The effect of patient race on patient-provider communication with pediatric asthma patients

Asthma is one of the most common chronic pediatric conditions in the United States. African-Americans and other racial/ethnic minority groups are disproportionately affected, having a higher prevalence and suffering more adverse health outcomes. The National Asthma Education and Prevention Program has issued guidelines to assist physicians and other healthcare providers with the diagnosis and management of asthma. In addition to specific topics of asthma management, such as symptom monitoring and pulmonary function tests, the guidelines also emphasize the importance of effective communication when discussing topics of asthma management. Effective patient-provider communication is an important aspect of quality of care and has been linked with improved health outcomes. The objective of this research was to determine whether patient race was associated with differences in patient-provider communication about selected asthma management topics. This was a cross-sectional secondary analysis of survey and clinic visit audiotape data collected in North Carolina from 2006 to 2009 from physicians at pediatric and general practice clinics, patients with asthma, and their caregivers (parents). An instrument developed specifically for this research was used to code communication information from transcripts of the audiotapes. Multivariate analyses were used to examine the association of patient race with communication about four selected asthma management topics. Overall, selected topics of asthma management were shown to be discussed to varying degrees during the course of these medical visits, not necessarily in accordance with the recommended guidelines. The results from multivariate analysis did not show any significant association between patient race and communication regarding the selected asthma management topics. The interaction between patient race and the reason for the visit was also not significantly associated with communication regarding the selected topics. Patients visiting the doctor for annual check-ups and other reasons unrelated to asthma were generally less likely to discuss asthma management than those visiting the doctor for an asthma-related reason. The results from this study suggest that patient-provider communication regarding asthma management topics is not associated with patient race, and is not contributing to disparities in this population. Additional research is needed to understand the source of observed health disparities in pediatric asthma patients