Patient-Provider Communication and Medication Adherence

High blood pressure contributes to the racial disparities in death rates between minority
patients and whites. Understanding the factors underlying racial disparities in high blood
pressure-related outcomes is a major focus of Healthy People 2010. Several factors including
access to care, patient preferences and lower socioeconomic status have been used to explain
the differences seen in timely and effective delivery of preventive care between minority
patients and whites. However, when these factors are controlled for, health disparities still
exist. Recently, the Institute of Medicine identified interpersonal processes within the
patient-provider relationship as a potential reason for the health disparities between
minority and white patients. Specifically, providers' communication, including the ability to
listen, collaborate, and be empathetic during the medical encounter has emerged as an
important dimension of care that differs by race. Despite the increasing evidence that racial
differences in patient-provider communication affects patient care, many of these studies
have examined issues related to processes of care such as patient satisfaction with little
attention to intermediate outcomes such as medication adherence. Further, studies that have
used audio-taped analysis to examine racial differences in patient-provider communication are
limited by one-dimensional coding systems that lack the ability to capture the mutual
influence the patient and provider have on one another during the interaction. Thus, the
potential pathways through which patient-provider communication contribute to high blood
pressure-related disparities in minority patients compared to whites is not clearly
understood. This proposed two-phase, mixed-methods research study, provides a unique
opportunity to address these gaps by clarifying the effect of patient's race on
patient-provider communication and medication adherence among 120 hypertensive African
American and white patients receiving care in primary care practices. Specifically, findings
from a qualitative analysis of patient-provider communication (Phase 1) will inform the
development of a conceptual model that will be used to quantitatively evaluate the
relationship between patient's race, patient-provider communication and medication adherence
(Phase 2).

Inclusion Criteria:

- self-identification as black/African American or white/Caucasian

- Receiving care in the Bellevue Hospital Ambulatory Care Practice from the same primary
care provider for at least 3 months;

- Diagnosed with hypertension (ICD: # 401-401.9)

- Taking at least one antihypertensive medication;

- Age18 years or older

- Fluent in English

Exclusion Criteria:

- Unable to give informed consent

- Refuse to participate