Patient, Physician, and Community Demographics and Physicians' Perceptions of Patients, Their Practice, and the Management of Diabetes.

Disease Management;Diabetes;African American;Social Determinants of Health;Physician;Ecological Model;Public Health;Health Sciences;Health Services Organization & Policy

Shultz, Cameron G.Banaszak-Holl, Jane C. ;

University of Michigan

关键词: Disease Management;    Diabetes;    African American;    Social Determinants of Health;    Physician;    Ecological Model;    Public Health;    Health Sciences;    Health Services Organization & Policy;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/96150/cshultz_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

A growing body of health services research shows that African Americans, when compared to whites, are more likely to perceive discrimination in health care, be the target of negative stereotypes from health care providers, and receive lower quality of care for a broad range of services even after controlling for socioeconomic status.Less well documented are the physician- and setting-related factors that predict or protect against negative stereotypes and unequal treatment.Through a mail-based questionnaire administered to primary care physicians and endocrinologists in the greater-Southeast Michigan area, this research investigated these factors with the goal of improving our understanding of the intersections among race, place, socioeconomic status, and health care as it relates to the management of diabetes.Specifically, this dissertation explored physicians’ perceptions of patients, how these perceptions are associated with patients’ and physicians’ demographics, and how patients’ and physicians’ demographics are correlated with physicians’ decision making and strategies to manage diabetes.An overarching principle guiding this research is the notion that successful management of diabetes requires more than the provision of medical care; it requires balancing input from multiple influences across the ecological spectrum.Findings suggest that when physicians assess patients or when they make decisions on how to provide care they take into account not only information about patients’ illness or disease but are influenced by patients’ demographics, their own demographic and professional backgrounds, and the settings in which care is provided.After controlling for a broad set of covariates, physicians’ gender and training background proved to be the most salient predictors of physicians’ perceptions of patients, strategies to manage diabetes, and decision making style; results were not consistent with the notion that physicians respond more negatively or with biased attitudes when working with African American patients versus patients generally.Findings from this research indicate that (a) increasing physicians’ competency in social determinant of health, (b) promoting policies that finance patient centered medical homes, and (c) rewarding health systems that grow the primary care physician workforce in urban settings may help to improve the quality of diabetes care for the populations living in such areas.