Patient Perceptions of Provider Race Concordance and Quality of Chronic Illness Care.

Abstract

Black people are more likely to have hypertension and report lower quality of care than White people. Patient-provider race concordance could improve perceived quality of care, potentially lessening disparities. Investigate the association between patient-provider race concordance and patient-perceived quality of chronic disease care, as measured by the Patient Assessment of Chronic Illness Care (PACIC) scale. Cross-sectional analysis of baseline data from a randomized trial with Black patients with persistently uncontrolled hypertension. Participants received care at one of 69 rural primary care practices in Alabama and North Carolina. Three hundred and ninety-one Black patients with persistently uncontrolled hypertension enrolled in the Southeastern Collaboration to Improve Blood Pressure Control (SEC) trial. PACIC overall scores and subscale scores (patient activation, delivery system, goal setting, problem solving, follow-up). Of 1592 patients enrolled in the SEC trial, 391 participants self-reported race concordance data and completed the PACIC. Most participants were age < 60 (52.4%), 65.2% identified as women, and 50.1% were beneficiaries of either Medicare or Medicaid. Those with patient-provider race concordance reported higher overall PACIC scores (58.8% vs 46.1%, p < 0.05), with higher sub-scores of goal setting (60.9% vs 46.8%, p < 0.05) and problem-solving (62.7% vs 48.0%, p < 0.05) compared to those without race concordance. Poisson regression models of participants age ≥ 60 years demonstrated that those with race concordance were more likely to have higher overall PACIC scores (RR 1.53, 95% CI 1.17-2.0, p = 0.002), goal-setting subscale scores (RR 1.63, 95% CI 1.24-2.15, p = 0.0005), and problem-solving subscale scores (RR 1.66, 95% CI 1.29-2.14, p < 0.0001). Those < 60 years of age had no significant findings comparing those with and without race concordance. Older Black patients perceived greater quality of care if their providers were also Black.