior spinal element, specifically the pedicle is not uncommonly involved in spinal TB. Pedicle involvement is part of the disease process and usually associated with relatively severe vertebral body and disc destruction, wide prevertebral abscess, and severe kyphosis. Pedicle involvement can be detected early from MRI and need to be documented as it may influence the treatment strategy.
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Herndon MB, Schwartz LM, Woloshin S, Anthony D, Gallagher P, Fowler FJ, Fisher E. Older patients perceptions of "unnecessary" tests and referrals: a national survey of Medicare beneficiaries. J Gen Intern Med 2008; 23:1547-54. [PMID: 18592324 PMCID: PMC2533360 DOI: 10.1007/s11606-008-0626-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 01/31/2008] [Accepted: 03/24/2008] [Indexed: 11/26/2022]
Abstract
CONTEXT Unnecessary exposure to medical interventions can harm patients. Many hope that generalist physicians can limit such unnecessary exposure. OBJECTIVE To assess older Americans' perceptions of the need for tests and referrals that their personal physician deemed unnecessary. DESIGN Telephone survey with mail follow-up in English and Spanish, conducted from May to September 2005 (overall response rate 62%). STUDY PARTICIPANTS Nationally representative sample of 2,847 community-dwelling Medicare beneficiaries. Main analyses focus on the 2,319 who had a personal doctor ("one you would see for a check-up or advice if you were sick") whom they described as a generalist ("doctor who treats many different kinds of problems"). MAIN OUTCOME MEASURE Proportion of respondents wanting a test or referral that their generalist suggested was not necessary using 2 clinical vignettes (cough persisting 1 week after other flu symptoms; mild but definite chest pain lasting 1 week). RESULTS Eighty-two percent of Medicare beneficiaries had a generalist physician; almost all (97%) saw their generalist at least once in the past year. Among those with a generalist, 79% believed that it is "better for a patient to have one general doctor who manages most of their medical problems" than to have each problem cared for by a specialist. Nevertheless, when faced with new symptoms, many would want tests and referrals that their doctor did not think necessary. For a cough persisting 1 week after flu symptoms, 34% would want to see a lung specialist even if their generalist told them they "probably did not need to see a specialist but could if they wanted to." For 1 week of mild but definite chest pain when walking up stairs, 55% would want to see a heart specialist even if their generalist did not think it necessary. In these same scenarios, even higher proportions would want diagnostic testing; 57% would want a chest x-ray for the cough, and 74% would want "special tests" for the chest pain. CONCLUSIONS When faced with new symptoms, many older patients report that they would want a diagnostic test or specialty referral that their generalist thought was unnecessary. Generalists striving to provide patient-centered care while at the same time limiting exposure to unnecessary medical interventions will need to address their patients' perceptions regarding the need for these services.
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Affiliation(s)
- M Brooke Herndon
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA.
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Schauer DP, Johnston JA, Moomaw CJ, Wess M, Eckman MH. Racial disparities in the filling of warfarin prescriptions for nonvalvular atrial fibrillation. Am J Med Sci 2007; 333:67-73. [PMID: 17301583 DOI: 10.1097/00000441-200702000-00001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Warfarin has been shown to decrease the rate of thromboembolic events in patients with nonvalvular atrial fibrillation, but it is frequently underprescribed. Our goal was to establish whether there have been racial disparities in the filling of warfarin prescriptions for patients with newly incident nonvalvular atrial fibrillation. METHODS We conducted a retrospective analysis of Ohio Medicaid claims between January 1, 1997 and May 31, 2002, for recipients with newly incident nonvalvular atrial fibrillation. Race was identified from the demographic information in the database, and the analysis was limited to white and African-American patients. The main outcome measure was the filling of a prescription for warfarin at any time between 7 days prior to the initial diagnosis of atrial fibrillation and 30 days after the initial diagnosis. To evaluate the independent role of race in the filling of warfarin prescriptions, we created a multivariable logistic regression model incorporating predictors significant at P < 0.10 in the univariate model. RESULTS A total of 6283 patients were identified as having newly incident nonvalvular atrial fibrillation, 18.5% of whom were African-American. In general, African-American patients had a higher rate of comorbid illness. Warfarin prescriptions were filled for 9.4% of white patients and 7.6% of African-American patients. When controlling for significant confounders in the multivariable logistic regression model, African-American patients had an adjusted odds ratio for receiving warfarin of 0.76 (95% CI, 0.60-0.98) when compared with white patients. CONCLUSION African-American patients in the Ohio Medicaid population between 1998 and 2002 were significantly less likely than white patients to fill a warfarin prescription for newly incident nonvalvular atrial fibrillation.
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Affiliation(s)
- Daniel P Schauer
- Division of General Internal Medicine, Institute for the Study of Health, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0535, USA.
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Chinese and white Canadian satisfaction and compliance with physicians. BMC FAMILY PRACTICE 2007; 8:11. [PMID: 17376235 PMCID: PMC1847678 DOI: 10.1186/1471-2296-8-11] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 03/21/2007] [Indexed: 11/10/2022]
Abstract
Background Patient satisfaction has become an important indicator of primary care and healthcare system performance. Ethnic disparities in patient satisfaction and compliance with physician care have been studied in several countries. However, this issue has not received significant attention in Canada. The unique characteristics of the Canadian healthcare system and ethnic population make it worthwhile to examine this issue in this population. Therefore, we conducted a survey among Chinese and Whites in a Canadian city to determine their reported satisfaction, and perceptions of physicians. Methods The survey was conducted in English, Mandarin and Cantonese in 2005 among Chinese and White Canadians, 18 years of age or older, who had visited at least one physician in Canada. Results We analyzed 746 Chinese and 711 Whites in the general practitioner (GP) visit group and 485 Chinese and 637 Whites in the specialist visit group. A lower proportion of Chinese compared to Whites reported that they were very satisfied or satisfied with GP (73.7% vs. 92.8%) and specialist care (75.5% vs. 85.6%) and the differences between the two groups remained after adjustment for demographic variables and chronic conditions (risk adjusted OR: 0.70, 95%CI: 0.42–1.18 for the GP visit group and OR: 0.77, 95%CI: 0.48–1.23 for the specialist visit group). A similar proportion of Chinese and Whites reported that they always followed a physician's advice (59.4% vs. 59.6% for the GP visit group and 67.2% vs. 62.8% for the specialist visit group). Non-English speaking Chinese and recent arrivals in Canada were less likely to be satisfied with GPs than Chinese born in Canada [risk adjusted OR: 0.5, 95%CI: 0.3–0.9, 0.2 and 0.1–0.7, respectively]. Conclusion Chinese Canadians reported lower satisfaction with physicians and perceived physicians slightly more negatively than White Canadians. Particularly, Chinese with limited English and short length of stay in Canada were less satisfied than Canadian born Chinese.
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Coates TJ, Szekeres G. A plan for the next generation of HIV prevention research: seven key policy investigative challenges. ACTA ACUST UNITED AC 2005; 59:747-757. [PMID: 15554841 DOI: 10.1037/0003-066x.59.8.747] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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