Patient-provider racial/ethnic concordance (i.e., physician and patient identify as the same race/ethnicity) has emerged as one key suggestion for mitigating healthcare disparities. Past research has underlined its benefits, including improved infant mortality and more appropriate prescription regimens. However, the sum of the evidence remains unclear and many facets of the patient-provider relationship have yet to be examined. From historical and practical perspectives, shared decision-making and doctors communicating treatment options are critical in improving healthcare trust and experiences.
Recent Turbulence in the Care Environment
The COVID-19 pandemic left us reevaluating patient-provider relationships and how disparities impact healthcare experiences. Unpredictable changes in access, combined with the exacerbation of already entrenched inequity, created a particularly brutal intersectional storm. For example, the rapid rise of telemedicine and virtual care technologies—accelerated by the pandemic—has its challenges. The digital divide looms large, especially in resource-poor communities, leaving some confused and others without care.
This turbulent landscape prompts a critical reassessment of patient-centered care, recognizing the imperative to address unique needs and experiences. Healthcare providers and educators are increasingly embracing a more holistic approach, acknowledging the social, cultural, and economic factors of patient care. But can doctors be trained to fully understand the cultural nuances and background of every patient?
Communication of treatment options is a cornerstone of patient-provider interaction, as it measures the degree to which providers tell patients what their options are. This allows them to participate in shared decision-making, a linchpin of patient-centered care, which fosters more therapeutic relationships. This two-step process is essential for improving patient outcomes, treatment adherence, and overall trust in providers.
Concordance in the Patient-Provider Relationship
Our research team at the University of Utah School of Medicine set out to assess the associations between racial/ethnic concordance and the patient experience during the early stages of the pandemic. We used a sample of 9,634 adults from the 2020 U.S. Medical Expenditure Panel Survey (MEPS), given its robust sampling methodology and inclusion of provider and patient demographic characteristics. The analysis used patient-reported shared decision-making and good communication as binary outcomes and included demographic characteristics and concordance as predictors. The preliminary results, presented here, revealed several key findings.
Overall, over half of the sample had a primary care doctor of the same race or ethnicity as them. After considering other factors that could influence the results, the odds of physicians explaining treatment options are 1.5 times greater in concordant pairs. The odds were 1.68 times greater for individuals living above the poverty line. Age, marital status, education level, insurance coverage, and race had no significant impact on predicting the communication of treatment options.
Regarding shared decision-making, white patients have 1.41 times greater odds of being included by their physician compared to patients from other racial/ethnic backgrounds. Marital status also plays a role, with currently married individuals having 1.15 times higher odds of being involved in decision-making.
Lastly, as the education level of Hispanic patients decreases, the odds of receiving a thorough explanation of treatment options decrease (57% lower odds), and the likelihood of engaging in shared decision-making also decreases (25% lower). This suggests that Hispanic patients with less education experience less comprehensive communication about treatment options and a reduced likelihood of actively participating in decisions.
Concordance was associated with age, poverty status, marital status, race/ethnicity, and provider race/ethnicity (Table 2).
Looking Deeper into Patient-Provider Paradigms
Following this preliminary analysis, our team has begun trying to better understand the differences between concordant and discordant patient-provider pairs. In a subsequent study (manuscript under review), domain analyses examined how social determinants of health (SDOH) impact patient experiences across concordance status. The findings reveal complex nuances in the way patients experience healthcare interactions. For example, shared decision-making was associated with education for discordant Hispanic patients and marital status for discordant white patients, but neither was associated with concordant patient-provider pairs. This suggests that there may be differences in the way SDOH impacts the patient experience across race and ethnicity. It may be that Hispanic and non-Hispanic providers treat Hispanic patients with less education differently.
Overall, these findings suggest that concordance may improve healthcare experiences, but this may differ by cultural nuances that are difficult to identify with only survey data. Thus, these findings will hopefully help lay the foundation for a more intricate exploration of concordance, shared decision-making, and communication.
An Opportunity to Improve the Quality of Care
To be sure, a paradigm shift toward comprehensive and compassionate healthcare education is paramount, regardless of provider characteristics. This shift is critical in reducing health disparities and ensuring broader access to quality care. Cultural competence and training are important elements in addressing identified disparities and enhancing patient experiences. Investments in healthcare professionals’ education will improve cultural competence, communication skills, and shared decision-making techniques. Policymakers should consider the impact of concordance when developing initiatives prioritizing patient-centered care for diverse populations.
Our research seeks to shed light on the relationship between patient-provider concordance and communication during the early stages of the pandemic. It beckons further research into the mechanisms behind these associations. Longitudinal studies will demonstrate the long-term effects of concordance on healthcare outcomes, including treatment adherence, patient satisfaction, and overall health.
The post-pandemic healthcare landscape is an opportunity to leverage insights. Collaborative efforts among policymakers, healthcare providers, community organizations, and patients are pivotal to a just and equitable healthcare system.
***This post is part of a series highlighting winners of the 2023 APHA Medical Care Student Abstract Award. The author also presented their award-winning work at the Annual Meeting in Atlanta, GA in early November 2023.***
JB Eyring