Browsing by Author "Cooper, Lisa A."
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Item Death Toll From Uncontrolled Blood Pressure in Ethnic Populations: Universal Access and Quality Improvement May Not Be Enough(2008) Cené, Crystal Wiley; Cooper, Lisa A.Cardiovascular disease (CVD) is the number 1 cause of death globally.1 An estimated 17.5 million people died from CVD in 2005 (7.6 million from coronary heart disease and 7.6 million from stroke), representing 30% of all global deaths.2 Globally, two-thirds of stroke and one-half of ischemic heart disease are attributable to nonoptimal blood pressure. Worldwide, nonoptimal blood pressure contributes to approximately 12.8% of all deaths (7.1 million) and 4.4% of all disability-adjusted life years (64.3 million) in the year 2000. These proportions are highest in more developed countries, such as the United States and the United Kingdom.3 Racial and ethnic disparities in cardiovascular disease prevalence, treatment, and outcomes are well documented in the United States, and racial and ethnic differences in hypertension are no exception.4-7 Cardiovascular disease accounts for 35% of excess overall mortality in US blacks, largely because of hypertension.8 In Europe, ethnic differences in hypertension prevalence and morbidity and mortality from cardiovascular disease have also been described.Item Patient Race/Ethnicity and Quality of Patient–Physician Communication During Medical Visits(2004) Johnson, Rachel L.; Roter, Debra; Powe, Neil R.; Cooper, Lisa A.Objectives. We examined the association between patient race/ethnicity and patient–physician communication during medical visits. Methods. We used audiotape and questionnaire data collected in 1998 and 2002 to determine whether the quality of medical-visit communication differs among African American versus White patients. We analyzed data from 458 African American and White patients who visited 61 physicians in the Baltimore, Md–Washington, DC–Northern Virginia metropolitan area. Outcome measures that assessed the communication process, patient centeredness, and emotional tone (affect) of the medical visit were derived from audiotapes coded by independent raters. Results. Physicians were 23% more verbally dominant and engaged in 33% less patient-centered communication with African American patients than with White patients. Furthermore, both African American patients and their physicians exhibited lower levels of positive affect than White patients and their physicians did. Conclusions. Patient–physician communication during medical visits differs among African American versus White patients. Interventions that increase physicians’ patient centeredness and awareness of affective cues with African Americans patients and that activate African American patients to participate in their health care are important strategies for addressing racial/ethnic disparities in health care.Item Patient–Physician Communication in the Primary Care Visits of African Americans and Whites with Depression(2008) Ghods, Bri K.; Roter, Debra L.; Ford, Daniel E.; Larson, Susan; Arbelaez, Jose J.; Cooper, Lisa A.Background Little research investigates the role of patient–physician communication in understanding racial disparities in depression treatment. Objective The objective of this study was to compare patient–physician communication patterns for African-American and white patients who have high levels of depressive symptoms. Design, Setting, and Participants This is a cross-sectional study of primary care visits of 108 adult patients (46 white, 62 African American) who had depressive symptoms measured by the Medical Outcomes Study–Short Form (SF-12) Mental Component Summary Score and were receiving care from one of 54 physicians in urban community-based practices. Main Outcomes Communication behaviors, obtained from coding of audiotapes, and physician perceptions of patients’ physical and emotional health status and stress levels were measured by post-visit surveys. Results African-American patients had fewer years of education and reported poorer physical health than whites. There were no racial differences in the level of depressive symptoms. Depression communication occurred in only 34% of visits. The average number of depression-related statements was much lower in the visits of African-American than white patients (10.8 vs. 38.4 statements, p = .02). African-American patients also experienced visits with less rapport building (20.7 vs. 29.7 statements, p = .009). Physicians rated a higher percentage of African-American than white patients as being in poor or fair physical health (69% vs. 40%, p = .006), and even in visits where depression communication occurred, a lower percentage of African-American than white patients were considered by their physicians to have significant emotional distress (67% vs. 93%, p = .07). Conclusions This study reveals racial disparities in communication among primary care patients with high levels of depressive symptoms. Physician communication skills training programs that emphasize recognition and rapport building may help reduce racial disparities in depression care.Item Perceived Discrimination and Adherence to Medical Care in a Racially Integrated Community(2007) Casagrande, Sarah Stark; Gary, Tiffany L.; LaVeist, Thomas A.; Gaskin, Darrell J.; Cooper, Lisa A.Background Past research indicates that access to health care and utilization of services varies by sociodemographic characteristics, but little is known about racial differences in health care utilization within racially integrated communities. Objective To determine whether perceived discrimination was associated with delays in seeking medical care and adherence to medical care recommendations among African Americans and whites living in a socioeconomically homogenous and racially integrated community. Design A cross-sectional analysis from the Exploring Health Disparities in Integrated Communities Study. Participants Study participants include 1,408 African-American (59.3%) and white (40.7%) adults (≥18 years) in Baltimore, Md. Measurements An interviewer-administered questionnaire was used to assess the associations of perceived discrimination with help-seeking behavior for and adherence to medical care. Results For both African Americans and whites, a report of 1–2 and >2 discrimination experiences in one’s lifetime were associated with more medical care delays and nonadherence compared to those with no experiences after adjustment for need, enabling, and predisposing factors (odds ratio [OR]=1.8, 2.6; OR=2.2, 3.3, respectively; all P<.05). Results were similar for perceived discrimination occurring in the past year. Conclusions Experiences with discrimination were associated with delays in seeking medical care and poor adherence to medical care recommendations INDEPENDENT OF NEED, ENABLING, AND PREDISPOSING FACTORS, INCLUDING MEDICAL MISTRUST; however, a prospective study is needed. Further research in this area should include exploration of other potential mechanisms for the association between perceived discrimination and health service utilization.Item Race and Trust in the Health Care System(2003) Boulware, L. Ebony; Cooper, Lisa A.; Ratner, Lloyd E.; LaVeist, Thomas A.; Powe, Neil R.Objective. A legacy of racial discrimination in medical research and the health care system has been linked to a low level of trust in medical research and medical care among African Americans. While racial differences in trust in physicians have been demonstrated, little is known about racial variation in trust of health insurance plans and hospitals. For the present study, the authors analyzed responses to a cross sectional telephone survey to assess the independent relationship of self-reported race (non-Hispanic black or non-Hispanic white) with trust in physicians, hospitals, and health insurance plans. Methods. Respondents ages 18–75 years were asked to rate their level of trust in physicians, health insurance plans, and hospitals. Items from the Medical Mistrust Index were used to assess fear and suspicion of hospitals. Results. Responses were analyzed for 49 (42%) non-Hispanic black and 69 (58%) non-Hispanic white respondents (N=118; 94% of total survey population). A majority of respondents trusted physicians (71%) and hospitals (70%), but fewer trusted their health insurance plans (28%). After adjustment for potential confounders, non-Hispanic black respondents were less likely to trust their physicians than non-Hispanic white respondents (adjusted absolute difference 37%; p=0.01) and more likely to trust their health insurance plans (adjusted absolute difference 28%; p=0.04). The difference in trust of hospitals (adjusted absolute difference 13%) was not statistically significant. Non-Hispanic black respondents were more likely than non-Hispanic white respondents to be concerned about personal privacy and the potential for harmful experimentation in hospitals. Conclusions. Patterns of trust in components of our health care system differ by race. Differences in trust may reflect divergent cultural experiences of blacks and whites as well as differences in expectations for care. Improved understanding of these factors is needed if efforts to enhance patient access to and satisfaction with care are to be effective.Item Racial and Ethnic Differences in Patient Perceptions of Bias and Cultural Competence in Health Care(2004) Johnson, Rachel L.; Saha, Somnath; Arbelaez, Jose J.; Beach, Mary Catherine; Cooper, Lisa A.Abstract available at publisher's web site.Item Transforming Clinical Practice to Eliminate Racial–Ethnic Disparities in Healthcare(2008) Washington, Donna L.; Bowles, Jacqueline; Saha, Somnath; Horowitz, Carol R.; Moody-Ayers, Sandra; Brown, Arleen F.; Stone, Valerie E.; Cooper, Lisa A.Abstract available at publisher's website.