title: Impact of patient race on patient experiences of access and communication in HIV care.
abstract: BACKGROUND
  Patient-centered care--including the domains of access and communication--is an important determinant of positive clinical outcomes.
  
  
  OBJECTIVE
  To explore associations between race and HIV-infected patients' experiences of access and communication.
  
  
  METHODS
  This was a cross-sectional survey.
  
  
  METHODS
  Nine hundred and fifteen HIV-infected adults receiving care at 14 U.S. HIV clinics.
  
  
  METHODS
  Dependent variables included patients' reports of travel time to their HIV care site and waiting time to see their HIV provider (access) and ratings of their HIV providers on always listening, explaining, showing respect, and spending enough time with them (communication). We used multivariate logistic regression to estimate associations between patient race and dependent variables, and random effects models to estimate site-level contributions.
  
  
  RESULTS
  Patients traveled a median 30 minutes (range 1-180) and waited a median 20 minutes (range 0-210) to see their provider. On average, blacks and Hispanics reported longer travel and wait times compared with whites. Adjusting for HIV care site attenuated this association. HIV care sites that provide services to a greater proportion of blacks and Hispanics may be more difficult to access for all patients. The majority of patients rated provider communication favorably. Compared to whites, blacks reported more positive experiences with provider communication.
  
  
  CONCLUSIONS
  We observed racial disparities in patients' experience of access to care but not in patient-provider communication. Disparities were explained by poor access at minority-serving clinics. Efforts to make care more patient-centered for minority HIV-infected patients should focus more on improving access to HIV care in minority communities than on improving cross-cultural patient-provider interactions.
authors.affiliation: Department of Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA. korthuis@ohsu.edu
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.forename: Somnath
authors.initials: S
authors.lastname: Saha
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: Moriah McSharry
authors.initials: MM
authors.lastname: McGrath
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Josephs
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
authors.forename: James
authors.initials: J
authors.lastname: Hellinger
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000208:ethnology* / Q000523:psychology* / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010817:Physician-Patient Relations; D044469:Racial Groups / Q000523:psychology*; D055815:Young Adult