"Does Racial Concordance Between HIV-Positive Patients and Their Physicians Affect the Time to Receipt of Protease Inhibitors?" is published in the November issue of the Journal of General Internal Medicine.
The clinical implications of the findings are that delay in effective treatment could result in more deaths for African-American patients. The researchers conclude that policy changes boosting the number of African-American physicians are "imperative."
"This is an important study because so many African-American people have HIV infection and African-Americans die more frequently from the disease than any other group," said Dr. William Cunningham, professor of medicine and public health and a study co-author. "We need to improve the relationship between African-Americans with HIV and their (mostly white) doctors. We need to teach doctors to communicate effectively with patients of all races, particularly with African-Americans who may feel they have reasons to mistrust doctors (most of whom are white). Better training would help doctors to follow published treatment guidelines for all patients. And ultimately, we need to increase the number of African-American physicians who can treat African-American patients with HIV."
In this study, the researchers found that African-American patients treated by white doctors receive their HIV medications nearly four months later than African-American patients being treated by African-American doctors. Furthermore, the study confirms these startling differences are not because of patient's income levels, years of education, or insurance coverage. On the doctor's part, the knowledge, specialty, degree of training and years of experience did not affect the results. The fact remained that African-American patients seen by African-American doctors, received better care than African-American patients seeing white doctors.
"Our findings are significant for several reasons," said Dr. William King, visiting associate physician in the department of infectious disease, UCLA Center for Clinical AIDS Research and Education (CARE), and the study's lead investigator. "One, our study advances prior research in this field by demonstrating that patient-provider racial concordance can impact access to medical treatment. We are the first study to demonstrate this effect. Two, our study on patient-provider racial concordance provides an explanation as to why African-Americans are the least likely to receive antiretrovirals compared to other racial and ethnic groups. Three, our study presents the importance of incorporating patient-provider racial concordance in analyses of patient-provider relationships, particularly analyses involving racial disparities."
The patients and doctors participating in this study were part of the only nationwide HIV study of its kind in the United States from 1996 to 1999. Participants were adults who made regular visits to their HIV doctors. The researchers studied a group of patients of which 61% were white with white doctors, 32% were African-American with white doctors, 6% were African-American with African-American doctors, and less than 1% were white with African-American doctors. Although the last group was very small, the patients of this group received the HIV medication over three months sooner than every other group.
The researchers found that African-American patients received their HIV medications a median 439 days versus 277 for whites. They also found that African-Americans received protease inhibitors later from white physicians (a median 461 days) than they did when their providers were also African-American (342 days). They also received medications later compared with white patients who had white physicians (353 days).
There may be a number of explanations for the great differences, the researchers write. For example, verbal and non-verbal communication may be better between a patient and doctor of the same race, and as a result the patient is more likely to report greater participation in decision-making, have longer visits and ultimately be more likely to trust the provider and accept the life-saving HIV medication. African-American patients in racial-discordant patient/provider relationships may experience direct or indirect discrimination by white physicians, which would impact their receipt of antiretrovirals. For example, prior studies have shown that most doctors delay treatment for patients they think are not likely to stick to their drug regimen--with several of those studies indicating that African-Americans are among the patients often placed into that category by their doctors.
In addition to Drs. King and Cunningham, other researchers included Dr. Mitchell Wong, assistant professor of general internal medicine and health services research; Dr. Martin F. Shapiro, professor of general internal medicine and chief of health services research; and Dr. Bruce E. Landon of Harvard Medical School.
Funding for the study came from: the Agency for Healthcare Research and Quality; the Health Resources and Services Administration; the National Institute of Mental Health; the National Institute on Drug Abuse; the Robert Wood Johnson Foundation; the Universitywide AIDS Research program; UCLA Center for AIDS Research and Education; UCLA-Drew Project Export; National Institutes of Health, National Center on Minority Health Disparities; and the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, National Institutes of Health, National Institute of Aging.