Patient–physician racial/ethnic concordance and blood pressure control: the role of trust and medication adherence

Abstract

Objectives. To examine the associations between racial/ethnic concordance and blood pressure (BP) control, and to determine whether patient trust and medication adherence mediate these associations.

Design. Cross-sectional study of 723 hypertensive African-American and white patients receiving care from 205 white and African-American providers at 119 primary care clinics, from 2001 to 2005. Racial/ethnic concordance was characterized as dyads where both the patient and physician were of the same race/ethnicity; discordance occurred in dyads where the patient was African-American and the physician was white. Patient perceptions of trust and medication adherence were assessed with self-report measures. The BP readings were abstracted from patients' medical charts using standardized procedures.

Results. Six hundred thirty-seven patients were in race/ethnic-concordant relationships; 86 were in race/ethnic-discordant relationships. Concordance had no association with BP control. White patients in race/ethnic-concordant relationships were more likely to report better adherence than African-American patients in race/ethnic-discordant relationships (OR: 1.27, 95% CI: 1.01, 1.61, p = 0.04). Little difference in adherence was found for African-American patients in race/ethnic-concordant vs. discordant relationships. Increasing trust was associated with significantly better adherence (OR: 1.17, 95% CI: 1.04, 1.31, p < 0.01) and a trend toward better BP control among all patients (OR: 1.26, 95% CI: 0.97, 1.63, p = 0.07).

Conclusions. Patient trust may influence medication adherence and BP control regardless of patient–physician racial/ethnic composition.

Keywords:

• blood pressure control
• trust
• medication adherence
• racial/ethnic concordance

Acknowledgment

Design and conduct of the MEMO study were supported by the Agency for Healthcare Research and Quality (Grant number 5 R01 HS011955).

Key messages

1. Despite mounting evidence that patient–physician racial/ethnic concordance affects processes of care (e.g. patient satisfaction and health service utilization), the impact on clinical outcomes such as BP control is unclear.

2. Higher levels of trust were associated with better medication adherence and a tendency toward better BP control, irrespective of patient–physician racial/ethnic concordance.

3. Future research is needed to understand whether interventions that facilitate patient trust at the interpersonal and organizational levels can improve heath behaviors and clinical outcomes for all patients.