Abstract P16: Cultural Competency to Reduce Stroke Disparities - A Patient Perspective

Abstract

Background: Increased physician cultural competence has been recommended to reduce racial disparities in stroke and cardiovascular (CV) disease. Culturally appropriate care may be especially important to enhance primary stroke risk reduction for blacks and other high-risk populations. To better understand the extent of culturally competent care, this study explored patient perceptions of their primary care physician (PCP). Methods: A survey derived from the Patient-Reported Provider Cultural Competency (PRPCC) scale assessed history-taking and explanatory behaviors of PCPs, patient satisfaction and trust. The survey was mailed to adults in 25 counties in the stroke belt region (6% margin of error), with a small incentive offered for participation. Results: Responses from 1181 patients were analyzed. Respondents were mostly white (54%) or black (42%) and had a mean age of 56 years. Respondents' PCP was most often a family physician (66%) and either white (72%) or black (19%). Patient-reported omissions in PCP history-taking were common and occurred more frequently than explanatory behaviors. The biggest omissions involved PCP failure to assess (61%) and invite (52%) family participation in health care decision-making. The most common explanatory omission involved never directing patients to community resources (40%). More than 85% of patients felt satisfaction and trust toward their PCP. White patients reported more frequent assessment of traditional healing remedies than black patients. Otherwise there were no differences by patient ethnic group. Trust and satisfaction was similarly high towards black and white physicians, but both history-taking and explanatory behaviors were reported at higher frequencies for black physicians. Conclusions: Many PCPs in the South inadequately assess cultural health determinants and underutilize optimal communication methods. These gaps may have adverse consequences when white physicians care for black patients with CV risk factors, but may not be apparent to either party. Interventions that enhance cultural sensitivity and promote physician skill in effective communication and cross-cultural brokering may strengthen treatment alliances to reduce CV risk and reduce disparities in stroke.