Rushed HCP Interactions with Black Patients Erode Glycemic Control

Hurried communication and inadequate explanation of health status and care can negatively impact glycemic control in black patients with type 2 diabetes (T2D), according to research presented this week at the American Diabetes Association’s 80th Virtual Scientific Sessions.

The disparities in outcomes among black patients with T2D compared with those among white patients are not fully explained by patient and system-level factors, according to study authors.

In a cross-sectional study, researchers examined domains of the patient-provider relationship and their associations with race and glycemic outcomes in patients with T2D. A total of 115 black and 106 white patients with T2D representing 34 primary care practices completed the study (mean age, 64.4 years; 55% women; average A1c, 7.3% [blacks, 7.4%; white, 7.3%]).

The Interpersonal Process of Care (IPC) survey was used to measure 7 domains that describe the patient-provider relationship:

• Hurried communication
• Elicited concerns and response
• Explanation of results and medications
• Patient-centered decision making
• Compassion and respect
• Discrimination
• Disrespect from office staff

Adjusted linear regression models revealed no significant main effects of any of the subscales in the overall cohort.

However, race interactions for 2 of the subscales achieved statistical significance.

Among black patients who reported no hurried communication, A1c was on average 0.45% lower [95% CI, -1 to 0.1] vs black patients who reported some hurried communication (p=0.48). Among black patients who reported that providers fully explained results and medications, A1c was on average 0.64% lower [95% CI, -1.19 to -0.08] than among those who did not endorse a full explanation of results and medications from providers (p=0.01).

No such relationship was observed between these IPC subdomains and improved glycemic control among white patients.

Racial disparities in glycemic control, the authors note, could be improved using interventions that target communication in the patient-provider relationship particularly with respect to time spent in discussion and in explaining results and medications.
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Source: Reid H, Lin O, Fabbro RL, et al. Provider communication in black patients with T2DM is associated with glycemic control. Presented at: American Diabetes Association 80th Scientific Sessions; June 12-16, 2020. Abstract 52-LB.